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Cited by 38Balance, Gait, and Falls PreventionFibromyalgia and Chronic Fatigue Syndrome ResearchCardiovascular Syncope and Autonomic Disorders

Impaired Balance in Patients with Fibromyalgia Syndrome: Predictors of the Impact of This Disorder and Balance Confidence

Open access
Peinado-Rubia, Ana, Osuna-Pérez, María C., Rodríguez-Almagro, Daniel, Zagalaz-Anula, Noelia, López-Ruiz, María C., Lomas-Vega, Rafael·2020·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph17093160PMC PMC7246608
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Abstract

Patients with fibromyalgia syndrome (FMS) have a nonspecific postural balance disorder and a greater prevalence of falls. Objective: to clarify which aspects of maintaining balance are associated with the impact of the disorder and with balance confidence. Methods: A total of 182 persons with FMS agreed to participate in this study. After re-evaluation, 57 fully met inclusion criteria: age 40–70 years and moderate-severe impact of the illness according to the Fibromyalgia Impact Questionnaire (FIQ). All participants underwent a posture control analysis with a stabilometric platform, an evaluation of the perception of verticality and an exploration of the vestibular system via functional tests. Additionally, they self-completed questionnaires about balance confidence, central sensitization, pain catastrophizing, kinesiophobia, dizziness and days with episodes of instability. Results: The FIQ was associated with central sensitization and dizziness, which explained 56% of its variance (AdjR2 = 0.566), while days with instability, kinesiophobia and dizziness also explained more than half of the variance of the balance confidence scale (AdjR2 = 0.527). A high percentage of positive responses was found for functional tests (>50%) and a high dispersion in the stabilometric parameters. Conclusion: the detection of factors susceptible to intervention, such as disability due to dizziness, takes on special relevance in patients with FMS.

AI snapshot

Written from the paper’s full text.

TL;DR

In 57 patients with fibromyalgia and moderate-to-severe disease impact, disease impact was predicted by central sensitization and dizziness-related disability, while balance confidence was predicted by days with instability, kinesiophobia, and dizziness-related disability. Functional balance tests showed high rates of impairment, and stabilometric parameters were highly dispersed.

Key findings

  • The mean FIQ score was 68.69 (SD = 13.97), and the mean ABC balance-confidence score was 58.05 (SD = 22.34); 61.4% of participants scored below 67% on the ABC, indicating substantial fall risk.
  • Multiple regression for FIQ retained central sensitization (CSI) and dizziness disability (DHI), explaining 56.6% of variance (adjusted R² = 0.566). For ABC, the model retained days with instability, kinesiophobia (TSK), and DHI, explaining 52.7% of variance (adjusted R² = 0.527). DHI appeared in both models.
  • Functional balance tests showed high percentages of positive/pathological responses: static balance tests around 50% with open eyes and 90% with closed eyes, and dynamic/gait balance tests exceeded 40% of the sample. Stabilometric center-of-pressure values were high, especially with closed eyes, with high dispersion.
  • Sample clinical means were: instability days 4.28 (SD = 2.16), TSK 28.88 (SD = 7.11), PCS 27.37 (SD = 11.05), CSI 61.74 (SD = 10.94), and DHI 53.71 (SD = 20.81).

Methods

  • Observational descriptive cross-sectional study conducted at the Fibromyalgia Association of Jaen (AFIXA) from January to May 2019. Of 264 contacted, 182 agreed, 70 met criteria, and 57 completed the protocol. Inclusion criteria were age 40–70 years, 2016 ACR fibromyalgia diagnosis, and FIQ ≥ 50; exclusions included cognitive impairment, recent lower-limb surgery/trauma, lower-limb deformity, vestibular/visual/auditory pathology, and neurologic balance disorder.
  • Measures included FIQ, ABC-16, CSI, PCS, TSK, DHI, and self-reported days with instability; stabilometric Romberg testing with open and closed eyes; subjective visual vertical via virtual reality; and seven functional balance/vestibular tests.
  • Analysis used Kolmogorov–Smirnov tests, bivariate Pearson correlations and T-tests, and stepwise multiple linear regression (keep p < 0.05, exclude p > 0.10), with adjusted R², multicollinearity checks (condition indices > 10), SPSS v21, and 95% confidence.

