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Abstract

Introduction: To date, the Foot Health Status Questionnaire (FHSQ) has not been applied to women who suffer from fibromyalgia. The main purpose of this study was to compare both foot and general health-related quality of life between women with fibromyalgia and healthy matched women. We hypothesized that women with fibromyalgia may present an impaired quality of life related to foot and general health. Material and methods: A sample of 208 women, mean age of 55.00 ±8.25 years, was recruited from an outpatient clinic and divided into 2 groups, 104 women with fibromyalgia (for the case group) and 104 healthy matched women (for the control group). Demographic data and the domains of the FHSQ scores were registered. Results: Statistically significant differences (p < 0.001) between case and control groups were found for both all specific foot domains (pain, foot function, foot health and footwear) and all general wellbeing domains (general health, physical activity, social capacity and vigor), showing a worse foot and general health-related quality of life (with lower scores for all FHSQ domains) in the women with fibromyalgia compared to healthy matched women. Conclusions: Impaired foot and general health-related quality of life was observed in women who suffered from fibromyalgia compared to healthy matched women.
Clinical research
Rheumatology
Corresponding author:
César Calvo Lobo PhD
Nursing and
Physiotherapy
Department
Institute of Biomedicine
(IBIOMED)
Faculty of
Health Sciences
Universidad de León
Av. Astorga
24401 Ponferrada
León, Spain
Phone: +34 987442053
E-mail: cecalvo19@hotmail.com
1
University Center of Plasencia, Universidad de Extremadura, Spain
2 Nursing and Physiotherapy Department, Institute of Biomedicine (IBIOMED),
Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain
3 Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid,
Madrid, Spain
4 Faculty of Health Sciences, Universidad Rey Juan Carlos, Madrid, Spain
5 Universidad Europea, Faculty of Sport, Madrid, Spain
6 Research, Health and Podiatry Unit, Department of Health Sciences,
Faculty of Nursing and Podiatry, Universidade da Coruna, Coruna, Spain
Submitted: 2 June 2018
Accepted: 26 June 2018
Arch Med Sci 2019; 15 (3): 694–699
DOI: https://doi.org/10.5114/aoms.2018.77057
Copyright © 2018 Termedia & Banach
Quality of life related to foot health status in women
with fibromyalgia: a case-control study
Patricia Palomo-López1, César Calvo-Lobo2, Ricardo Becerro-de-Bengoa-Vallejo3,
Marta Elena Losa-Iglesias4, David Rodriguez-Sanz3,5, Rubén Sánchez-Gómez3, Daniel López-López6
Abstract
Introduction: To date, the Foot Health Status Questionnaire (FHSQ) has not
been applied to women who suffer from fibromyalgia. The main purpose of
this study was to compare both foot and general health-related quality of
life between women with fibromyalgia and healthy matched women. We hy-
pothesized that women with fibromyalgia may present an impaired quality
of life related to foot and general health.
Material and methods: Asample of 208 women, mean age of 55.00 ±8.25
years, was recruited from an outpatient clinic and divided into 2 groups,
104 women with fibromyalgia (for the case group) and 104 healthy matched
women (for the control group). Demographic data and the domains of the
FHSQ scores were registered.
Results: Statistically significant differences (p < 0.001) between case and
control groups were found for both all specific foot domains (pain, foot func-
tion, foot health and footwear) and all general wellbeing domains (general
health, physical activity, social capacity and vigor), showing aworse foot
and general health-related quality of life (with lower scores for all FHSQ
domains) in the women with fibromyalgia compared to healthy matched
women.
Conclusions: Impaired foot and general health-related quality of life was
observed in women who suffered from fibromyalgia compared to healthy
matched women.
Key words: fibromyalgia, foot, foot injuries, musculoskeletal pain, quality
of life.
Introduction
Fibromyalgia may be considered as the most frequent central sensi-
tization syndrome, with ahigher prevalence in women who suffer from
chronic widespread pain and other symptoms that lead to considerable
functional impairment [1]. Its prevalence may reach up to 2.10% of the
worldwide population, 2.31% of the European population, and 2.40% of
Quality of life related to foot health status in women with fibromyalgia: a case-control study
Arch Med Sci 3, May / 2019 695
the Spanish population. This painful syndrome
may cause quality of life impairment in women
who suffer it. In Spain, enormous economic costs
were reported and reached up to 12,993 million
euros per year [2].
Women were more likely to suffer from fibro-
myalgia, showing a younger age than patients
diagnosed with other pain conditions and higher
presence of several psychiatric comorbidities com-
bined with other types of pain, such as headaches
and connective tissue diseases. Consequently,
women with fibromyalgia seemed to show ahigh-
er demand of medical outpatient services use [3].
Regarding health-related quality of life ques-
tionnaires applied to women who suffered from
fibromyalgia, general quality of life tools, such as
the EuroQoL 5-Dimensions 5-Levels (EQ-5D-5L) [4],
15-Dimensions (15D) [5], Assessment of Quality
of Life 8-Dimensions (AQoL-8D) [6], Short Form
Health Survey 12-item (SF-12) [7] and 36-item
(SF-36) [8], and specific condition tools, such as the
Fibromyalgia Impact Questionnaire (FIQR) [9], were
used with adequate correlations between these
questionnaires in this kind of population [10].
