A Review of Movement and Functional Impairments in Fibromyalgia: Implications for Targeted Treatment

May combine two claims.

FM was associated with an increased BMI, which was positively correlated with decreased reaction time during gait initiation.

“FM was associated with an increased BMI, which was positively correlated with decreased reaction time during gait initiation.2”

• cites [2] Rasouli, 2017, J Pain Res sourceDisputed

  The Discussion says the FM group had the highest BMI, but the between-group BMI difference was not significant. It reports a positive correlation between weight—not BMI—and reaction time during gait initiation; the Results report longer, not decreased, reaction times for FM compared with healthy controls. (LLM, conf=0.88)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Fibromyalgia is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.

“Fibromyalgia (FM) is a disabling chronic pain syndrome characterized by multiple symptoms, including medically unexplained widespread pain, fatigue, cognitive, mood and sleep disorders.1–11”

• cites [1] Gerdle, 2010, BMC Musculoskeletal Disord sourcePartly supported

  The Background (page unavailable) characterizes fibromyalgia as a widespread pain syndrome with unknown aetiology, supporting the pain portion of the claim. It does not describe fibromyalgia as disabling or list cognitive, mood, or sleep disorders; its references to fatigue concern muscle activity or myoelectrical findings, not fatigue as a general symptom. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [2] Rasouli, 2017, J Pain Res sourcePartly supported

  The Introduction describes fibromyalgia as characterized by chronic widespread pain, reports cognitive complaints, and notes substantial symptom overlap with chronic fatigue syndrome. The Discussion says newer diagnostic criteria include fatigue and cognition. The passages do not describe mood or sleep disorders as features of fibromyalgia, or characterize its pain as medically unexplained. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [3] Estévez-López, 2021, Arch. Phys. Med. Rehabil sourcePartly supported

  The opening passage labeled Abstract (page not provided) identifies fatigue and poor sleep quality as core fibromyalgia symptoms and discusses pain-related outcomes. The copy does not establish that the pain is medically unexplained or identify cognitive and mood disorders as characteristic symptoms; searches for those terms found no supporting passage. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [4] Borst, 2024, Neuropsychol. Rehabil sourcePartly supported

  The Introduction (page not provided) calls fibromyalgia a disabling chronic pain syndrome and describes multi-site pain, fatigue, sleeping problems, and common comorbid mood disorders. It does not describe the pain as medically unexplained or identify cognitive disorders among its symptoms. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [5] Colas, 2021, Front Public Health sourcePartly supported

  The Introduction (page not specified) describes fibromyalgia as a syndrome involving pain, fatigue and sleep disorders that alters quality of life; it also specifies chronic pain across multiple body regions and discusses anxiety and depression in patients. It does not describe cognitive disorders or characterize the pain as medically unexplained. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [6] Nagakura, 2023, Scandinavian J Pain sourceNot checked — no full text of the source
• cites [7] El-Shewy, 2019, Biomed Pharmacothe sourcePartly supported

  The Introduction describes fibromyalgia as chronic and reports widespread pain, sleep disturbances, anxiety, cognitive dysfunction, and depressive symptoms; section 3 also mentions fatigue. Section 2 notes a lack of evidence for structural abnormalities, but the paper does not clearly characterize the pain as medically unexplained or fibromyalgia as disabling. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [8] Rasouli, 2018, Pain res manag sourcePartly supported

  The Introduction describes pain, fatigue, and cognitive dysfunction in fibromyalgia, supporting those parts of the symptom list. Our copy does not characterize fibromyalgia as a disabling chronic pain syndrome or describe its pain as medically unexplained and widespread; it also does not identify mood or sleep disorders as symptoms. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [9] Tran, 2017, Arthritis Care Res sourcePartly supported

  The paper’s introductory passage (indexed under Abstract > Conclusion; page unavailable) describes juvenile fibromyalgia as a chronic pain condition involving widespread pain, fatigue, sleep difficulties, and anxiety or depressive symptoms. The Study Measures section also addresses functional disability. Our copy does not characterize the pain as medically unexplained or identify cognitive disorders as a symptom, and its description is specifically of juvenile fibromyalgia rather than fibromyalgia generally. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [10] Hadlandsmyth, 2020, J Health Psychol sourcePartly supported

  The Introduction (page unavailable) describes fibromyalgia as a chronic pain condition that can be disabling and is associated with fatigue, sleep disturbance, cognitive difficulties, and psychological distress. It also discusses depression and anxiety in people with fibromyalgia. Our copy does not characterize the pain as medically unexplained or explicitly describe it as widespread. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Fatigue, more than pain, is correlated with balance deficits, attributed to impaired sensorimotor learning.

“Fatigue, more than pain, is correlated with balance deficits, attributed to impaired sensorimotor learning.8”

• cites [8] Rasouli, 2018, Pain res manag sourcePartly supported

  The Results (§3.3) report correlations between fatigue and several postural-control measures, but none for pain; the Conclusion likewise suggests fatigue may explain reduced postural control. The Introduction (§1) proposes that pain and fatigue may interfere with sensorimotor learning, but the paper does not establish impaired learning as the cause of the observed balance deficits. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

FM patients may also experience real pain flare-ups post-exercise, linked to metabolic dysfunction and impaired endogenous pain inhibition.

“FM patients may also experience real pain flare-ups post-exercise, linked to metabolic dysfunction and impaired endogenous pain inhibition.17”

• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Introduction (page unavailable) says fibromyalgia patients may be prone to increased pain with exercise and reports impaired endogenous pain inhibition in adults. It does not link post-exercise pain flares to metabolic dysfunction. The Results (page unavailable) distinguish post-exercise soreness from participants’ usual pain flares, which they described as unrelated to the exercises. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

High BMI and inactivity may exacerbate motor deficits and perpetuate the cycle of disability.

