Physical and psychological paths toward less severe fibromyalgia: A structural equation model.

Manuel Pulido-Martos, Octavio Luque-Reca, Víctor Segura-Jiménez, Inmaculada C Álvarez-Gallardo, Alberto Soriano-Maldonado, Pedro Acosta-Manzano, Blanca Gavilán-Carrera, Joseph G McVeigh, Rinie Geenen, Manuel Delgado-Fernández, Fernando Estévez-López

Journal: Annals of physical and rehabilitation medicine 2020;63(1):46-52

PMID: 31386910

Free Full Text on Elsevier Science View on PubMed

Abstract

OBJECTIVES

Previous research suggested isolated associations of physical and psychological factors with fibromyalgia severity. Integration of physical and psychological, experienced and observed, modifiable factors associated with fibromyalgia severity in a single model will reveal therapeutic paths toward less severity of disease. We aimed to examine an encompassing model of determinants of fibromyalgia severity.

METHODS

This observational, population-based cross-sectional study included 569 people with fibromyalgia. An integrative model of fibromyalgia severity was tested by using structural equation modelling. This model included 8 factors: resilience, catastrophizing, active lifestyle, declarative memory, subjective fitness, objective fitness, psychological distress, and physical fatigue.

RESULTS

Two core paths were associated with reduced fibromyalgia severity: 1) a psychological path connecting high resilience and low catastrophizing with low distress and 2) a physical path, connecting a more active lifestyle (directly and via high objective and subjective physical fitness) with low fatigue. Additional interconnecting paths especially suggested a connection from the psychological to physical path. Our model explained 83% of the fibromyalgia severity.

CONCLUSIONS

The present model integrated the complexity of mutually influencing factors of fibromyalgia severity, which may help to better understand the disease. It emphasised the importance of: 1) physical factors and psychological factors and their interconnections, 2) patients' experiences and clinical measurements, and 3) positive and negative signs such as physical fitness and distress. Future longitudinal and experimental research should aim at testing the causal direction of the associations in the model as well as the clinical implications suggested by the model. For instance, to reduce fatigue, exercise should enhance not only objective fitness but also fitness-related perceptions. Reducing distress and fatigue seems crucial for lowering fibromyalgia severity.

Address: Department of Psychology, Faculty of Humanities and Education Sciences, University of Jaén, Jaén, Spain.; Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain. Electronic address: [email protected].; Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain.; Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain.; Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain.; Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland.; Department of Psychology, Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.

DOI: 10.1016/j.rehab.2019.06.017

Link outs

Free resources

Full Text Sources:

Medical:

https://medlineplus.gov/fibromyalgia.html

Subscription / membership required

Full Text Sources:

https://www.clinicalkey.com/content/playBy/pii?v=S...

MeSH Terms: Adult, Catastrophization, Diagnostic Self Evaluation, Fatigue, Female, Fibromyalgia, Humans, Latent Class Analysis, Life Style, Male, Memory, Middle Aged, Patient Acuity, Physical Fitness, Psychological Distress, Resilience, Psychological