Although women with fibromyalgia did not
seem to show ahigher prevalence of stiffness or
mobility abnormalities as well as hyperkeratosis
or other foot problems, these patients may ex-
perience significantly more pain in the foot than
healthy subjects and, consequently, demand more
pain-killing drugs [11]. Based on these anteced-
ents, foot health-related quality of life measure-
ments may be necessary in order to determine the
impact of fibromyalgia in women who suffer from
this syndrome. For this purpose, the Foot Health
Status Questionnaire (FHSQ) may be considered
a foot and general health-related quality of life
tool with specific foot domains (pain, foot func-
tion, foot health and footwear) and general well-
being domains (general health, physical activity,
social capacity and vigor) [12, 13].
To date, the FHSQ has not been applied to wom-
en who suffer from fibromyalgia [12, 13]. Thus,
the main purpose of this study was to compare
both foot and general health-related quality of life
between women with fibromyalgia and healthy
matched women. We hypothesized that women
with fibromyalgia may present an impaired quali-
ty of life related to foot and general health.
Material and methods
Study design
An observational case-control study was per-
formed following the Strengthening the Report-
ing of Observational Studies in Epidemiology
(STROBE) criteria [14]. From March to May 2018,
asample of 208 women was recruited by acon-
secutive sampling method from auniversity po-
diatric medicine and surgery unit which provided
interventions for foot problems at the University
of Extremadura (Plasencia, Spain).
Sample size calculation
The sample size was calculated by means of
the difference between two independent groups
using the G*Power 3.1.9.2 software [15] and the
foot pain domain score (mean ± SD) from the
FHSQ [12, 13] of aprior pilot study (n = 30) with
two groups. Acase group of 15 patients with fibro-
myalgia (FHSQ score for foot pain domain of 38.58
±24.35) and ahealthy matched control group of
15 subjects (FHSQ scores for foot pain domain
score = 56.26 ±29.23) were used for the data anal-
ysis. Furthermore, a2-tailed hypothesis, an effect
size of 0.65, an α error probability of 0.01, apow-
er (1 – β error probability) of 0.95, and an alloca-
tion ratio (N2/N1) of 1 were used in order to carry
out the sample size calculation. Therefore, atotal
sample size of 170 participants, with 85 subjects
per each group, was determined. Considering
20% of possible subjects lost to follow-up, 204 sub-
jects would be necessary. Finally, 208 participants,
104 cases with fibromyalgia and 104 healthy
matched controls, were included in the study.
Patients
A sample of 208 women, mean age of 55.00
±8.25 years, was recruited from an outpatient
clinic and divided into 2 groups, 104 women with
fibromyalgia (for the case group) and 104 healthy
matched women (for the control group).
For the control group, women older than 18
years old were included in the healthy-matched
control group if they reported no spontaneous or
chronic pain (at least during the prior 3 months)
and no pain-related conditions and were not tak-
ing antidepressant or analgesic medications [16].
For the case group, women older than 18
years old diagnosed with fibromyalgia according
to a validated experienced rheumatologist diag-
nosis, based on acombination of both 1990 and
modified 2010 criteria, were included [16–20].
Tender points were positively screened if patients
experienced pain under a4 kg pressure by means
of digital palpation located at the 18 points pro-
posed by the American College of Rheumatology
[17]. In addition, the presence of fatigue, sleep dis-
orders and other self-reported symptoms by the
patient was considered [18].
Exclusion criteria considered for both groups
were women older than 18 years old, prior exis-
tence of other types of rheumatic diseases differ-
ent from fibromyalgia, neurological alterations,
other systemic, neoplastic or inflammatory condi-
P. Palomo-López, C. Calvo-Lobo, R. Becerro-de-Bengoa-Vallejo, M.E. Losa-Iglesias, D. Rodriguez-Sanz, R. Sánchez-Gómez, D. López-López
696 Arch Med Sci 3, May / 2019
tions, diagnosis of psychiatric illnesses (e.g. schizo-
phrenia), non-controlled endocrine conditions
(e.g. hyperthyroidism, hypothyroidism or diabetes),
pregnancy, non- or semi-independence in daily life
activities, and difficulties understanding the in-
structions for completing the research course [16].
Outcome measurements
Demographic data such as age, height, weight,
and body mass index (BMI) were collected before
self-reporting the questionnaire. The Spanish vali-
dated self-FHSQ (1.03 Version) was composed of
3 sections. Section one was composed of 13 ques-
tions and divided into 4 specific domains regard-
ing foot health-related quality of life: foot function
(four questions), foot pain (four questions), foot-
wear (three questions), and general foot health
(two questions). Adequate content, criterion, and
construct validity (Cronbach α from 0.89 to 0.95)
and test-retest intraclass correlation coefficient re-
liability (ICC from 0.74 to 0.92) were reported for
section one. Section two was composed of 4 over-
all health-related quality of life domains (physical
activity, general health, social capacity and vigor),
whose questions were largely adapted from the
SF-36 [21]. Finally, section three included descrip-
tive data such as socioeconomic status, comorbidi-
ties, satisfaction or medical record data. Each ques-
tion showed several responses by means of aLikert
ordinal scale, including only 1 response as the most
correct. This tool generated different scores for each
domain obtained by means of computer software,
whose scores varied from 0 to 100. Considering the
health-related quality of life, ascore of 0 indicat-
ed the worst health status while 100 indicated the
best health status [12, 13, 22, 23].
