title: A Systematic Review of the Efficacy of Creative Arts Therapies in the Treatment of Adults With PTSD Minimal clinically important difference on the Beck Depression Inventory - II according to the patient's perspective Eight months of physical training in warm water improves physical and mental health in women with fibromyalgia: a randomized controlled trial. Effects on musculoskeletal pain, work ability and sickness absence in a 1-year randomised controlled trial among cleaners A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial. Exergames for women with fibromyalgia: a randomised controlled trial to evaluate the effects on mobility skills, balance and fear of falling Cost-utility of an 8-month aquatic training for women with fibromyalgia: a randomized controlled trial Assessment of the effects of aquatic therapy on global symptomatology in patients with fibromyalgia syndrome: a randomized controlled trial. Effects of Exergames on Quality of Life, Pain, and Disease Effect in Women With Fibromyalgia: A Randomized Controlled Trial. Effectiveness of dance in patients with fibromyalgia: a randomized, single-blind, controlled study. Reliability of the PEDro scale for rating quality of randomized controlled trials. A randomized controlled trial of deep water running: clinical effectiveness of aquatic exercise to treat fibromyalgia. Efficacy of Biodanza for treating women with fibromyalgia. Zumba dancing can improve the pain and functional capacity in women with fibromyalgia.
abstract: Objective : There is a growing body of literature supporting the use of creative arts therapies ; however , the efficacy of creative arts therapies in the treatment of  posttraumatic stress disorder ( PTSD )  has not been systematic ally evaluated . The aim of this systematic review was to examine the efficacy of creative arts therapy including music therapy , art therapy , dance/movement therapy , and drama therapy , in the treatment of PTSD . Method : Ten data bases were search ed for peer- review ed literature published from inception to December 2016 . Studies were included in the review if they used a r and omized controlled trial ( RCT ) , a pseudo RCT , or a controlled study design ; tested the efficacy of one of the creative arts therapies described above ; and reported changes to PTSD diagnosis or symptomatology . Results : From an initial yield of 1,918 records , 1,653 records were screened on title and abstract and 125 were screened at full-text . Seven studies met the inclusion criteria for review , with four studies investigating art therapy , two studies investigating music therapy , and a final study investigating drama therapy . Individual studies were initially rated on a st and ardized quality and bias checklist , and then GRADE was used to rate the overall evidence for each intervention . The evidence for music therapy , art therapy , and drama therapy  was ranked as low to very low , with no studies found for dance/movement therapy . Generally , the quality of the trials was very poor . Future directions for this field of research are to improve the scientific quality of the research trials in this area Background The Beck Depression Inventory , 2nd edition ( BDI-II ) is widely used in research on depression . However , the minimal clinical ly important difference ( MCID ) is unknown . MCID can be estimated in several ways . Here we take a patient-centred approach , anchoring the change on the BDI-II to the patient 's global report of improvement . Method We used data collected ( n = 1039 ) from three r and omized controlled trials for the management of depression .  Improvement on a ‘ global rating of change ’ question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency , assessing whether MCID is best measured in absolute terms ( i.e. difference ) or as percent reduction in scores from baseline ( i.e. ratio ) , and receiver operator characteristics ( ROC ) to estimate MCID according to the optimal threshold above which individuals report feeling ‘ better ’ . Results Improvement in BDI-II scores associated with reporting feeling ‘ better ’ depended on initial depression severity , and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score . We estimated a MCID of a 17.5 % reduction in scores from baseline from ROC analyses . The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32 % . Conclusions MCID on the BDI-II is dependent on baseline severity , is best measured on a ratio scale , and the MCID for treatment-resistant depression is larger than that for more typical depression . This has important implication s for clinical trials and practice OBJECTIVE To evaluate the feasibility of 8 months of supervised exercise therapy in warm water and its effects on the impact of fibromyalgia