“High BMI and inactivity may exacerbate motor deficits and perpetuate the cycle of disability.2,17”

• cites [2] Rasouli, 2017, J Pain Res sourcePartly supported

  The Discussion (page not provided) says high BMI may impair fine and gross motor skills and that low physical activity may adversely affect motor proficiency in patients with fibromyalgia or chronic fatigue syndrome. It also links avoidance of pain and fatigue to inactivity and deconditioning, but does not establish that these factors perpetuate a cycle of disability. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Introduction (page not provided) links activity avoidance and poor body mechanics in adolescents with juvenile fibromyalgia to a possible downward spiral of pain and disability. It does not say that high BMI contributes to this cycle or that inactivity exacerbates motor deficits. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Specific deficiencies in gait include reduced stride length and alterations in dorsiflexion, eversion, and internal rotation at the knee during early stance.

“Specific deficiencies in gait include reduced stride length and alterations in dorsiflexion, eversion, and internal rotation at the knee during early stance.30”

• cites [30] Sil, 2015, Arthritis Care Res sourceSupported

May combine two claims.

FM has been characterized by an increase in lactate levels, which appeared to facilitate the response of neuronal voltage-insensitive sodium channels.

“FM has been characterized by an increase in lactate levels, which appeared to facilitate the response of neuronal voltage-insensitive sodium channels.15”

• cites [15] Proia, 2019, Eur J Trans Myol sourcePartly supported

  The section labeled “Ethical Publication Statement” says fibromyalgia is characterized by increased lactate and that lactate appears to facilitate the response of ASICs, which it identifies as neuronal voltage-insensitive sodium channels. It qualifies that proposed effect as occurring together with ATP following exposure to low pH; the citing sentence omits those conditions. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Stride frequency may differentiate FM patients from healthy controls (HC) and was correlated with diverted attention and reduced self-assessed coping skills.

“Stride frequency may differentiate FM patients from healthy controls (HC) and was correlated with diverted attention and reduced self-assessed coping skills.”

• cites [14] Auvinet, 2011, BMC Musculoskeletal Disord sourcePartly supported

  The Results (Population characteristics) identify stride frequency as the most discriminating marker between FM patients and controls. The Results (Correlation analysis) report positive correlations between stride frequency and both diverting attention and coping self-statements. They do not report a correlation with a measure of reduced self-assessed coping skills; reduced coping self-statements are reported for the low-stride-regularity subgroup instead. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

The symptoms of FM may lead to a sedentary lifestyle by reducing physical abilities, which can lead to adverse effects on the functional capacity of the patient.

“The symptoms of FM may lead to a sedentary lifestyle by reducing physical abilities, which can lead to adverse effects on the functional capacity of the patient.19”

• cites [19] Costa, 2017, Front. hum. neurosci sourceSupported

May combine two claims.

Stride regularity was correlated to quality of life measures and pain catastrophizing, prospectively predicting high levels of comorbid pain and depression.

“Stride regularity was correlated to quality of life measures and pain catastrophizing, prospectively predicting high levels of comorbid pain and depression.14”

• cites [14] Auvinet, 2011, BMC Musculoskeletal Disord sourcePartly supported

  The Results (Correlation analysis) report that stride regularity correlated with the Fibromyalgia Impact Questionnaire score and catastrophizing, but found no correlation with SF-36 quality-of-life measures. The Discussion (Gait markers in fibromyalgia) says catastrophizing—not stride regularity—can prospectively predict high pain and depression; the paper does not report a prospective prediction by stride regularity. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Over 80% of FM patients report severe fatigue, which significantly impairs postural control and motor performance.

“Over 80% of FM patients report severe fatigue, which significantly impairs postural control and motor performance.3,8,21”

• cites [3] Estévez-López, 2021, Arch. Phys. Med. Rehabil sourcePartly supported

  The opening passage (labelled Abstract in our copy; page unavailable) says that more than 80% of people with fibromyalgia experience severe fatigue or poor sleep quality. The paper does not say that fatigue significantly impairs postural control or motor performance, so that part of the claim is unsupported. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [8] Rasouli, 2018, Pain res manag sourcePartly supported

  The Conclusion (page unavailable) reports reduced postural control in FM patients and correlations between fatigue and postural control. The Discussion says fatigue may explain the deficits, but does not establish that it significantly impairs motor performance. Our copy does not support the claim that over 80% of FM patients report severe fatigue. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [21] Sempere-Rubio, 2018, PLoS One sourcePartly supported

  The Introduction identifies fatigue as a feature of fibromyalgia, and the Discussion calls it one of the population’s most common symptoms. The Discussion and Conclusions report impaired postural control in women with fibromyalgia. The paper does not give an over-80% prevalence for severe fatigue or establish that fatigue significantly impairs postural control and motor performance. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Avoiding pain and fatigue presumably explains low levels of physical activity.

“Avoiding pain and fatigue presumably explains low levels of physical activity.8”

• cites [8] Rasouli, 2018, Pain res manag sourceCould not verify

  The Introduction discusses pain and fatigue as possible influences on motor performance, and the Conclusion links fatigue to reduced postural control. Neither section addresses whether people avoid pain and fatigue or whether such avoidance explains low physical activity (searched: physical activity, avoidance, pain, and fatigue). (LLM, conf=0.72)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

FM has an unknown aetiology but has been described as a complex hyperalgesic pain syndrome in which abnormalities of central sensory processing interact with peripheral pain generators.