Ethics considerations
The Bioethics and Biosafety Committee of the
Extremadura University (Spain) approved this
study (approval code: 24/2018). All voluntary
women signed the informed consent forms before
beginning this study. Ethical standards concerning
research on human beings according to the Hel-
sinki Declaration (World Medical Association) and
the Council of Europe Convention about human
rights and biomedicine, and those standards of
the UNESCO Universal Declaration about the Hu-
man Genome and Human Rights, as well as other
national or institutional rules, were respected [24].
Statistical analysis
The FHSQ (v1.03) was used to obtain the foot
and general health related quality of life scores.
In all analyses, statistically significant differences
with aP-value < .01 and aconfidence interval (CI)
of 99% were considered. Furthermore, all analyses
were performed by means of the SPSS 22.0 soft-
ware (Chicago, IL, USA).
First, the Kolmogorov-Smirnov test was used to
assess normality, and a normal distribution was
considered with p-value > 0.01. Demographic data
and FHSQ domains were non-parametric data. Thus,
median and interquartile range (IR) as well as maxi-
mum and minimum (range) values were used to de-
scribe the total sample, women with fibromyalgia
(case group), and healthy matched women (control
group). The Mann-Whitney Utest was applied to as-
sess differences between case and control groups.
Results
Demographic data
Atotal sample of 208 women between 26 and
83 years old with amedian ± IR of 55.00 ±8.25 years
completed the study. The sample was divided into
2 groups, 104 women with fibromyalgia (for the
case group) and 104 healthy matched women (for
the control group). Regarding Table I, demographic
characteristics did not show any statistically signifi-
cant difference (p > 0.01) between the groups.
FHSQ domains
As shown in Table II, statistically significant
differences (p < 0.001) between case and control
groups were found for all specific foot domains
(foot pain, foot function, foot health and footwear)
and general wellbeing domains (general health,
physical activity, social capacity and vigor), showing
aworse foot and general quality of life (with lower
scores of all FHSQ domains) in the women with fi-
bromyalgia compared to healthy matched women.
Discussion
To the authors’ knowledge, the present study
may be considered as the first research applying
the FHSQ [12, 13, 22, 23] which demonstrates
specific impairment of the foot health-related
quality of life. According to the health-related
quality of life questionnaires applied to women
who suffered from fibromyalgia – both general
quality of life questionnaires, such as the EQ-5D-
5L [4], 15D [5], AQoL-8D [6], SF-12 [7] and SF-36
[8], and specific disease questionnaires, such as
the FIQR [9] – our findings showed similar results
with an impaired general-health related quality of
life in women with fibromyalgia [10].
Although women who suffer fibromyalgia show
similar foot characteristics of stiffness or mobility
and hyperkeratosis or other conditions [11], our
study showed aworse foot health related quali-
ty of life compared to healthy women. This may
be due to the fact that these patients present
acentral sensitization process [1] as well as more
Quality of life related to foot health status in women with fibromyalgia: a case-control study
Arch Med Sci 3, May / 2019 697
foot pain and analgesic medication use than the
general population [11]. Prior FHSQ studies have
shown an impaired quality of life in some do-
mains of the specific foot and general health for
specific foot problems such as hallux valgus [25],
calcaneal apophysitis [26], foot arch height [27],
lesser toe deformities [28], plantar heel pain [29,
30], onychomycosis [31] or hyperkeratosis [32],
as well as general conditions such as Alzheimer
disease [33] and breast cancer [34]. Nevertheless,
our findings showed the most significant results
of health-related quality of life impairment for all
foot specific and general domains of the FHSQ
compared to these prior studies.
Implications for clinical practice
Although other studies have previously shown
general health-related quality of life differences
between women with fibromyalgia and healthy
controls [8–10], our study added specific foot
health-related quality of life domains such as foot
pain, foot function, foot health and footwear. For
the medical research field, the present study pro-
vides the quality of life differences related to over-
all health (general health = –29.04; physical activity
= –28.37; social capacity = –24.30; vigor = –22.96
points) and specific foot health (foot pain = –31.69;
foot function = –36.46; foot health = –20.95; foot-
wear = –19.53 points) in women with fibromyal-
gia compared to healthy matched women. Future
interventional studies, i.e. generic treatments such
as pregabalin [35] or specific interventions such as
foot trigger points dry needling [36, 37] and cus-
tom-made foot orthotics [38] in women with fibro-
myalgia, could use these clinical differences as key
references in order to normalize the specific foot
and general health-related quality of life. In line
with prior research [8], we highlight that health
authorities should pay more attention to improving
the general and foot specific health-related quality
of life in women with fibromyalgia.
Table I. Comparison of demographic characteristics of the total sample, women with fibromyalgia and healthy
matched women with normalized reference values
Parameter Total group
Median ± IR
n = 208
Fibromyalgia
Median ± IR
n = 104
Healthy controls
Median ± IR
n = 104
Mann-Whitney U
P-value
Age [years] 55.00 ±8.25 (26–83) 56.00 ±9.00 (26–83) 55.00 ±5.00 (45–82) 0.016
Weight [kg] 70.00 ±15.00 (43–120) 70.50 ±14.00 (50–90) 70.00 ±17.50 (43–120) 0.300
Height [m] 1.60 ±0.07 (1.45–1.79) 1.60 ±0.06 (1.45–1.75) 1.61 ±0.09 (1.50–1.79) 0.166
BMI [kg/m2]27.26 ±5.07 (18.59–43.51) 27.47 ±3.90 (18.59–37.46) 26.48 ±6.74 (18.75–43.51) 0.627
BMI – body mass index, IR – interquartile range. In all the analyses, p < 0.01 (with a99% confidence interval) was considered statistically
significant.