on physical and mental health and physical fitness in affected women . METHODS Thirty women with fibromyalgia were r and omly assigned to an exercise therapy group ( n = 15 ) or a control group ( inactive ) ( n = 15 ) . The impact of fibromyalgia on physical and mental health was assessed using the Fibromyalgia Impact Question naire and the anxiety state with State-Trait Anxiety Inventory . Physical fitness was measured using the following tests : Canadian Aerobic Fitness ; h and -grip dynamometry ; 10-metre walking ; 10-step stair-climbing and blind 1-leg stance . RESULTS After 8 months of training , the exercise therapy group improved compared with the control group in terms of physical function ( 20 % ) , pain ( 8 % ) , stiffness ( 53 % ) , anxiety ( 41 % ) , depression ( 27 % ) , Fibromyalgia Impact Question naire total scores ( 18 % ) , State-Trait Anxiety Inventory score ( 22 % ) , aerobic capacity ( 22 % ) , balance ( 30 % ) , functional capacity for walking ( 6 % ) , stair-climbing with no extra weight ( 14 % ) and stair-climbing 10 kg-weighted ( 25 % ) . CONCLUSION Eight months of supervised exercise in warm water was feasible and led to long-term improvements in physical and mental health in patients with fibromyalgia at a similar magnitude to those of shorter therapy programmes Background Only a few workplace initiatives among cleaners have been reported , even though they constitute a job group in great need of health promotion . The purpose of this trial was to evaluate the effect of either physical coordination training or cognitive behavioural training on musculoskeletal pain , work ability and sickness absence among cleaners . Methods A cluster-r and omised controlled trial was conducted among 294 female cleaners allocated to either physical coordination training ( PCT ) , cognitive behavioural training ( CBTr ) or a reference group ( REF ) .  Question naires about musculoskeletal pain and work ability were completed at baseline and after one year 's intervention . Sickness absence data were obtained from the managers ' records . Analyses were performed according to the intention-to-treat-principle ( ITT ) . Results No overall reduction in musculoskeletal pain , work ability or sickness absence from either PCT or CBTr compared with REF was found in conservative ITT analyses . However , explorative analyses revealed a treatment effect for musculoskeletal pain of the PCT . People with chronic neck/shoulder pain at baseline were more frequently non-chronic at follow-up after PCT compared with REF ( p = 0.05 ) . Conclusions The PCT intervention appeared effective for reducing chronic neck/shoulder pain among the female cleaners . It is recommended that future interventions among similar high-risk job groups focus on the implementation aspects of the interventions to maximise outcomes more distal from the intervention such as work ability and sickness absence . Trial registration IS RCT N : IS RCT Fibromyalgia is characterized by chronic and extended musculoskeletal pain . The combination of exercise therapy with the warm water may be an appropriate treatment . However , studies focusing on the analysis of immediate pain during and after an exercise session are rare . This study aim ed to determine the immediate changes of a warm water pool-based exercise program ( 12 weeks ) on pain ( before vs. after session ) in female fibromyalgia patients . 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks ( 2 sessions/week ) low-moderate intensity warm water pool-based program . We assessed pain by means of a Visual Analogue Scale before and after each single session ( i. e. , 24 sessions ) . We observed immediate benefits on pain with a mean decrease ~15 % in all sessions , except in the fourth one . There was an association of pain difference ( pre-post ) session with pain pre session ( p=0.005 ; β=0.097±0.034 ) and with age ( p<0.001 ; β=0.032±0.008 ) . There were no significant accumulative differences on pain , pre session , post session , and pre-post changes ( all p>0.05 ) . Therefore this study showed that a warm water pool-based exercise program for 12 weeks ( 2 times/week ) led to a positive immediate decrease in level of pain in female patients with fibromyalgia . Improvements were higher in older women and in those with more intense pain Background Exergames are a new form of rehabilitation that combine the characteristics of physical exercise and the benefits of non-immersive virtual reality ( VR ) . Effects of this novel therapy in women fibromyalgia are still unknown . The objective was to evaluate the effects of exergame-based intervention on mobility skills , balance and fear of falling in women with fibromyalgia . Methods This study was a r and omized controlled trial with concealed allocation . Seventy-six women with fibromyalgia were divided into two groups : the exercise group received an eight week intervention based on exergames , while the control group continued their usual activities . Mobility skills  were evaluated using the timed up and go test , while balance was assessed using the functional reach test , and the CTSIB protocol .  