Effects of Aquatic Physiotherapy vs Health Education for Fibromyalgia

Aquatic physiotherapy may not be superior to a health education program in treating women with fibromyalgia.

Aquatic physiotherapy may not be superior to a health education program (HEP) in treating women with fibromyalgia, according to study results published in Physiotherapy Theory and Practice.

A range of nonpharmacologic options are used for the management of fibromyalgia and include acupuncture, physiotherapy, cognitive behavioral therapy, aquatic physiotherapy, and HEPs.

In this randomized blinded clinical trial, 46 women aged 25 to 60 years with body mass index <30 kg/m2 were recruited through advertisements and clinically evaluated to confirm fibromyalgia. All participants continued their previous prescribed medical treatment.

Participants were randomly assigned to receive aquatic physiotherapy (n=27), consisting of exercises performed in a pool with heated water, or HEP (n=19), consisting of a multidisciplinary approach to increase patients’ knowledge about fibromyalgia, both over a period of 11 weeks.

Data regarding pain (assessed with the McGill Pain questionnaire), fatigue (Piper Fatigue Scale-Revised), functional capability (Fibromyalgia Impact questionnaire), anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), and quality of sleep (Pittsburgh Sleep Quality Index) were collected at baseline, after the intervention, and 6 weeks later.

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Within groups, both interventions were associated with an average improvement of all evaluated outcomes of 13.1% with aquatic physiotherapy, and of 23.2% with HEP.

In the aquatic physiotherapy group, there were significant improvements in sleep quality, depression, anxiety, and functional capacity. Patients in the HEP group reported improvements in depression, anxiety, functional capacity, and fatigue. There were greater but nonsignificant within-group differences in HEP vs aquatic physiotherapy, with greater reductions in the level of impact of fibromyalgia.

There were no within-group or between-group significant differences in pain, and pain indicators were comparable during the 3-month study period in both groups.

Study limitations include the sole inclusion of adult women participants, a short follow-up period, and the lack of control for some confounders (eg, placebo effect and recall bias).

“The findings do not allow to affirm that one intervention is superior to the other for the treatment of people with [fibromyalgia]. Within-group changes occurring during the study period in both groups, although clinically important, cannot be attributed exclusively to the effects of the intervention used,” concluded the researchers.

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Fonseca ACS, Faria PC, Alcântara MA, et al. Effects of aquatic physiotherapy or health education program in women with fibromyalgia: a randomized clinical trial [published online July 15, 2019]. Physiother Theory Pract. doi:10.1080/09593985.2019.1639229