Table II. Comparison of FHSQ scores of the total sample, women with fibromyalgia and healthy matched women
with normalized reference values
Variable Total group
Median ± IR
n = 208
Fibromyalgia
Median ± IR
n = 104
Healthy controls
Median ± IR
n = 104
Mann-Whitney U
P-value
Foot pain 48.12 ±49.38
(0–100)
35.62 ±25.00
(0–90)
76.50 ±34.00
(0–100)
< 0.001
Foot function 59.37 ±57.00
(0–100)
37.50 ±37.50
(0–100)
88.00 ±31.00
(0–100)
< 0.001
Footwear 25.00 ±50.00
(0–100)
00.00 ±41.67
(0–100)
42.00 ±43.67
(0–100)
< 0.001
General foot health 25.00 ±47.50
(0–100)
25.00 ±25.50
(0–85)
43.00 ±35.00
(0–100)
< 0.001
General health 40.00 ±40.00
(0–100)
20.00 ±30.00
(0–90)
60.00 ±30.00
(0–100)
< 0.001
Physical activity 56.00 ±49.67
(0–100)
38.88 ±33.33
(0–100)
78.00 ±38.00
(11–100)
< 0.001
Social capacity 50.00 ±53.13
(0–100)
37.50 ±37.50
(0–100)
75.00 ±38.00
(0–100)
< 0.001
Vigor 37.50 ±31.25
(0–100)
25.00 ±31.25
(0–100)
44.00 ±32.00
(0–100)
< 0.001
FHSQ – Foot Health Status Questionnaire, IR – interquartile range. In all the analyses, p < 0.01 (with a99% confidence interval) was
considered statistically significant.
P. Palomo-López, C. Calvo-Lobo, R. Becerro-de-Bengoa-Vallejo, M.E. Losa-Iglesias, D. Rodriguez-Sanz, R. Sánchez-Gómez, D. López-López
698 Arch Med Sci 3, May / 2019
Some limitations should be considered regard-
ing the present study. First, the consecutive sam-
pling method may be the main limitation of this
research. Second, although adequate validity and
reliability have been shown for the FHSQ [12, 13,
22, 23], its reliability has not yet been established
specifically for women who suffer from fibromy-
algia and should be considered for future studies.
Finally, quality of life could be modified according
to socio-demographic factors such as the origin
of women with fibromyalgia from rural or urban
areas [39] as well as physical factors such as re-
duced bone mineral density [40].
In conclusion, an impaired foot and gener-
al health-related quality of life was observed in
women who suffered from fibromyalgia compared
to healthy matched women.
Conflict of interest
The authors declare no conflict of interest.
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... A hypothesis highlighted among articles included in this review [49] reported an association between nociceptive sensitization and cognitive performance impairments in FM. This assumption revealed that the hyperalgesia characterizing the disorder is congruent with the central pain sensitization hypothesis of FM [91][92][93]. Exaggerated pain processing in FM implies increased demands on central-nervous resources, reducing those available for cognition [49,94]. In another study [54] in which no significant differences in neuropsychological functions were found compared to healthy subjects, it was hypothesized that an influence of dysregulated attention modulation or other dysfunction of the reward/aversion circuit is plausible to explain DM difficulties. ...
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Decision making (DM) is the ability to choose among multiple options, considering external and internal variables and identifying potential paths of action that need to be assessed. Some brain areas involved in decision making are also implicated in pain processing, such as in fibromyalgia (FM). FM is a syndrome characterized by chronic widespread musculoskeletal pain and cognitive difficulties. We conducted a systematic review with the aim of identifying articles that evaluated DM in people with fibromyalgia, highlighting the main assessment tools. This work was conducted according to the PRISMA statement by consulting six online databases and providing a quality assessment of each search that met the inclusion criteria. In line with the limited interest in this in the scientific landscape to date, we found nine studies that evaluated the performance of DM in patients with FM; furthermore, we discovered that only certain types of DM were tested. The importance of our work lies in shedding light on a cognitive ability that is often undervalued in the scientific landscape but essential in everyday life. This review can serve as a starting point for further studies to clarify the relationship between DM and FM, improving understanding of the topic.
... The small fibre impairment described in these studies, commonly defined as small fibre pathology [7], may, therefore, be associated with the pain and autonomic disturbances that patients with fibromyalgia commonly experience. The impact of small fibre impairment over distally distributed painful symptoms, which represent an independent factor affecting the life quality of patients with fibromyalgia [10], has yet to be defined. ...