Limitations

  • The authors state that the cross-sectional correlational design prevented sequential analysis of variable evolution and causal relationships, and that the small sample size may have reduced statistical significance for some variables.
  • Evident from the text: the sample was restricted to FMS patients with moderate-to-severe impact (FIQ ≥ 50), was 93% women, and had a mean age of 55.56 years, limiting generalizability to milder FMS, men, or other age groups.
  • Evident from the text: the study included only FMS patients and no healthy or other-disease control group, and several predictors relied on self-administered questionnaires.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3390/ijerph17093160

Cites

36 of 36 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 17 cited sources checked · 5 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Studies analyzing the effectiveness of balance-based treatments in improving the clinical picture of patients with fibromyalgia syndrome have not reached conclusive results.

    “Nevertheless, the studies that have analyzed the effectiveness of treatments based on balance in improving the clinical picture of these patients have not reached conclusive results [9].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [9] Collado-Mateo, D., Gallego-Diaz, J.M., Adsuar, J.C., Domínguez-Muñoz, F.J., Olivares, P.R., and Gusi, N. (2015). Fear of falling in women with fibromyalgia and its relation with number of falls and balance performance. Biomed. Res. Int. source

      The Introduction says there is no consensus on predictors of falls, not on the effectiveness of balance-based treatments. The Discussion recommends including balance exercises in comprehensive programs but does not assess whether studies of those treatments reached conclusive results. Searched for balance-training effectiveness and inconclusive treatment results in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Premisecitation

    There is a significant correlation between balance confidence measured with the ABC scale and disease severity measured with the FIQ (r = −0.64).

    “Evidence shows a significant correlation between balance confidence (measured with the Activities-Specific Balance Confidence—ABC) and disease severity measured with the fibromyalgia impact questionnaire FIQ (r = −0.64) [3].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] Jones, 2009, Fibromyalgia is associated with impaired balance and falls, J. Clin. Rheumatol. source
  • Premisecitation

    Persons with fibromyalgia syndrome have sensory deficits measured with stabilometry despite having a normal clinical neurological exam.

    “Recent studies [4,8,34], have found that persons with FMS have sensory deficits, measure with stabilometry, despite have a normal clinical neurological exam.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [4] Muto, 2015, Postural control and balance self-efficacy in women with fibromyalgia: Are there differences?, Eur. J. Phys. Rehabil. Med.
    • cites [8] Jones, 2011, Postural control deficits in people with fibromyalgia: A pilot study, Arthritis Res. Ther. source
    • cites [34] Yang, 1990, Postural dynamics in the standing human, Biol. Cybern. source
  • Findingown data

    Using days with instability, kinesiophobia, and severity of perceived vertigo, the model explained 52.7% of the variance of ABC (adjusted R2 = 0.527).

    “Using these three variables, the model explained 52.7% of the variance of the aforementioned variable (ABC), therefore, the corrected R2 can also be described as high (R2 adjusted = 0.527).”
    • Also stated in: § 5. Conclusions · plain
      “while days with episodes of instability, kinesiophobia (TSK) and dizziness on daily life (DHI) also explained more than half of the variance of the balance confidence (measured with ABC Scale).”
    Quote in the paperSubstantial claim
  • Findingown data

    The ABC mean score in the sample was 58.05 (SD 22.34), indicating moderate balance confidence.

    “Balance confidence, measured with the ABC scale, obtained data showing moderate balance confidence levels, with a mean score of 58.05 (SD = 22.34).”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 11
  • May combine two claims. 11

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

    Premisecitation

    The incidence of falls in patients with fibromyalgia syndrome is 1.75 falls per person each 6 months.

    “The incidence of falls in FMS patients has been reported as 1.75 falls/person each 6 months [3].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] Jones, 2009, Fibromyalgia is associated with impaired balance and falls, J. Clin. Rheumatol. source

      The Results report 37 falls among FM patients over six months, not 1.75 falls per patient. The Study sample and setting section says 46 FM patients underwent testing and five were excluded from group analyses; even using the remaining 41 patients, 37 falls is about 0.90 per patient. (LLM, conf=0.87)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Patients with fibromyalgia syndrome present with a nonspecific postural balance disorder and an increased prevalence of falls.

    “Recent studies have shown that patients with FMS present with a nonspecific postural balance disorder and an increased prevalence of falls [3].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [3] Jones, 2009, Fibromyalgia is associated with impaired balance and falls, J. Clin. Rheumatol. source

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

    Premisecitation

    Patients with fibromyalgia syndrome identify balance issues as one of the ten most debilitating symptoms of the disease, with a reported prevalence of 45%.