“FM has an unknown aetiology but has been described as a complex hyperalgesic pain syndrome in which abnormalities of central sensory processing interact with peripheral pain generators.1,5,7”

• cites [1] Gerdle, 2010, BMC Musculoskeletal Disord sourceSupported
• cites [5] Colas, 2021, Front Public Health sourcePartly supported

  The Introduction (page not supplied) says FM physiopathology is poorly understood and evokes central nervous system dysfunction involving pain pathways. It does not describe FM as a hyperalgesic syndrome or say that central sensory-processing abnormalities interact with peripheral pain generators. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [7] El-Shewy, 2019, Biomed Pharmacothe sourcePartly supported

  The Introduction describes fibromyalgia as involving hyperalgesia, and Section 2 discusses possible abnormalities in central pain processing and says nociceptive input can maintain central sensitization. Section 3 also describes hypothesized muscle abnormalities. The review does not clearly establish the claimed interaction between central abnormalities and peripheral pain generators; it presents these mechanisms as possibilities. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Gait analysis was proposed to provide additional information in identifying subgroups among FM patients.

“Gait analysis was proposed to provide additional information in identifying subgroups among FM patients.14”

• cites [14] Auvinet, 2011, BMC Musculoskeletal Disord sourceSupported

May combine two claims.

Low levels of physical activity were correlated with poor motor control, lower movement velocity, and a higher body mass index (BMI), which are typical in FM populations.

“Low levels of physical activity were correlated with poor motor control, lower movement velocity, and a higher body mass index (BMI), which are typical in FM populations.”

• cites [2] Rasouli, 2017, J Pain Res sourcePartly supported

  The Discussion says low physical activity is common in FM and may be correlated with poor motor control and lower movement velocity. It also says high BMI is common in FM, but does not establish a correlation between BMI and physical activity. The claim presents the tentative motor-control association as an established correlation. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Introduction says that most patients with fibromyalgia, including adolescents with JFM, are sedentary and that adolescents with JFM show altered biomechanics and movement deficits. It does not report a correlation between activity level and motor control, movement velocity, or BMI; the searches for movement velocity and BMI found no supporting passage. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Patients with FM present with slower gait speed, reduced stride length, delayed gait initiation, altered postural sway, and altered muscle activation patterns during walking.

“Patients with FM present with slower gait speed, reduced stride length, delayed gait initiation, altered postural sway,2,21 and altered muscle activation patterns during walking.30”

• cites [2] Rasouli, 2017, J Pain Res sourcePartly supported

  The Results (Gait initiation; page not provided) report significantly longer gait-initiation reaction times in patients with FM than in healthy controls. The Introduction also reports reduced gait velocity in FM. Our copy does not establish reduced stride length or altered postural sway; the separately cited muscle-activation clause is not necessary to this verdict. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [21] Sempere-Rubio, 2018, PLoS One sourceSupported
• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The Results (Biomechanical and Biodynamic Assessments; page unavailable) report shorter self-selected strides in adolescents with juvenile fibromyalgia, but no significant difference in walking speed. The paper does not report delayed gait initiation or altered postural sway, and its adolescent findings do not establish those claims for FM patients generally. Muscle activation patterns are attached to a separate citation in the citing sentence. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Kinesiophobia was reported in patients with FM due to the association between pain, fatigue and movement, and was associated with reduced levels of physical activity, increased disability, and perpetuation of pain.

“Kinesiophobia was reported in patients with FM due to the association between pain, fatigue and movement, and was associated with reduced levels of physical activity, increased disability, and perpetuation of pain.17,29,30”

• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Introduction (page unavailable) reports marked fear of movement in adolescents with juvenile fibromyalgia and describes pain-related activity avoidance as a possible contributor to reduced exercise and a downward spiral of pain and disability. It does not establish fatigue as a cause of fear of movement, and its account of the pain–disability spiral is qualified rather than a demonstrated association for fibromyalgia patients generally. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [29] Salvador, 2021, Braz. J. Phys. Ther sourceSupported
• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The Results (Physical and Psychosocial Functioning; page unavailable) report marked fear of movement in adolescents with juvenile fibromyalgia. The Discussion (page unavailable) describes a possible cycle of pain-related fear, activity avoidance, disability, and pain, but does not establish that kinesiophobia arises from an association between pain, fatigue, and movement. The claim also states the activity and pain consequences more definitively than the paper does. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S2 (checkable).

Understanding the underlying disease process will provide insights for targeted therapeutic approaches.

“Understanding the underlying disease process will provide insights for targeted therapeutic approaches.7,10”

• cites [7] El-Shewy, 2019, Biomed Pharmacothe sourceSupported
• cites [10] Hadlandsmyth, 2020, J Health Psychol sourcePartly supported

  The Introduction says that identifying fibromyalgia patient subgroups and understanding relationships between symptoms and psychological distress can inform targeted interventions. The Discussion likewise suggests tailored treatments, but the paper does not establish that understanding the underlying disease process—as distinct from symptom patterns—will provide those insights. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

• AssumptionRests on an assumption: Functional impairments in FM remain underexplored in the literature compared to pain-related symptoms.

Probably not a substantial claim: may not pass S3 (load-bearing).

Multiple position statements recommend that medications be accompanied by exercise and coping skills approaches.

“Multiple position statements recommend that medications be accompanied by exercise and coping skills approaches.18”

• cites [18] Carson, 2010, Pain sourceSupported

May combine two claims.

Patients with chronic pain often have deficits in motor performance, including restricted movement or altered motor planning, leading to posture, gait and balance insufficiencies.