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Converging evidence shows that patients with fibromyalgia syndrome have signs of small fibre impairment, possibly leading to pain and autonomic symptoms, with a frequency that has not yet been systematically evaluated. To fill this gap, our review aims to define the frequency of somatic and autonomic small fibre damage in patients with fibromyalgia syndrome, as assessed by objective small fibre-related testing. We found 360 articles on somatic and autonomic small fibre assessment in patients with fibromyalgia. Out of the 88 articles assessed for eligibility, 20 were included in the meta-analysis, involving 903 patients with fibromyalgia. The estimated prevalence of somatic small fibre impairment, as assessed with skin biopsy, corneal confocal microscopy, and microneurography, was 49% (95% confidence interval (CI): 39–60%, I2 = 89%), whereas the estimated prevalence of autonomic small fibre impairment, as assessed with heart rate variability, sympathetic skin response, skin conductance, and tilt testing, was 45% (95% CI: 25–65%, I2 = 91%). Our study shows that a considerable proportion of patients with fibromyalgia have somatic and autonomic small fibre impairment, as assessed by extensive small fibre-related testing. Nevertheless, the heterogeneity and inconsistencies across studies challenge the exact role of small fibre impairment in fibromyalgia symptoms.
... pathologies in the feet with and without infection, where they confirm that early diagnosis prevents long-term structural or infectious sequelae, morbidity and cost associated with foot care 17 . In addition, several existing studies indicate lower satisfaction in quality of life related to foot health in people diagnosed with foot problems and the presence of systemic diseases [18][19][20][21][22][23] . However, based on our knowledge, there is a lack of studies that analyse the quality of life related to foot health in the general population diagnosed with foot problems without the presence of associated risk factors and without the presence of other systemic diseases that may influence the negative impact on general health and specifically on the foot. ...
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Foot problems are highly prevalent conditions, being a frequent reason for medical and podiatric consultation. The aim of this study was to compare the differences of quality of life (QoL) related to foot health in people with and without the presence of foot problems. A case–control study was carried out in an outpatient centre, where a clinician recorded data related to sociodemographic and clinical characteristics. In addition, self-reported data on foot health-related quality of life were recorded using the Spanish version of the Foot Health Status Questionnaire. The sample consisted of 498 participants (249 cases and 249 controls), with a median age of 30 years and an interquartile range of 23 years. The differences between the groups were statistically significant for gender, age, footwear, general health, foot health, and physical activity. Cases showed lower scores for the domain of footwear, physical activity and vitality compared to controls. Foot pathologies have a negative impact on quality of life related to foot health, and the domains of footwear, general health and physical activity seem to be the factors that are associated with the presence of alterations and foot deformities.
... Consequently, foot management is considered as main objective in haemophilic subjects as a consequence of the expanding of ostheo articular disorders in different body region with a great health impact in haemophilic subjects, regarding the previous research which may be considered as a public health problem according the results of Peyvandi [2] who analyse several kind of haemophilia treatment or in the other hand the review of Bertamino [20] who evaluated treatment in children. Furthermore, a research had studied the perception of quality of life concluded that damage in haemophilic Qol and also releated to foot disorders on fibromyalgia women patients [21][22][23]. ...
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Background: Haemophilia is considered as a chronic genetic disease related with alteration in coagulation mechanism which affects to health related quality of life (HQoL). Purpose: The goal compared marks of HQoL, in haemophiliacs with respect non haemophilic subjects. Methods: A population of 74 subjects, were recruited from association of haemophilic illness separated in haemophilic subjects (n = 37) and no haemophilic (n = 37). For subjects who suffered haemophilia were enlisted from the association of haemophilic illness after a seminar of 45 minutes to them and to their relatives about foot health. Control subjects, were recruited from their relatives who live with the patient. The marks of the Foot Health Status Questionnaire Spanish S_FHSQ sub-scales were recompiled. Results: All S_FHSQ domains as foot pain, foot function, tootwear, general foot health, general health, physical activity and social capacity showed lower scores in the haemophilic than non-haemophilic group (P <0.01) except for vigour (P = 0.173). Regarding the rest sub-scale marks of S_FHSQ, showed no significant difference P <0.01. Conclusion: Subjects with a haemophilia showed significant worse foot QoL in all S_FHSQ domains except vigour domain compared with non-haemophilic subjects.
... Furthermore, prior studies have identified females who suffered from fibromyalgia and had developed foot problems as a consequence had an increased frailty degree [28]. ...
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Frailty is a condition that can increase the risk of falls. In addition, foot pain can influence older adults and affect their frail condition. The main objective was to measure the frailty degree in older adults in a Spanish population with foot pain from moderate to severe. Method: This is a cross-sectional descriptive study. A sample of people older than 60 years (n = 52), including 26 males and 26 females, were recruited, and frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). Results: Spearman's correlation coefficients were categorized as weak (rs ≤ 0.40), moderate (0.41 ≤ rs ≥ 0.69), or strong (0.70 ≤ rs ≥ 1.00). There was a statistically significant correlation for the total score (p < 0.001) and most of the subscales of the 5-Frailty scale compared with the EFS, except for Mood (p > 0.05). In addition, females and males showed similar 5-Frailty and Edmonton Frail scales scores with no difference (p > 0.05). Conclusion: Foot pain above 5 points, i.e., from moderate to severe, does not affect the fragility more in one sex than another.