Fear of falling was evaluated on a scale of 0–100 ( 0 , no fear ; 100 , extreme fear ) . Measurements were performed before and after the intervention . A repeated- measures linear mixed model was used to compare the effects of the intervention between the two groups . Results The exercise group was significantly quicker than the control group in the timed up and go test ( MD , −0.71 ; 95 % CI [ −1.09–0.32 ] ; p < 0.001 ) . There were also significant improvements in functional reach and a reduced fear of falling ( MD , 4.34 ; 95 % CI [ 1.39–7.30 ] ; p = 0.005 and MD , −9.85 ; 95 % CI [ −0.19–−0.08 ] ; p = 0.048 , respectively ) . Discussion The improved TUG observed herein was better than the smallest real difference . Based on the results on mobility skills , balance and fear of falling , exergames may be an effective tool as a therapy for women with fibromyalgia Introduction Physical therapy in warm water has been effective and highly recommended for persons with fibromyalgia , but its efficiency remains largely unknown . Should patients or health care managers invest in this therapy ? The aim of the current study was to assess the cost-utility of adding an aquatic exercise programme to the usual care of women with fibromyalgia . Methods Costs to the health care system and to society were considered in this study that included 33 participants , r and omly assigned to the experimental group ( n = 17 ) or a control group ( n = 16 ) . The intervention in the experimental group consisted of a 1-h , supervised , water-based exercise sessions , three times per week for 8 months . The main outcome measures were the health care costs and the number of quality -adjusted life-years ( QALYs ) using the time trade-off elicitation technique from the EuroQol EQ-5D instrument . Sensitivity analyses were performed for variations in staff salary , number of women attending sessions and time spent going to the pool . The cost effectiveness acceptability curves were created using a non-parametric bootstrap technique . Results The mean incremental treatment costs exceeded those for usual care per patient by € 517 for health care costs and € 1,032 for societal costs . The mean incremental QALY associated with the intervention was 0.131 ( 95 % CI : 0.011 to 0.290 ) . Each QALY gained in association with the exercise programme cost an additional € 3,947/QALY ( 95 % CI : 1,782 to 47,000 ) for a health care perspective and € 7,878/QALY ( 3,559 to 93,818 ) from a societal perspective . The curves showed a 95 % probability that the addition of the water-based programme is a cost-effective strategy if the ceiling of inversion is € 14,200/QALY from a health care perspective and € 28,300/QALY from a societal perspective . Conclusion The addition of an aquatic exercise programme to the usual care regime for fibromyalgia in women  is cost effective in terms of both health care costs and societal costs . However , the characteristics of facilities ( distance from the patients ' homes and number of patients that can be accommo date d per session ) are major determinants to consider before investing in such a programme . Trial registration Current controlled trials IS RCT N53367487 OBJECTIVES To evaluate the effects of a 16-week exercise therapy in a chest-high pool of warm water through applicable tests in the clinical practice on the global symptomatology of women with fibromyalgia ( FM ) and to determine exercise adherence levels . DESIGN A r and omized controlled trial . SETTING Testing and training were completed at the university . PARTICIPANTS Middle-aged women with FM ( n=60 ) and healthy women ( n=25 ) . INTERVENTION A 16-week aquatic training program , including strength training , aerobic training , and relaxation exercises . MAIN OUTCOME MEASURES Tender point count ( syringe calibrated ) , health status ( Fibromyalgia Impact Question naire ) ; sleep quality ( Pittsburgh Sleep Quality Index ) ; physical ( endurance strength to low loads tests ) , psychologic ( State Anxiety Inventory ) , and cognitive function ( Paced Auditory Serial Addition Task ) ; and adherence 12 months after the completion of the study . RESULTS For all the measurements , the patients showed significant deficiencies compared with the healthy subjects . Efficacy analysis ( n=29 ) and intent-to-treat analysis ( n=34 ) of the exercise therapy was effective in decreasing