“Patients with chronic pain often have deficits in motor performance, including restricted movement or altered motor planning,20 leading to posture, gait and balance insufficiencies.19,21”

• cites [19] Costa, 2017, Front. hum. neurosci sourcePartly supported

  The Discussion reports impaired gait, balance, and postural control in patients with fibromyalgia compared with pain-free controls. It does not establish that restricted movement or altered motor planning leads to those impairments, or that the finding applies to chronic-pain patients generally. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [21] Sempere-Rubio, 2018, PLoS One sourcePartly supported

  The Conclusions (page unavailable) report impaired postural control in women with fibromyalgia, supporting the posture and balance portion of the clause cited to this paper. The study does not establish gait impairment or extend its finding to patients with chronic pain generally; it also does not show that motor deficits caused the postural impairment. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

FM patients demonstrate reduced differential muscle activation, likely due to impaired descending motor inhibition and altered neuromuscular strategies.

“FM patients demonstrate reduced differential muscle activation, likely due to impaired descending motor inhibition and altered neuromuscular strategies.1”

• cites [1] Gerdle, 2010, BMC Musculoskeletal Disord sourcePartly supported

  The Conclusions report less frequent differential activation in the upper trapezius of FM patients than controls and describe it as a possible altered neuromuscular control strategy. The Discussion mentions altered descending inhibition only as one possible consequence of chronic pain; it does not establish impaired descending motor inhibition as the cause. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Moderate exercise, integrative neuromuscular training, Tai Chi, and Virtual Reality (VR) based exergaming show promise in improving postural stability and physical functioning.

“Moderate exercise, integrative neuromuscular training, Tai Chi, and Virtual Reality (VR) based exergaming show promise in improving postural stability and physical functioning.5,24”

• cites [5] Colas, 2021, Front Public Health sourcePartly supported

  The Introduction (page not provided) reports improved physical function with mixed exercise training in adults with fibromyalgia, and the Methods and Analysis > Interventions section includes an exercise that solicits balance. The paper does not address integrative neuromuscular training, Tai Chi, or VR exergaming, or report an improvement in postural stability; its own intervention is a study protocol, not a reported result. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [24] Giggins, 2013, J Neuroeng Rehabil sourcePartly supported

  The ‘Recent developments in biofeedback signal delivery’ section reports promising evidence for VR-based biofeedback and exergaming in rehabilitation, including studies of postural stability and upper-limb function. It does not support the claims about moderate exercise, integrative neuromuscular training, or Tai Chi; a search for those terms found no relevant discussion. The exergaming study also found similar postural-stability improvements with and without exergaming feedback. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Aerobic or resistance training programs may be challenging for patients with FM due to poor movement confidence and competence and increased baseline lactate concentrations.

“Aerobic or resistance training programs may be challenging for patients with FM due to poor movement confidence and competence17 and increased baseline lactate concentrations.15”

• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Introduction says traditional aerobic or resistance training may be difficult to sustain for adolescents with juvenile fibromyalgia because of poor movement confidence and a lack of fundamental movement competence. The citing sentence extends that explanation to patients with fibromyalgia generally. Increased baseline lactate has a separate citation and is not attributed to this source. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [15] Proia, 2019, Eur J Trans Myol sourceSupported

May combine two claims.

Longer response times in reaction time tasks were observed in FM, along with reduced psychomotor function, resulting in slower movement initiation and lower movement speed, especially in tasks with higher cognitive demands.

“Longer response times in reaction time tasks were observed in FM, along with reduced psychomotor function, resulting in slower movement initiation and lower movement speed, especially in tasks with higher cognitive demands.2”

• cites [2] Rasouli, 2017, J Pain Res sourceSupported

May combine two claims.

Observed biomechanics include reduced trunk flexion, increased hip flexion, and poor proximal stabilization, all of which contribute to fall risk.

“Observed biomechanics include reduced trunk flexion, increased hip flexion, and poor proximal stabilization, all of which contribute to fall risk.30”

• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The Discussion (page not provided) describes decreased trunk flexion and increased hip flexion during landing, and suggests these deficits may indicate reduced proximal stabilization. The paper discusses fall risk in connection with biodynamic deviations generally, but does not establish that all three specified findings contribute to falls; its discussion of these landing findings instead mentions jump height and possible injury risk. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

These deficits were accompanied by pain, functional disability, lowered mood, and kinesiophobia.

“These deficits were accompanied by pain, functional disability, lowered mood, and kinesiophobia.30”

• cites [30] Sil, 2015, Arthritis Care Res sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Although there is a growing number of studies regarding the effect of neurofeedback on FM in the literature, the level of evidence is still uncertain.

“Although there is a growing number of studies regarding the effect of neurofeedback on FM in the literature, the level of evidence is still uncertain.28”

• cites [28] Ribeiro, 2023, Front Neurosci sourcePartly supported

  The Introduction (page unavailable) says neurofeedback studies are growing in number but their evidence remains questionable; it does not say that the number of fibromyalgia-specific studies is growing. The Discussion and Final considerations (pages unavailable) describe fibromyalgia findings as promising but limited by small samples and in need of confirmation, supporting uncertainty about the evidence for FM. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Associations between restless leg syndrome and FM were identified, positively associated with both pain severity and the number of pain sites.

“Associations between restless leg syndrome and FM were identified, positively associated with both pain severity and the number of pain sites.”

• cites [25] Hoogwout, 2015, BMC Musculoskeletal Disord sourcePartly supported

  The Background reports an association between restless legs syndrome (RLS) and fibromyalgia. It separately says that an association between RLS and multi-site pain in middle-aged women increased with pain severity and the number of pain sites. The paper does not establish that this severity-and-site pattern applies specifically to fibromyalgia; its own study examined musculoskeletal pain more generally (Discussion, “MSK pain and RLS”; page numbers unavailable). (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Activity in certain basal ganglionic areas has been correlated with motivation versus physical fatigue, namely widespread throughout the basal ganglia in the former and in the putamen for the latter.