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Our purpose was to demonstrate the possibility of providing foot-healthcare application by using an in-shoe motion sensor (IMS) through validating the feasibility of applying an IMS for measuring the first metatarsophalangeal angle (FMTPA), which is the most important parameter regarding the common foot problem hallux valgus. Methods: The IMS signals can represent foot motions when the mid-foot and hindfoot were modelled as a rigid body. FMTPAs can be estimated from the foot-motion signals measured using an IMS embedded beneath the foot arch near the calcaneus side using a machine-learning method. The foot-motion signals were collected from 50 participants with different FMTPAs. The true FMTPAs were assessed from digital photography. Correlation-based feature-selection processes (significance level p < 0.05) were used to search for the predictors from the foot-motion signals. Leave-one-subject-out cross-validation, root mean squared error, and intra-class coefficients were used for FMTPA-estimation model evaluation. Results: Eleven FMTPA-impacted gait-phase clusters, which were used to construct effective foot-motion predictors, were observed in all gait-cycle periods except terminal swing. The range of the foot motion in the sagittal and coronal planes significantly correlated with the FMTPA (p < 0.05). Linear regression could be the best method for constructing an FMTPA estimation model with a root mean squared error and intra-class correlation coefficient of 4.2 degrees and 0.789, respectively. Conclusion: The results indicate the reliability of our FMTPA estimation model constructed from foot-motion signals and the possibility to providing foot-healthcare applications by using an IMS.
Article
Background Parkinson's disease (PD) is a common neurodegenerative disorder, characterised by the presence of motor disturbances. Therefore, it can be related to musculoskeletal and orthopaedic problems, particularly in the foot status, that are linked to a negative effect on overall health, mobility and social function. Objective The aim was to analyse the impact of foot health and quality of life in patients with Parkinson's disease and people without Parkinson's disease, with normalised reference scores, in the light of the values recorded with regard to foot health status and overall health. Material and methods This is a prospective case-control investigation. A sample of Parkinson's patients (n = 62) including 24 men and 38 women was recruited, and foot HQoL was measured using the Foot Health Status Questionnaire Spanish (Sp_FHSQ). Results The PD group recorded lower levels of foot health quality of life (HQoL) with lower scores on the Sp_FHSQ in general foot health, general health, physical activity, social capacity and vigour sub-scales. Regarding the rest of the sub-scales of the Sp_FHSQ, foot pain showed higher values in the PD group. Differences between the cases and control groups were analysed by means of a Mann–Whitney U test, showing statistical significance (P < 0.05). Conclusions PD presents an increased negative impact on foot health and quality of life which appears to be related to the chronic neurodegenerative disease.
Article
Purpose The objective of this study is examine Quality of Life in subjects with chronic kidney disease utilizing Foot Health Status Questionnaire (FHSQ). Material and Methods 101 subjects with chronic kidney disease (CKD) was studied in specialized clinics, in Extremadura (Spain). An observational descriptive study. The FHSQ was utilized to assess specific foot health (first section) and overall health (second division). The differences between clumps they were assessed using a t-test to independent samples. Results 59.40% (n=60) were men and 40.59% (n=41) women. The mean age was 68.77±14.07. In first division of the FHSQ, a less score was registered in footwear domain (39.25) and in general foot health domain (46.37). In second division, less scores were resulted in general health domain (72) and vigour domain (60.43). CKD women got less scores in every domain. Women with CKD obtained significantly less scores in dimensions of foot pain, foot function, footwear, general foot health, general health and physical activity and there was no difference contrasted with men in the dimensions of social capacity and vigour. Conclusions The studied CKD population has problems their feet. Quality of life of CKD subjects is negatively impacted by health of their feet, difficulties with footwear, their overall health, and lack of vitality. Women with CKD show lower values of quality of life contrasted to male patients, associated with inability to perform physical activity, lack of energy and tiredness.
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Background and purpose Plantar fasciitis (PF) is a foot disorder in adults secondary to an inflammatory response caused by repetitive micro-trauma. We evaluated and compared the impact on quality of life (QoL) related to foot health and general health between males and females with PF. Methods In this cross-sectional descriptive study, patients with PF were recruited from a podiatry clinic. Physical examination, sociodemographic data, and the self-reported Foot Health Status Questionnaire (FHSQ) were recorded. The FHSQ has three sections and provides two composite scores from 0 to 100. Higher scores (close to 100) reflect better QoL related to foot health and health in general; lower scores (close to 0) denote a worse QoL related to these health items. Results One hundred patients (49 males [42.38 ± 14.065 years old] and 51 females [43.90 ± 14.305 years old]) were recruited. Section one of the FHSQ evaluates four foot domains, and significant differences (P<0.05) were shown for foot pain and footwear, with males having higher scores than females, but not for foot function and general foot health (P>0.05). Section two assesses four domains of general wellbeing, and significant differences (P<0.05) were shown for overall health, physical function, social capacity, and vigor, with males having higher scores than females. Conclusion Females with PF showed a worse health-related QoL for foot pain, foot function, footwear, and general foot health than males. A better health-related QoL was also shown for males with PF than for females with regard to general health, physical activity, social capacity, and vigor.
