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Open AccessArticle

Effectiveness of a Multicomponent Treatment for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): A Pragmatic Randomized Controlled Trial

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Unitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain
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Stress and Health Research Group, Departament de Psicologia Bàsica, Evolutiva i de l’Educació, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Escola Universitària de Fisioteràpia, Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, 08174 Barcelona, Spain
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Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Catalonia, Spain
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Teaching, Research, & Innovation Unit—Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, 08830 Catalonia, Spain
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Department of Medicine, International University of Catalonia, C/Josep Trueta s/n, Sant Cugat del Vallès, 08195 Barcelona, Spain
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Research Group on Socioeducative Interventions in Childhood and Youth (GRISIJ), Department of Methods of Research and Diagnosis in Education, Faculty on Education, University of Barcelona, 08007 Barcelona, Spain
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Sport Research Institute UAB, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Authors to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(10), 3348; https://doi.org/10.3390/jcm9103348
Received: 4 September 2020 / Revised: 13 October 2020 / Accepted: 16 October 2020 / Published: 18 October 2020
A recent study (FIBROWALK) has supported the effectiveness of a multicomponent treatment based on pain neuroscience education (PNE), exercise therapy (TE), cognitive behavioral therapy (CBT), and mindfulness in patients with fibromyalgia. The aim of the present RCT was: (a) to analyze the effectiveness of a 12-week multicomponent treatment (nature activity therapy for fibromyalgia, NAT-FM) based on the same therapeutic components described above plus nature exposure to maximize improvements in functional impairment (primary outcome), as well as pain, fatigue, anxiety-depression, physical functioning, positive and negative affect, self-esteem, and perceived stress (secondary outcomes), and kinesiophobia, pain catastrophizing thoughts, personal perceived competence, and cognitive emotion regulation (process variables) compared with treatment as usual (TAU); (b) to preliminarily assess the effects of the nature-based activities included (yoga, Nordic walking, nature photography, and Shinrin Yoku); and (c) to examine whether the positive effects of TAU + NAT-FM on primary and secondary outcomes at post-treatment were mediated through baseline to six-week changes in process variables. A total of 169 FM patients were randomized into two study arms: TAU + NAT-FM vs. TAU alone. Data were collected at baseline, at six-week of treatment, at post-treatment, and throughout treatment by ecological momentary assessment (EMA). Using an intention to treat (ITT) approach, linear mixed-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective than TAU at posttreatment for the primary and secondary outcomes evaluated, as well as for the process variables. Moderate-to-large effect sizes were achieved at six-weeks for functional impairment, anxiety, kinesiophobia, perceived competence, and positive reappraisal. The number needed to treat (NNT) was 3 (95%CI = 1.6–3.2). The nature activities yielded an improvement in affective valence, arousal, dominance, fatigue, pain, stress, and self-efficacy. Kinesiophobia and perceived competence were the mediators that could explain a significant part of the improvements obtained with TAU + NAT-FM treatment. TAU + NAT-FM is an effective co-adjuvant multicomponent treatment for improving FM-related symptoms. View Full-Text
Keywords: fibromyalgia; multicomponent treatment; pain neuroscience education; exercise therapy; cognitive behavioral therapy; mindfulness; nature exposure; randomized controlled trial fibromyalgia; multicomponent treatment; pain neuroscience education; exercise therapy; cognitive behavioral therapy; mindfulness; nature exposure; randomized controlled trial
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Serrat, M.; Almirall, M.; Musté, M.; Sanabria-Mazo, J.P.; Feliu-Soler, A.; Méndez-Ulrich, J.L.; Luciano, J.V.; Sanz, A. Effectiveness of a Multicomponent Treatment for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): A Pragmatic Randomized Controlled Trial. J. Clin. Med. 2020, 9, 3348.

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