“Further, activity in certain basal ganglionic areas has been correlated with motivation versus physical fatigue, namely widespread throughout the basal ganglia in the former and in the putamen for the latter.27”

• cites [27] Nakagawa, 2016, Sci Rep sourcePartly supported

  The Results (MRI data; page unavailable) report that motivation scores correlated with mean diffusivity across the right putamen, pallidum and caudate, while physical-activity scores correlated with mean diffusivity only in the right putamen. This supports the regional distinction, but the study measured a structural MRI property, not basal-ganglia activity, and assessed physical activity rather than physical fatigue. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Gait in fibromyalgia patients may be achieved preferentially by recruiting hip flexors instead of ankle plantar flexors, increasing metabolic demands and contributing to fatigue.

“Gait in FM patients may be achieved preferentially by recruiting hip flexors instead of ankle plantar flexors, increasing metabolic demands and contributing to fatigue.19”

• cites [19] Costa, 2017, Front. hum. neurosci sourceSupported

May combine two claims.

Quality of life is improved in patients with fibromyalgia treated with high-frequency repetitive transcranial magnetic stimulation of the motor cortex, with an impact on fatigue.

“Quality of life has been shown to be improved in patients with FM treated with high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) of the motor cortex, with evidence of an impact on fatigue.26”

• cites [26] Lefaucheur, 2020, Clin Neurophysiol sourcePartly supported

  Section 2.3 (page unavailable) reports improved quality of life in patients with fibromyalgia after high-frequency rTMS of the left motor cortex. Its evidence of improved fatigue, however, concerns stimulation of the left dorsolateral prefrontal cortex, not the motor cortex. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Functional dysregulation of dopaminergic circuitry was suggested as a common underlying pathway, and may account for comorbid depressive symptoms and anxiety disorders.

“Functional dysregulation of dopaminergic circuitry was suggested as a common underlying pathway, and may account for comorbid depressive symptoms and anxiety disorders.25”

• cites [25] Hoogwout, 2015, BMC Musculoskeletal Disord sourcePartly supported

  The Discussion (MSK pain and RLS; page unavailable) suggests that altered dopamine metabolism helps explain associations among restless legs syndrome, musculoskeletal pain, and depression. It does not extend that proposed pathway to anxiety disorders, so that part of the claim is unsupported. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

Regular moderate to vigorous physical activity and weight-bearing exercises are recommended for pain management in patients with FM, but adherence to these recommendations is often poor.

“Regular moderate to vigorous physical activity and weight-bearing exercises are recommended for pain management in patients with FM,5,21 but adherence to these recommendations is often poor.9,17,30”

• cites [5] Colas, 2021, Front Public Health sourcePartly supported

  The Introduction (page unavailable) says endurance training is recommended for fibromyalgia and favors moderate-to-vigorous activity over light-intensity activity for reducing symptoms. It also reports reduced pain perception with resistance training, but says there are no precise recommendations on training modalities; it does not establish a specific recommendation for weight-bearing exercise. The poor-adherence clause has separate citations in the citing sentence and is not attributed to this source. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [21] Sempere-Rubio, 2018, PLoS One sourceCould not verify

  The citation is attached to the statement that adherence to exercise recommendations is often poor. The Methods and Results passages describe postural-control, strength, and pain measurements, but do not report adherence; searches for exercise recommendations and adherence found no passage addressing that point. The earlier recommendation about physical activity has separate citations. (LLM, conf=0.73)

  Experimental — accuracy not yet measured
• cites [9] Tran, 2017, Arthritis Care Res sourceSupported
• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourceSupported
• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The passage labeled Abstract > Conclusions recommends moderate-to-vigorous activity and muscle-strengthening exercises at least twice weekly for pain management in juvenile fibromyalgia. The citing sentence attributes the exercise recommendation to this source, but broadens the population to FM generally and substitutes weight-bearing exercises for muscle strengthening. Its separate claim about poor adherence is attached to other citations. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Cognitive behavioural therapy (CBT) for FM is effective in reducing symptoms of depression, functional disability, and catastrophizing and increasing pain-coping efficacy, but does not result in greater engagement in more vigorous activity or exercise when applied in isolation.

“Cognitive behavioural therapy (CBT) for FM is effective in reducing symptoms of depression, functional disability, and catastrophizing and increasing pain-coping efficacy,9,17 but does not result in greater engagement in more vigorous activity or exercise when applied in isolation.17”

• cites [9] Tran, 2017, Arthritis Care Res sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Deficits in fine motor tasks, such as manual dexterity, reflect broader impairments in sensorimotor integration but may also be associated with dopamine dysregulation.

“Deficits in fine motor tasks, such as manual dexterity, reflect broader impairments in sensorimotor integration2 but may also be associated with dopamine dysregulation.25”

• cites [2] Rasouli, 2017, J Pain Res sourcePartly supported

  The Introduction reports prior findings of manual-dexterity deficits in fibromyalgia, and the Discussion describes sensory–motor processing deficits in fibromyalgia and chronic fatigue syndrome. But the Discussion presents their connection to poor motor function as a possible explanation, especially for gross motor function; this study found no statistically significant difference in fine-motor performance. Dopamine dysregulation is attached to a different citation and is not assessed here. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [25] Hoogwout, 2015, BMC Musculoskeletal Disord sourcePartly supported

  The Discussion section on MSK pain and RLS links altered dopamine metabolism to restless legs syndrome, musculoskeletal pain, and depression. It does not link dopamine dysregulation to deficits in fine motor tasks or manual dexterity, which is the relationship the citing sentence attributes to this source. The separate sensorimotor-integration clause carries a different citation. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

May combine two claims.

