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      Balance deficiencies in women with fibromyalgia assessed using computerised dynamic posturography: a cross-sectional study in Spain

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          Abstract

          Objectives

          Our aims were (1) to compare the sensory organisation of balance control and balance strategies between women with fibromyalgia (FM) and healthy women; (2) to investigate which sensory component, that is, vestibular, visual or somato-sensory, is the most affected in FM and (3) to determine the associations between the functional independence measure (FIM) and balance responses in FM.

          Design

          Cross-sectional observational study.

          Setting

          Urban regional hospital and university (Universidad Rey Juan Carlos, Madrid, Spain).

          Participants

          Twenty women with FM and 20 matched healthy women.

          Primary/secondary outcome measures

          The sensory organisation test (SOT) was used to determine postural sway and balance during six different conditions with subjects in a standing position. The FIM was used to determine the level of functional independence in daily life activities (ADL). Between-group differences were analysed with analysis of covariance, and the Spearman's test was used for correlations.

          Results

          Significant differences between-groups and between-conditions were found for all SOT conditions (all, p<0.001): women with FM showed lower scores being the vestibular score the most affected. Different correlations between SOT conditions and some specific ADL were observed in the FM group: bathing activity and balance condition 6 (r s=0.541; p<0.001), bed transfers activity and conditions 2 (r s=0.491; p<0.001) and 3 (r s=0.510; p<0.001), positioning strategy six and dressing the upper (r s=0.530; p<0.001) or lower (r s=0.562; p<0.001) body, and toileting (r s=0.521; p<0.001): the greater the loss of balance, the greater the interference on some daily life activities.

          Conclusions

          Women with FM exhibited balance deficiencies and used different strategies for maintaining their balance in standing, which was associated with a negative impact on functional independence.

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          Most cited references28

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          The fibromyalgia impact questionnaire: development and validation.

          An instrument has been developed to assess the current health status of women with the fibromyalgia syndrome. The Fibromyalgia Impact Questionnaire (FIQ) is a brief 10-item, self-administered instrument that measures physical functioning, work status, depression, anxiety, sleep, pain, stiffness, fatigue, and well being. We describe its development and validation. This initial assessment indicates that the FIQ has sufficient evidence of reliability and validity to warrant further testing in both research and clinical situations.
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            A validation of the functional independence measurement and its performance among rehabilitation inpatients.

            The Functional Independence Measurement (FIM) is a new functional status instrument for use among rehabilitation inpatients, but its validity and reliability have been only partially established. Because of its rapid dissemination, we sought further evidence concerning the FIM's internal consistency, responsiveness over time, and construct validity. We examined Uniform Data System (UDS) data on 11,102 general rehabilitation inpatients from the Pacific Northwest. Mean age was 65 and 51% were male. The most common diagnoses were stroke (52%), orthopedic conditions (10%), and brain injury (10%). Internal consistency of the FIM was calculated using Cronbach's alpha. To assess FIM responsiveness, we examined differences between admission and discharge FIM scores. For construct validation purposes, we hypothesized that the FIM would vary with age, comorbidity, discharge destination, and impairment severity. Comorbidity was quantified with the Charlson Comorbidity Index. The FIM had a high overall internal consistency (discharge FIM alpha = .93). The FIM registered significant functional gains during rehabilitation (33% FIM score improvement, p < .001), as do many other functional status indicators. The greatest and least functional improvements were observed for traumatic brain injury and low back pain (53% and 8% FIM score improvement, respectively). The FIM discriminates patients on the basis of age, comorbidity, and discharge destination. Severity differences could be distinguished among spinal cord injury and stroke patients. We conclude that the FIM has high internal consistency and adequate discriminative capabilities for rehabilitation patients. It is a good indicator of burden of care, and demonstrates some responsiveness, but its capacity to measure change over time needs further examination and comparison with competing scales.
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              Learning effects of repetitive administrations of the sensory organization test in healthy young adults.

              To evaluate the learning effect of multiple administrations of the Sensory Organization Test (SOT) on performance and to begin to establish clinical meaningful change scores for the SOT. Descriptive case series. University-affiliated clinic. Healthy young adults (6 men, 7 women; mean age, 24+/-4y). All subjects performed the standardized SOT using the SMART EquiTest 5 times over a 2-week period, and 1 month later. Composite and individual SOT test condition standardized equilibrium scores. Test-retest reliability (intraclass correlation coefficient model 2,3) of the composite (.67) and equilibrium score (range, .35-.79) were fair to good. Repeated-measures analysis of variance revealed a significant (P<.05) increase in the composite and equilibrium scores for conditions 4, 5, and 6 over the 5 sessions that plateaued after the third session, and were retained at 1 month. The 95% confidence interval for the composite score change from session 1 to session 4, the plateau of the learning effect, was 3.9 to 8.1. Although the findings of this study would indicate that multiple baseline measures are desirable for the more challenging conditions, a composite change of greater than 8 points would indicate change due to rehabilitation.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2017
                1 August 2017
                : 7
                : 7
                : e016239
                Affiliations
                [1 ] departmentDepartment of Physical Therapy , Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos , Alcorcón, Spain
                [2 ] departmentDepartment of Health Sciences , Burgos Universit , Burgos, Spain
                Author notes
                [Correspondence to ] Elisabet Huertas-Hoyas; elisabet.huertas@ 123456urjc.es
                Article
                bmjopen-2017-016239
                10.1136/bmjopen-2017-016239
                5642772
                28765133
                21fb7a9d-6fc0-4280-8374-d0f25a306fca
                © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 02 February 2017
                : 26 May 2017
                : 15 June 2017
                Categories
                Rheumatology
                Research
                1506
                1732
                1716
                1727
                Custom metadata
                unlocked

                Medicine
                postural balance,fibromyalgia,patient positioning
                Medicine
                postural balance, fibromyalgia, patient positioning

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