The online version of this article (doi:10.1186/ar3432) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
KDJ participated in all phases of the study, including study design; oversight of MS students; data collection, entry, analyses and interpretation; and final manuscript preparation. LAK participated in balance-related contributions to study design, analyses, interpretation and final manuscript preparation. SDM performed all statistical analyses and final manuscript preparation. RMB participated in all phases of the study, including study design, analyses, interpretation and final manuscript preparation and provided funding from the Fibromyalgia Information Foundation. FBH participated in balance-related contributions to study design, analyses, interpretation and final manuscript preparation and provided access to the Clinical Research Dynamic Posturography System (NeuroCom International, Inc.) and National Institute on Aging funding to support the physical therapist who collected posturography data. All authors read and approved the final manuscript.
Postural instability and falls are increasingly recognized problems in patients with fibromyalgia (FM). The purpose of this study was to determine whether FM patients, compared to age-matched healthy controls (HCs), have differences in dynamic posturography, including sensory, motor, and limits of stability. We further sought to determine whether postural instability is associated with strength, proprioception and lower-extremity myofascial trigger points (MTPs); FM symptoms and physical function; dyscognition; balance confidence; and medication use. Last, we evaluated self-reported of falls over the past six months.
In this cross-sectional study, we compared middle-aged FM patients and age-matched HCs who underwent computerized dynamic posturography testing and completed the Fibromyalgia Impact Questionnaire-Revised (FIQR) and balance and fall questionnaires. All subjects underwent a neurological and musculoskeletal examination. Descriptive statistics were used to characterize the sample and explore the relationships between variables. The relationships between subjective, clinical and objective variables were evaluated by correlation and regression analyses.
Twenty-five FM patients and twenty-seven HCs (combined mean age ± standard deviation (SD): 48.6 ± 9.7 years) completed testing. FM patients scored statistically lower on composite sensory organization tests (primary outcome; P < 0.010), as well as with regard to vestibular, visual and somatosensory ratio scores on dynamic posturography. Balance confidence was significantly different between groups, with FM patients reporting less confidence than HCs (mean ± SD: 81.24 ± 19.52 vs. 98.52 ± 2.45; P < 0.001). Interestingly, 76% to 84% of FM patients had gastrocnemius and/or anterior tibialis MTPs. Postural stability was best predicted by dyscognition, FIQR score and body mass index. Regarding falls, 3 (11%) of 27 HCs had fallen only once during the past 6 months, whereas 18 (72%) of 25 FM patients had fallen at least once. Fifteen FM patients (60%) reported falling at least three times in the past six months.
In this study, we report that middle-aged FM patients have consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological examination. Further study is needed to determine prospective fall rates and the significance of lower-extremity MTPs. The development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training.
Additional file 1: Additional file 1contains data output to support the reported regression model parameter estimates of independent variables in relation to the Sensory Organization Test Composite score for patients with fibromyalgia. (DOCX 12 KB)
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- Postural control deficits in people with fibromyalgia: a pilot study
Kim D Jones
Laurie A King
Scott D Mist
Robert M Bennett
Fay B Horak
- BioMed Central
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