FM patients show reduced muscle strength and altered joint mechanics during functional movements like jumping.

“FM patients show reduced muscle strength and altered joint mechanics during functional movements like jumping.21,30”

• cites [21] Sempere-Rubio, 2018, PLoS One sourcePartly supported

  The Introduction (page unavailable) describes loss of strength as common in people with fibromyalgia, and the Methods report measuring lower-limb strength. The paper studies postural control during standing, not joint mechanics during movements such as jumping; that part of the claim is unsupported. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The Results report reduced knee and hip strength in adolescents with juvenile fibromyalgia, and the Discussion describes altered knee mechanics during a drop vertical jump. The claim says “FM patients” generally, but this study directly tested adolescents with juvenile fibromyalgia, not FM patients across age groups. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Force plate systems provide feedback on balance, movement, and gait and have been shown to reduce the incidence of falls.

“Force plate systems provide feedback on balance, movement, and gait and have been shown to reduce the incidence of falls.24”

• cites [24] Giggins, 2013, J Neuroeng Rehabil sourcePartly supported

  The Biomechanical biofeedback section states that force plate systems provide feedback on balance, movement and gait. It also reports reduced fall incidence, but specifically among frail older women living in residential care; the claim omits that population limit. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Gait and postural control deficits were observable even after adjusting for BMI, indicating disease-specific mechanisms.

“However, gait and postural control deficits were observable even after adjusting for BMI, indicating disease-specific mechanisms.30”

• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The Results (Sample Characteristics; page unavailable) report that a normal-BMI subgroup showed differences consistent with the full sample, and the Discussion says functional deficits, including altered gait, were evident beyond group differences in BMI. The paper did not report a formal BMI-adjusted analysis or directly assess postural control, and it does not establish a disease-specific mechanism. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

Subgrouping fibromyalgia patients by stride frequency could facilitate prescribing physical activity for those with normal stride frequency and a slowly progressive physical activity program for those with reduced stride frequency.

“Subgrouping FM patients on the basis of stride frequency measurement could facilitate the prescription of physical activity for patients with normal stride frequency, and encourage the prescription of a slowly progressive physical activity program for those who demonstrate reduced stride frequency on assessment.”

• cites [14] Auvinet, 2011, BMC Musculoskeletal Disord sourceSupported

Classified as probably not a substantial claim.

Exercise is the only strong therapy-based recommendation for fibromyalgia.

“Nonpharmacological therapies have been advocated as a first-line treatment for patients suffering from FM, including exercise, which is the only strong therapy-based recommendation.3,5”

• cites [3] Estévez-López, 2021, Arch. Phys. Med. Rehabil sourceSupported
• cites [5] Colas, 2021, Front Public Health sourceSupported

May combine two claims.

Pharmacological therapies for fibromyalgia are not always effective and frequently cause undesirable effects.

“Pharmacological management often relies on the prescription of analgesics, antidepressants, and/or antiepileptics, but these therapies are not always effective and frequently cause undesirable effects.5”

• cites [5] Colas, 2021, Front Public Health sourceSupported

May combine two claims.

Stride regularity has been linked to neurodegeneration and diminished executive function and attention.

“Stride regularity, in contrast, has been associated with the unsteadiness of gait, and has been linked to neurodegeneration and diminished executive function and attention.14”

• cites [14] Auvinet, 2011, BMC Musculoskeletal Disord sourceSupported

May combine two claims.

The reduced blood flow and degenerative muscle changes in fibromyalgia are presumably due to local hypoxia, creating higher levels of free radicals that induce apoptosis, reduce ATP and increase lactate concentrations in muscle cells, leading to muscle weakness and pain.

“FM patients exhibit reduced blood flow and degenerative changes in the muscles, presumably due to local hypoxia, creating higher levels of free radicals that induce apoptosis, reduce ATP and increase lactate concentrations in muscle cells, leading to muscle weakness and pain.7,15”

• cites [7] El-Shewy, 2019, Biomed Pharmacothe sourceSupported
• cites [15] Proia, 2019, Eur J Trans Myol sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Severe fatigue impacts depression, pain perception, physical functioning, and exercise adherence in fibromyalgia.

“More than 80% of people with FM experience poor sleep quality with severe fatigue impacting depression,3 pain perception, physical functioning10 and exercise adherence.2,17,21”

• cites [3] Estévez-López, 2021, Arch. Phys. Med. Rehabil sourcePartly supported

  The Abstract reports that more than 80% of people with fibromyalgia experience severe fatigue or poor sleep quality. However, the Synthesis of the data discusses adherence only as a criterion used in exercise studies; it does not establish that severe fatigue affects exercise adherence. The cited passages also do not establish effects of fatigue on depression, pain perception, or physical functioning. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [10] Hadlandsmyth, 2020, J Health Psychol sourcePartly supported

  The Results (Fatigue) report that women with fibromyalgia in the high-depression group had significantly higher fatigue scores. This supports an association, but not the claim that fatigue impacts or causes depression. In the citing sentence, this source is attached to depression; the other outcomes have separate citations. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [2] Rasouli, 2017, J Pain Res sourcePartly supported

  The Discussion (page unavailable) suggests that avoiding aggravation of pain and fatigue contributes to low physical activity in fibromyalgia, and reports reduced motor performance. It does not establish that severe fatigue affects depression or pain perception, or measure exercise adherence; avoiding activity is not the same as adherence to an exercise program. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Results (Domain 1: Feasibility; page unavailable) report that adolescents with juvenile fibromyalgia identified fatigue as a barrier to maintaining their exercise regimen. This supports the exercise-adherence portion of the sentence, but the paper does not establish that severe fatigue associated with poor sleep has this effect across people with fibromyalgia generally. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [21] Sempere-Rubio, 2018, PLoS One sourceCould not verify

  The citation appears alongside the claim about exercise adherence. The Introduction lists fatigue among fibromyalgia symptoms, and the Discussion mentions fatigue as a reason to limit assessment trials, but neither addresses whether severe fatigue affects exercise adherence. Searches for exercise adherence and related effects found no supporting passage in our copy. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

May combine two claims.