the tender point count and improving sleep quality , cognitive function , and physical function . Anxiety remained unchanged during the follow-up . The exercise group had a significant improvement of health status , not associated exclusively with the exercise intervention . There were no changes in the control group . Twenty-three patients in the exercise group were exercising regularly 12 months after completing the program . CONCLUSIONS An exercise therapy 3 times a week for 16 weeks in a warm pool could improve most of the symptoms of FM and cause a high adherence to exercise in unfit women with heightened FM symptomatology . The therapeutic intervention 's effects can be assessed through applicable tests in the clinical practice OBJECTIVE To evaluate the effects of an exergame-based intervention on a population sample of women with fibromyalgia . DESIGN Single-blinded , r and omized controlled trial with 8-week intervention . SETTING Fibromyalgia center . PARTICIPANTS Participants ( all women ) ( N=83 ) were divided into 2 groups : an  exercise group  ( n=42 ; mean age ± SD , 52.52±9.73y ) and a nonexercise group ( n=41 ; mean age ± SD , 52.47±8.75y ) . INTERVENTIONS Women in the exercise group completed an 8-week exergame-based training program , which was focused on postural control and coordination of the upper and lower limbs , aerobic conditioning , strength , and mobility . Women ( groups of 3 ) were encouraged to exercise for 120 minutes ( over 2 sessions ) per week . MAIN OUTCOME MEASURES Main outcome measures included pain and disease effect , which were assessed with the Fibromyalgia Impact Question naire ( FIQ ) , a specific measure for fibromyalgia . Secondary outcome measure included quality of life , which was assessed with the EuroQoL-5 Dimensions-5 Levels ( EQ-5D-5L ) generic instrument . RESULTS The results showed that 97.62 % of participants in the exercise group completed the 8-week intervention . The exercise group showed a significant improvement ( P<.05 ) in the EQ-5D-5L utility index , and in 3 of 5 dimensions . For the FIQ , significant improvements were observed in the dimensions of pain , stiffness , anxiety , and feel good . The FIQ score was also reduced . The mean between-group improvement was 8.25 ( 95 % confidence interval , 2.85 - 13.65 ) . CONCLUSIONS The results and levels of compliance/adherence suggest this exergame-based training program is an effective intervention for reducing pain and increasing health-related quality of life in women with fibromyalgia OBJECTIVES The aim of the present study was to assess the effectiveness of belly dance as a treatment option for patients with fibromyalgia . METHODS Eighty female patients with fibromyalgia between 18 to 65 years were r and omly allocated to a dance group ( n=40 ) and control group ( n=40 ) . Patients in the dance group underwent 16 weeks of belly dance twice a week , while the patients in the control group remained on a waiting list . The patients were evaluated with regard to pain ( VAS ) , function ( 6MWT ) , quality of life ( FIQ and SF-36 ) , depression ( Beck Inventory ) , anxiety ( STAI ) and self-image ( BDDE ) . Evaluations were carried out at baseline , 16 weeks and 32 weeks by a blinded assessor . RESULTS The dance group achieved significant improvements in VAS for pain ( p<0.001 ) , six-minute walk test ( p<0.001 ) , FIQ ( p=0.003 ) , BDDE ( p<0.009 ) as well as the pain ( p<0.001 ) , emotional aspects ( p<0.003 ) and mental health ( p<0.021 ) subscales on the SF-36 . CONCLUSIONS Belly dance can be used in the treatment of fibromyalgia to reduce pain and improve functional capacity , quality of life and self-image BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVE To compare the clinical effectiveness of aerobic exercise in the water with walking/jogging for women with fibromyalgia ( FM ) . METHODS Sixty sedentary women with FM , ages 18 - 60 years , were r and omly assigned to either deep water running ( DWR ) or l and -based exercises ( LBE ) . Patients were trained for 15 weeks at their anaerobic threshold .  