    “Patients with FMS identify balance issues as one of the ten most debilitating symptoms of this disease; with a reported prevalence of 45% [6].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [6] Bennett, R.M., Jones, J., Turk, D.C., Russell, I.J., and Matallana, L. (2007). An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet. Disord., 8. source

      The Results, under “Symptoms and functionality” (page unavailable), list balance problems among the most common symptoms reported by survey respondents. The passage does not rank them among the ten most debilitating symptoms or give a 45% prevalence for balance problems; its separate 45% figure refers to respondents reporting no difficulty walking two blocks. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Falls prevention requires multiple rapid automatic corrections coordinated by the central nervous system, a process that appears to be affected in fibromyalgia.

    “Falls prevention requires multiple rapid automatic corrections coordinated by the central nervous system; a process that appears to be affected in fibromyalgia [8].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [8] Jones, 2011, Postural control deficits in people with fibromyalgia: A pilot study, Arthritis Res. Ther. source

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

    Premisecitation

    Some studies have found an association between disability and worse scores on balance assessments in patients with fibromyalgia syndrome.

    “Some studies have found an association between disability and worse scores on different balance assessments in patients with FMS [4,5,8].”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [4] Muto, 2015, Postural control and balance self-efficacy in women with fibromyalgia: Are there differences?, Eur. J. Phys. Rehabil. Med.

      Not checked in the free run.

    • cites [5] Trevisan, 2017, Static postural sway of women with and without fibromyalgia syndrome: A cross-sectional study, Clin. Biomech. source
    • cites [8] Jones, 2011, Postural control deficits in people with fibromyalgia: A pilot study, Arthritis Res. Ther. source

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

    Premisecitation

    Patients with fibromyalgia show poor balance and use different strategies to maintain an upright posture which could be associated with disorders of the vestibular system.

    “According to Pérez-de-Heredia-Torres et al. [35] patients with fibromyalgia show poor balance and use different strategies to maintain an upright posture which could be associated with disorders of the vestibular system.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [35] 2017, Balance deficiencies in women with fibromyalgia assessed using computerised dynamic posturography: A cross-sectional study in Spain, BMJ Open source

      The Conclusions state that women with fibromyalgia have poor balance, use different strategies to maintain upright posture, and may have vestibular-system disturbances. The claim extends this finding to patients generally, although the study included only women. The Discussion also notes that vestibular function was not directly evaluated. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

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

    Premisecitation

    Postural stability is a predictor of the severity of fibromyalgia as measured with the FIQ.

    “In a study by Jones et al. [3], postural stability was a predictor of the severity of fibromyalgia as measured with the FIQ”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [3] Jones, 2009, Fibromyalgia is associated with impaired balance and falls, J. Clin. Rheumatol. source

      The Results report that the BESTest balance score correlated with FIQ severity (r = −.48, p<.05), and the Methods identify the FIQ as the measure of fibromyalgia severity. The paper reports an association, not an analysis establishing postural stability as a predictor of severity. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The highest percentages of vestibular symptom response were obtained in the static balance test, the sensitized Romberg test, and the one-leg standing time tests, with values around 50% with open eyes and 90% with closed eyes.

    “The highest percentages of vestibular symptom response were obtained in the static balance test, the sensitized Romberg test and in the one-leg standing time tests; with values around 50% when the test was performed with open eyes and 90% when performed with closed eyes (Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The FIQ mean total score in the sample was 68.69 (SD 13.97), indicating a moderately severe impact on quality of life.

    “The impact of fibromyalgia as measured with the FIQ questionnaire and had a mean total score of 68.69 (SD = 13.97); a moderately severe impact on quality of life.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Days with instability, central sensitization, catastrophism, kinesiophobia, and severity of perceived vertigo were significantly associated with balance confidence (ABC).

    “These same variables were those that were significantly associated with balance confidence (ABC).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Stabilometric measurements related to center of pressure displacements showed particularly high values during recordings with open eyes and even more so with closed eyes.

    “The stabilometric measurements related with CoP displacements showed values particularly high during the recordings made with open eyes (OE) and even more so, as expected, with closed eyes (CE).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    No single mechanism exists that could explain altered postural instability in patients with fibromyalgia syndrome, but it could be explained by vestibular, somatosensory, or postural reflex disturbances.

    “No single mechanism exists that could explain the altered postural instability in patients with FMS, but it could be explained by vestibular, somatosensory, or postural reflex disturbances [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Akkaya, 2013, Assessment of the relationship between postural stability and sleep quality in patients with fibromyalgia, Clin. Rheumatol. source

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

    Study design and conductnone given

    The research protocol was approved by the Ethics committee of the University of Jaen and was designed and conducted in accordance with the Declaration of Helsinki.