Fibromyalgia patients exhibit reduced blood flow and degenerative changes in the muscles.

“FM patients exhibit reduced blood flow and degenerative changes in the muscles, presumably due to local hypoxia, creating higher levels of free radicals that induce apoptosis, reduce ATP and increase lactate concentrations in muscle cells, leading to muscle weakness and pain.7,15”

• cites [7] El-Shewy, 2019, Biomed Pharmacothe sourceSupported
• cites [15] Proia, 2019, Eur J Trans Myol sourcePartly supported

  The References list a study of decreased muscle blood flow in fibromyalgia patients during standardized exercise, offering limited support for that part of the claim. But the paper’s background discussion reports another study finding no significant blood-flow difference, and its Discussion proposes hypervascularization in some muscles. No passage found describes degenerative changes in fibromyalgia patients’ muscles. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Identifying and quantifying consistent balance abnormalities in fibromyalgia patients may improve the specificity and effectiveness of treatments.

“Balance training is generally not included in FM treatment; however, by identifying and quantifying consistent balance abnormalities in FM patients, the specificity and effectiveness of treatments may be improved.31”

• cites [31] Jones, 2011, Arthritis Res Therap sourceSupported

Classified as probably not a substantial claim.

Nonpharmacological therapies, including exercise, have been advocated as a first-line treatment for patients with fibromyalgia.

“Nonpharmacological therapies have been advocated as a first-line treatment for patients suffering from FM, including exercise, which is the only strong therapy-based recommendation.3,5”

• cites [3] Estévez-López, 2021, Arch. Phys. Med. Rehabil sourcePartly supported

  The Clinical applications section (page not provided) says European League Against Rheumatism recommendations highlight exercise as the only therapy with a strong level of evidence for managing fibromyalgia. Our copy does not say that nonpharmacological therapies generally are advocated as first-line treatment, so that broader part of the citing sentence is unsupported. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [5] Colas, 2021, Front Public Health sourceSupported

May combine two claims.

Kinesiophobia and pain catastrophizing compound activity avoidance and contribute to functional deficits and physical deconditioning in fibromyalgia.

“further compounding activity avoidance and contributing to functional deficits and physical deconditioning.30”

• cites [30] Sil, 2015, Arthritis Care Res sourcePartly supported

  The introduction (page unavailable) says pain-related fear may reinforce activity avoidance, contribute to functional deficits, and further contribute to physical deconditioning. The Conclusions also link fear of movement to activity avoidance in adolescents with juvenile fibromyalgia. Our copy does not address pain catastrophizing, and it presents these links as possibilities rather than established causal effects. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

The search for better treatments is ongoing and directed towards multidisciplinary, patient-centred care, ideally focused on identified pathology.

“The search for better treatments is ongoing and directed towards multidisciplinary, patient-centred care, ideally focused on identified pathology.34”

• cites [34] Gracely, 2015, Curr Rheumatol Rev sourcePartly supported

  The “Epidemiology: Different Diagnoses, Similar Symptoms” section says the search for better treatments is ongoing, describes attention to patient-centered therapy, and says treatment would ideally focus on identified pathology. It does not describe the proposed care as multidisciplinary. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Pain is recommended as the primary outcome measure for chronic pain treatment interventions.

“While pain is recommended as the primary outcome measure for chronic pain treatment interventions, functional deficits have long been reported by patients with FM and warrant investigation and appropriate, evidence-based intervention.33”

• cites [33] Fitzgibbon, 2018, Eur. J. Pain sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The addition of virtual reality and therapeutic exergames offers patients opportunities to engage in meaningful, intensive, and enjoyable tasks related to their real-life interests and daily activities.

“The addition of VR and therapeutic exergames offer patients opportunities to engage in meaningful, intensive, and enjoyable tasks related to their real-life interests and daily activities.24”

• cites [24] Giggins, 2013, J Neuroeng Rehabil sourceSupported

May combine two claims.

Kinesiophobia and pain catastrophizing are prevalent in fibromyalgia.

“Kinesiophobia and pain catastrophizing are prevalent in FM and are strongly associated with decreased physical performance, reduced postural control, and muscle weakness,9,17,29”

• cites [9] Tran, 2017, Arthritis Care Res sourcePartly supported

  The Study Measures section assesses fear of movement and pain catastrophizing in adolescents with juvenile fibromyalgia, and the Discussion reports that both decreased during the intervention. These passages show that the concerns were present in this small study, but they do not establish how prevalent they are in fibromyalgia generally. The cited passages also do not establish the stated strong associations with physical performance, postural control, or muscle weakness. Page numbers are unavailable in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured
• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourcePartly supported

  The Introduction reports marked fear of movement in adolescents with juvenile fibromyalgia compared with healthy peers, supporting the kinesiophobia part in that population. It does not report that pain catastrophizing is prevalent, and its evidence about fear of movement does not establish prevalence across fibromyalgia generally. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [29] Salvador, 2021, Braz. J. Phys. Ther sourcePartly supported

  The Introduction says kinesiophobia is commonly found in patients with fibromyalgia. The Results measure pain catastrophizing and report its correlation with kinesiophobia, but do not establish that pain catastrophizing is prevalent in fibromyalgia. No page numbers are provided in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Tailoring a flexible program with modifications in consultation with the patient, emphasizing graded exercise and positive coping strategies, may be effective in ensuring that initial muscle soreness does not hinder compliance.