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Background: Fibromyalgia is a poorly understood, chronically disabling pain syndrome. While research has focused on its clinical presentation and treatment, less is known about fibromyalgia's clinical epidemiology in real-world healthcare systems. Gender differences have been difficult to study because relatively few males are diagnosed with fibromyalgia. Methods: Veterans Health Administration (VHA) patients diagnosed with fibromyalgia nationwide in FY 2012 were compared to Veterans with other pain diagnoses on sociodemographic characteristics, medical and psychiatric diagnoses, health service use, and opioid and psychotropic prescription fills. Additional analyses compared characteristics of men and women diagnosed with fibromyalgia. Risk ratios and Cohen's d were used for bivariate comparisons, followed by logistic regression analyses to identify independent factors associated with a diagnosis of fibromyalgia in the VHA. Results: Altogether, 77,087 of 2,216,621 Veterans with pain diagnoses (3.48%) were diagnosed with fibromyalgia. They were more likely to be female, younger than patients with other pain conditions, more likely to have multiple psychiatric comorbidities and other types of pain, and used more medical outpatient services. Women diagnosed with fibromyalgia were younger and more likely to have headaches, connective tissue diseases (CTD), and psychiatric comorbidities, while men had more comorbid medical conditions. Conclusions: In this large, predominantly older male sample of Veterans with pain diagnoses, those with fibromyalgia were far more likely to be women. Gender comparisons showed women with fibromyalgia were more likely to be diagnosed with psychiatric disorders and CTD, while males were more likely to be diagnosed with medical conditions. Fibromyalgia shows a striking, gender-dependent picture of multimorbidity, which should be considered in treatment.
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Purpose The aim of this study was to compare the health-related quality of life impact related to foot health and health in general in older adults with lesser toe deformities (LTD) and without any foot conditions. Methods A case–control observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A total of 100 older adults with a mean age of 74.39±6.02 years were recruited at an outpatient clinic; 50 of these subjects had LTD (case group) and 50 subjects were without any foot conditions (control group). Presence of LTD was determined in both feet using the Kelikian push-up test, and the Foot Health Status Questionnaire scores were self-reported. Results The case group showed lower scores in quality of life in relation to health in general and to foot health specifically. Statistically significant differences (p<0.05) between case and control groups were shown by means of the Wicoxon test. Conclusion A negative impact in quality of life in relation to foot health should be considered in older adults with LTD, regardless of gender.
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Alzheimer's disease (AD) shows a marked presence of physiologic changes and the start or aggravation of underlying diseases such as physical frailty in diverse anatomical regions. It is believed to have a particularly harmful effect on the health of the foot. We examined the foot health status in older persons with AD, with a specific focus on the extent to which people with AD may be using inadequate footwear in old age. Seventy-three community-dwelling people with probable, mild to moderate AD aged 65-95 years were recruited from a center of excellence for AD. A single trained physician evaluated health status and foot conditions. Current shoe and foot length and width measurements were taken using a calibrated Brannock device. The results indicate that sixty-five participants (89.04%) suffered from feet problems. Also, only twenty-two subjects (30.14%) used the correct shoes in width and size related with the morphology of their feet. Fifty-one participants (69.86%) were using incorrect shoes in length or width. The present study revealed that peoples with AD had a high presence of foot health problems. Also, the use of inappropriate shoes revealed measurable differences of association between shoe size and the morphology of the foot.
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Introduction The quality of life (QoL) experienced by cancer patients depends both on their state of health and on sociodemographic factors. Tumours in the head and neck region have a particularly adverse effect on patients psychologically and on their social functioning. Material and methods The study involved 121 patients receiving radiotherapy treatment for head and neck cancers. They included 72 urban and 49 rural residents. QoL was assessed using the questionnaires EORTC-QLQ-C30 and QLQ-H&N35. The data were analysed using statistical methods: a χ² test for independence and a multinomial logit model. Results The evaluation of QoL showed a strong, statistically significant, positive dependence on state of health, and a weak dependence on sociodemographic factors and place of residence. Evaluations of financial situation and living conditions were similar for rural and urban residents. Patients from urban areas had the greatest anxiety about deterioration of their state of health. Rural respondents were more often anxious about a worsening of their financial situation, and expressed a fear of loneliness. Conclusions Studying the QoL of patients with head and neck cancer provides information concerning the areas in which the disease inhibits their lives, and the extent to which it does so. It indicates conditions for the adaptation of treatment and care methods in the healthcare system which might improve the QoL of such patients. A multinomial logit model identifies the factors determining the patients’ health assessment and defines the probable values of such assessment.
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Purpose: The aim of this study was to analyze and compare foot health and general health in a sample of women divided into two groups: 1) those with breast cancer and undergoing chemotherapy treatment and 2) healthy women without breast cancer and with normalized reference values. Methods: A case–control observational study was performed. Two-hundred women with a mean age of 51.00±8.75 years were recruited from podiatric medicine and surgery clinics from the University of Extremadura (Plasencia, Spain) and the Hospital Infanta Cristina (Badajoz, Spain). The women were divided into case and control groups (undergoing chemotherapy treatment and healthy women, respectively). The Foot Health Status Questionnaire was used to assess foot health domain scores. Results: Significant differences between both groups were seen for foot pain (P=0.003), foot function (P<0.001), physical activity (P<0.001), social capacity (P<0.001), and vigor (P=0.001). The remaining domains (footwear, general health, and foot health) did not show significant differences between the two groups (P≥0.01). Conclusion: Women with breast cancer presented a lower foot health-related quality of life. Clinical aspects with emphasis on foot pain and disability were increased. Furthermore, physical activity, social capacity, and vigor were affected. Therefore, general health care and foot problem prevention for breast cancer survivors should be given more consideration.