    “The research protocol was approved by the Ethics committee of the University of Jaen and was designed and conducted in accordance with the Ethics code of the World Medical Association for studies including human participants (Declaration of Helsinki).”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The RMSX stabilometric parameter is increased in patients at risk of falls.

    “In this sense, RMSX stabilometric parameter has been found increased in patients at risk of falls [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Mendoza, 2013, Predictive value of stabilometry and fear of falling on falls in postmenopausal women, Climacteric source

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

    Study design and conductcitation

    The assumptions of the multiple linear regression model were checked, with special attention to multicollinearity, verified when condition indices were greater than 10.

    “The assumptions of the model were checked paying special attention to the possible presence of multi-collinearity, which was verified when the condition indices were greater than 10 [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Yu, 2015, Multicollinearity in hierarchical linear models, Soc. Sci. Res. source

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

    Study design and conductnone given

    The small sample size may have resulted in less statistical significance for some variables.

    “Second, the small sample size, may have resulted in obtaining of data with less statistical significance for some variables of our study.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    All participants provided written informed consent.

    “All participants were provided with written informed consent to obtain voluntary agreement to participate in the study.”
    Quote in the paperNot a substantial claim
17 of 17

  • The paper relies on this without support.

    ABC scores lower than 67% are sensitive and specific for predicting falls and reduced independence.

    “Values lower than 67% have been shown to be both sensitive and specific for the prediction of falls, as well as for the considerable reduction in independence.”

  • The paper relies on this without support.

    Disability due to dizziness and vertigo is susceptible to intervention.

    “The detection of factors susceptible to intervention, such as disability due to dizziness and vertigo, takes on special relevance in patients with FMS”

  • The paper relies on this without support.

    No consensus exists on the predictive factors for falls in fibromyalgia syndrome.

    “No consensus exists on the predictive factors for falls, nevertheless, various studies have observed that the perception of postural instability and the deficit in the balance system performance could be considered as predictive factors [9,12,13].”

  • The paper relies on this without support.

    The uncertainty of balance tests has hampered finding a characteristic dysfunctional pattern for fibromyalgia syndrome.

    “The uncertainty of balance tests has hampered the finding of a characteristic dysfunctional pattern for this pathology.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Different mean and standard deviation reported for FIQ

    Minor

    The Results report a mean FIQ score of 68.69 (SD 13.97), whereas the Discussion reports 68.508 (SD 15.83) for the study sample. Both the mean and standard deviation differ.

  • FIQ inclusion threshold differs at 50 points

    Minor

    The Methods specify an FIQ score equal to or greater than 50, which includes a score of exactly 50. The Discussion instead describes the inclusion criterion as FIQ > 50, which excludes that score.

  • Conflicting counts of participants meeting inclusion criteria

    Minor

    The abstract says 57 people fully met the inclusion criteria after re-evaluation, but the Methods say 70 met all criteria and 57 completed the study protocol.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Garmendia, 2000, Adaptación cultural de dos cuestionarios de medida de salud en pacientes con vértigo, Acta Otorrinolaringol. Esp., 51, 572

Cited by

Sorted by citations

Related

Authors
Peinado-Rubia, A., Osuna-Pérez, M. C., Rodríguez-Almagro, D., Zagalaz-Anula, N., López-Ruiz, M. C., & Lomas-Vega, R.
Affiliations
  • Asociación Española Contra el Cáncer (ES)
  • Department of Health Sciences, University of Jaén, 23071 Jaén, Spain
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2020-05-01
Volume
17
Issue
9
Pages
3160
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph17093160
PMC
PMC7246608
OpenAlex
W3023739978
Semantic Scholar
8b7828cc1a04b7ae46e96321e2de311bc9da1e3c
Cited by
38
References
36
Citations by year
2026: 4 · 2025: 7 · 2024: 8 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 2
FWCI
8.27
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Repositorio de Patentes de la Universidad de Almería (Universidad de Almería) (submittedVersion, cc-by-nc-nd)
Funders
European Regional Development Fund (1263880)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
Keywords
fibromyalgia, postural stability, balance confidence, dizziness, central sensitization, kinesiophobia, pain catastrophizing, verticality perception, vestibular function, falls, Fibromyalgia Impact Questionnaire, postural instability
MeSH terms
Accidental Falls, Postural Balance, Female, Fibromyalgia, Humans, Male, Middle Aged, Surveys and Questionnaires, Prevalence

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