Visual analog scale of pain , Fibromyalgia Impact Question naire ( FIQ ) , Beck Depression Inventory , Short Form 36 Health Survey ( SF-36 ) , and a patient 's global assessment of response to therapy ( PGART ) were measured at baseline , week 8 , and week 15 . Statistical analysis included all patients . RESULTS Four patients dropped out from each group . Both groups improved significantly at week 15 compared with baseline , with an average 36 % reduction in pain intensity . For PGART , 40 % of the DWR group and 30 % of the LBE group answered " much better " at posttreatment . FIQ total score and FIQ depression improvements in the DWR group were faster ( week 8) than the LBE group and kept improving ( week 15 ; P < 0.05 ) . Only the DWR group showed improvements in SF-36 role emotional ( P = 0.006 ) . No significant between-group differences were observed for peak oxygen uptake and other outcomes . CONCLUSION DWR is a safe exercise that has been shown to be as effective as LBE regarding pain . However , it has been shown to bring more advantages related to emotional aspects . Aerobic gain was similar for both groups , regardless of symptom improvement . Therefore , DWR could be studied as an exercise option for patients with FM who have problems adapting to LBE or lower limbs limitations OBJECTIVE The objective of this study was to determine the effects of a 3-month Biodanza intervention in women with fibromyalgia ( FM ) . DESIGN This was a controlled trial . SETTING /LOCATION The study was conducted at a university research laboratory and social center . SUBJECTS The study comprised 59 women with FM recruited from a local association of patients with FM . Participants were allocated to the Biodanza intervention group ( n = 27 ) or usual-care group ( n = 32 ) . INTERVENTION The Biodanza intervention was carried out once a week for 3 months . OUTCOME MEASURES The outcome measures included the following : Pain threshold , body composition ( body-mass index and estimated body fat percentage ) , physical fitness ( 30-second chair st and , h and grip strength , chair sit and reach , back scratch , blind flamingo , 8 feet up and go , and 6-minute walk test ) and psychologic outcomes ( Fibromyalgia Impact Question naire [ FIQ ] , Short-Form Health Survey 36 , V and erbilt Pain Management Inventory , Hospital Anxiety and Depression Scale , General Self-Efficacy Scale , and Rosenberg Self-Esteem Scale ) . RESULTS We observed a significant interaction effect ( group*time ) for pain threshold of several tender points ( left [ L ] and right [ R ] side of the anterior cervical and supraspinatus , trapezius L and lateral epicondyle R , algometer score , tender points count ) , body fat percentage , and FIQ total score . In the intervention group , post hoc analysis revealed a significant improvement in pain threshold of the anterior cervical R and L and supraspinatus R and L tender points ( all p < 0.05 ) , algometer score ( p = 0.008 ) , tender point count ( p = 0.002 ) , body fat percentage ( p = 0.001 ) , and FIQ total score ( p = 0.003 ) . CONCLUSIONS A 3-month ( one session per week ) Biodanza intervention shows improvements on pain , body composition , and FM impact in female patients INTRODUCTION The importance of physical exercise for patients with fibromyalgia ( FM ) is very clear in the literature . Dancing is a type of aerobic exercise that has great acceptance . In addition to the beneficial effects of aerobic exercise , Zumba works on motor coordination and also has socializing as a part that should be included in patients with fibromyalgia . OBJECTIVES To evaluate the effectiveness of Zumba dancing in improving pain , functional capacity , quality of sleep and quality of life of women with fibromyalgia . DESIGN A pre-post treatment design . METHODS We evaluated 19 women with fibromyalgia , selected by convenience . Data were collected in the second half of 2016 . Zumba dancing was performed twice a week for 12 weeks . Patients were evaluated at week 0 ( T0 ) and at week 12 ( T12 ) , by the following instruments : VAS ( Visual Analogic Scale ) , Likert Scale , TUG ( Timed Up an Go Test ) , 6MWT ( Six-minute Walk Test ) , FIQ ( Fibromyalgia Impact Question naire ) , PSQI ( Pittsburgh Sleep Quality Index ) , ESS ( Epworth Sleepiness Scale ) and SF-36 quality of life . RESULTS We found differences in pain ( VAST0 = 6.21 and VAST12 = 4.53 ) with p = 0.001 and in the domain physical functioning of SF36 ( T0 = 42.37 and T12 = 52.11 ) with p = 0.04 . No differences were found for the other variables between the times . CONCLUSION Zumba dancing as a form of treatment for three months for patients with fibromyalgia was effective in improving pain and physical functioning . Future controlled and r and omized clinical trials should be performed to improve the evidence of Zumba dancing in women with fibromyalgia
target: In addition , significant improvements were observed in quality of life , depression , impact of the disease , anxiety , and physical function .
  Conclusion Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia , leading to a significant reduction of the level of pain with an effect size that can be considered as large .
background: Objective The aim of this study was to perform a systematic review on the effectiveness of dance-based programs in patients with fibromyalgia , as well as calculate the overall effect size of the improvements , through a meta- analysis .