“Tailoring a flexible program which allows for modifications in consultation with the patient, with an emphasis on graded exercise and positive coping strategies, may be effective in ensuring that initial muscle soreness does not hinder compliance.17”

• cites [17] Kashikar-Zuck, 2016, Clin J Pain sourceSupported

May combine two claims.

Providing patients with EMDR, CBT, biofeedback or rTMS may enable them to gain control over physical processes, allowing for improved functional task performance and increased autonomy in their rehabilitation.

“Providing patients with EMDR,4 CBT,9,12,17 biofeedback24 or rTMS26,33 may enable them to gain control over physical processes, allowing for improved functional task performance and increased autonomy in their rehabilitation.24”

• cites [4] Borst, 2024, Neuropsychol. Rehabil sourcePartly supported

  The Results (§3.11) report that some participants with fibromyalgia perceived improved physical functioning, coping with pain, and work-related activities after EMDR. That partly supports the proposed functional benefit, but the paper does not establish that EMDR gave patients control over physical processes or increased their autonomy in rehabilitation. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [9] Tran, 2017, Arthritis Care Res sourcePartly supported

  The Intervention and Discussion sections describe CBT coping skills practiced during neuromuscular exercises, improved self-reported functioning, and greater readiness to manage pain among adolescents with juvenile fibromyalgia (page numbers unavailable). These findings support the CBT-related possibility of better daily functioning and self-management, but the study tested a combined intervention and did not establish that CBT alone gives patients control over physical processes or increases rehabilitation autonomy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [24] Giggins, 2013, J Neuroeng Rehabil sourceSupported

May combine two claims.

The literature is scarce and there are no precise recommendations regarding frequency, intensity or type of exercise for fibromyalgia.

“Exercise has low to moderate effects on fatigue for FM patients; however, at this juncture, the literature is scarce and there are no precise recommendations regarding frequency, intensity or type.5”

• cites [5] Colas, 2021, Front Public Health sourcePartly supported

  The Introduction (page not provided) explicitly says there are no precise exercise recommendations for fibromyalgia after discussing frequency, intensity and type. It describes HIIT as minimally studied and strength training as less documented than aerobic training, but does not say exercise literature overall is scarce. It also notes exercise’s relevance to fatigue without specifying a low-to-moderate effect. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Pain was listed as a factor and/or measured in every paper elicited, confirming the weight pain is allocated as a symptom.

“Pain was listed as a factor and/or measured in every paper elicited, confirming the weight pain is allocated as a symptom.”

Probably not a substantial claim: may not pass S4 (based).

Most research has traditionally focused on pharmaceutical pain-related outcomes.

“Most research has traditionally focused on pharmaceutical pain-related outcomes, and the effects of pain and fatigue on motor function are often under-recognised.”

May combine two claims.

Limitations of the reviewed research include methodological inconsistencies, study heterogeneity, low subject numbers, and reliance on self-reported data.

“Limitations of this research are related to methodological inconsistencies, study heterogeneity, low subject numbers and the reliance on self-reported data.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There was no formal risk-of-bias assessment for each included paper.

“There was no formal risk-of-bias assessment for each included paper.”

May combine two claims.

These findings reveal a multifactorial profile of motor and postural dysfunction in FM, shaped by pain processing abnormalities, psychological distress, deconditioning, and altered biomechanics.

“These findings reveal a multifactorial profile of motor and postural dysfunction in FM, shaped by pain processing abnormalities, psychological distress, deconditioning, and altered biomechanics.”

Probably not a substantial claim: may not pass S2 (checkable).

Collectively, these impairments suggest the need for integrative, multidisciplinary management approaches.

“Collectively, these impairments suggest the need for integrative, multidisciplinary management approaches.”

• AssumptionRests on an assumption: Pharmaceutical therapies provide limited relief, achieving only about 30% effectiveness in relieving symptoms and 20% in improving function.
• AssumptionRests on an assumption: Functional impairments in FM remain underexplored in the literature compared to pain-related symptoms.

Probably not a substantial claim: may not pass S2 (checkable).

Our current understanding underscores the need to address multiple domains of care, including physical, psychological and neurological treatment.

“Thus, our current understanding underscores the need to address multiple domains of care, including physical, psychological and neurological treatment.”

• AssumptionRests on an assumption: Pharmaceutical therapies provide limited relief, achieving only about 30% effectiveness in relieving symptoms and 20% in improving function.
• AssumptionRests on an assumption: Functional impairments in FM remain underexplored in the literature compared to pain-related symptoms.

May combine two claims.

CBT combined with adapted physical activity may help reduce kinesiophobia and pain catastrophizing, enabling better adherence to exercise.

“CBT combined with adapted physical activity seems more effective than either approach alone and may help reduce kinesiophobia and pain catastrophizing, enabling better adherence to exercise.”

May combine two claims.

Identifying and quantifying consistent motor dysfunction in fibromyalgia may provide insight into broader deficits such as proprioception and sensorimotor integration and indicate how treatment specificity and effectiveness may be improved.

“Identifying and quantifying consistent motor dysfunction, including reaction time, hypermobility, gait, balance, and postural abnormalities in FM, may provide insight into broader deficits, such as proprioception and sensorimotor integration, and indicate how the specificity and effectiveness of treatments may be improved.”

May combine two claims.

Poor balance confidence and pain may lead to a sedentary lifestyle, reducing physical abilities and further compounding functional capacity in fibromyalgia.

“This, along with pain, may lead to a sedentary lifestyle, reducing physical abilities, further compounding the patient’s functional capacity.”