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Objectives Our aims were (1) to compare the sensory organisation of balance control and balance strategies between women with fibromyalgia (FM) and healthy women; (2) to investigate which sensory component, that is, vestibular, visual or somato-sensory, is the most affected in FM and (3) to determine the associations between the functional independence measure (FIM) and balance responses in FM. Design Cross-sectional observational study. Setting Urban regional hospital and university (Universidad Rey Juan Carlos, Madrid, Spain). Participants Twenty women with FM and 20 matched healthy women. Primary/secondary outcome measures The sensory organisation test (SOT) was used to determine postural sway and balance during six different conditions with subjects in a standing position. The FIM was used to determine the level of functional independence in daily life activities (ADL). Between-group differences were analysed with analysis of covariance, and the Spearman's test was used for correlations. Results Significant differences between-groups and between-conditions were found for all SOT conditions (all, p<0.001): women with FM showed lower scores being the vestibular score the most affected. Different correlations between SOT conditions and some specific ADL were observed in the FM group: bathing activity and balance condition 6 (rs=0.541; p<0.001), bed transfers activity and conditions 2 (rs=0.491; p<0.001) and 3 (rs=0.510; p<0.001), positioning strategy six and dressing the upper (rs=0.530; p<0.001) or lower (rs=0.562; p<0.001) body, and toileting (rs=0.521; p<0.001): the greater the loss of balance, the greater the interference on some daily life activities. Conclusions Women with FM exhibited balance deficiencies and used different strategies for maintaining their balance in standing, which was associated with a negative impact on functional independence.
Article
Purpose: To compare the effectiveness of dry needling versus myofascial release on myofascial trigger points pain in cervical muscles, quality of life, impact of symptoms pain, quality of sleep, anxiety, depression, and fatigue in patients with fibromyalgia syndrome. Method: A single-blind randomized controlled trial was conducted. Sixty-four subjects with fibromyalgia were randomly assigned to a dry needling group or a myofascial release group. Pain pressure thresholds of myofascial trigger points were evaluated in the cervical muscles. In addition, quality of life, impact of fibromyalgia symptoms, quality of sleep, intensity of pain, anxiety and depression symptoms, impact of fatigue at baseline and post treatment after four weeks of intervention were evaluated. Results: Significant improvement was found in most pain pressure thresholds of the myofascial trigger points in cervical muscles in the dry needling group compared to myofascial release (p < 0.05). Similarly, these differences between groups were found for the components of quality of life of physical function (F = 12.74, p = 0.001), physical role (F = 11.24, p = 0.001), body pain (F =30.26, p < 0.001), general health (F = 15.83, p < 0.001), vitality (F = 13.51, p = 0.001), social function (F = 4.73, p = 0.034), emotional role (F = 8.01, p = 0.006), and mental health (F = 4.95, p = 0.030). Similar results were achieved for total impact of FMS symptoms (F = 42.91, p < 0.001), quality of sleep (F = 11.96, p = 0.001), state anxiety (F = 7.40, p = 0.009), and trait anxiety (F = −14.63, p < 0.001), hospital anxiety and depression (F = 20.60, p < 0.001), general pain intensity (F = 29.59, p < 0.001), and fatigue (F = −25.73, p < 0.001). Conclusion: The dry needling therapy showed higher improvements in comparison with myofascial release therapy for pain pressure thresholds, the components of quality of life of physical role, body pain, vitality and social function, as well as the total impact of FMS symptoms, quality of sleep, state and trait anxiety, hospital anxiety-depression, general pain intensity and fatigue. • Implications for rehabilitation • Dry needling therapy reduces myofascial trigger point pain in the short term in patients with fibromyalgia syndrome. • This therapeutic approach improves anxiety, depression, fatigue symptoms, quality of life, and sleep after treatment. • Dry needling and myofascial release therapies decrease intensity of pain, and the impact of fibromyalgia symptoms in this population. • These intervention approaches should be considered in an independent manner as complementary therapies within a multidisciplinary setting.
Article
Background Mechanical hyperkeratotic lesions (MHL) are common condition amongst population of all ages. Such problems may be associated with pain, reduction of mobility, changes of gait, risk of falls and is believed to affect to quality of life (QoL), general health and optimal foot health. Objective The main aim of this study was to describe and compare both foot and general health‐related QoL in two groups of participants: 1.) with MHL and 2.) healthy controls. Method A total sample of 150 patients, mean age 49.50 ± 36.50 years, was recruited from an outpatient clinic. Demographic data, medical history and clinical characteristics of overall health were determined and the obtained values were compared by the Foot Health Status Questionnaire (FHSQ). Results The FHSQ scores of the sample with MHL showed lower scores than control subjects in Sections One and Two for footwear, general and foot health, foot pain, foot function and physical activity (P<.01), but not for social capacity and vigor (P>.01). Conclusions People with MHL showed a decrease QoL, based on FHSQ scores, regardless of gender. This article is protected by copyright. All rights reserved.
Article
Fibromyalgia is an idiopathic chronic condition that causes widespread musculoskeletal pain, hyperalgesia and allodynia. This review aims to approach the general epidemiology of fibromyalgia according to the most recent published studies, identifying the general worldwide prevalence of the disease, its basic epidemiological profiles and its economic costs, with specific interest in the Spanish and Comunidad Valenciana cases. Fibromyalgia affects, on average, 2.10% of the world's population; 2.31% of the European population; 2.40% of the Spanish population; and 3.69% of the population in the Comunidad Valenciana. It supposes a painful loss of the quality of life of the people who suffer it and the economic costs are enormous: in Spain is has been estimated at more than 12,993 million euros annually. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.