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Sempere-Rubio et al. | Journal of Clinical and Translational Research 2023; 9(6): 369-380 371
exercise, improve adherence, active coping skills training, analysis) regarding the studies’ questions and objectives. The first
and sleep regulation strategies. It may also include techniques screening was based on each study’s title information, abstract, and
such as sensory retraining, sensory reinterpretation, keywords. The full text was reviewed if there was no consensus
experiential motor restructuring, activity and exercise, and or if the abstracts contained insufficient information. In the second
graded exercise exposure as part of TE. phase of the screening, the full text was assessed if the studies
• PNE corresponds to educational processes that focus on a met all of the inclusion criteria. Differences between the reviewers
broad, multidisciplinary understanding of pain, including were resolved by a discussion and consensus process mediated
neuroanatomical, neurochemical, cognitive emotional, by a third reviewer. The data described in the results section were
and social aspects that relate to the perception of the pain extracted by means of a structured protocol that ensured that the
experience. most relevant information was obtained from each study.
• Finally, PNpE corresponds to educational aspects that focus
on a more specific understanding of the neurophysiological 2.4. Methodological quality assessment
and neurobiological processes underlying pain perception, The two independent reviewers assessed the methodological
also including the transmission of the nociceptive signal, quality of the SR (with or without meta-analysis), assessing each
its processing at the central nervous system level and pain of the selected studies based on the Modified Quality Assessment
modulation systems. Scale for SR (AMSTAR) developed by Barton et al. [27] a
scale shown to be a valid and reliable tool for assessing the
2.1.3. Outcome measures
methodological quality of SR. With a total of 13 items, each worth
The outcomes employed to assess the effectiveness of HEI 2 points (with “yes” scoring 2; “in part” scoring 1; “no” scoring 0),
were pain intensity, quality of life, functionality, anxiety, and pain the maximum possible score is 26. A high-quality cutoff of 20 or
catastrophizing. more points was provided by the developers. The exclusion and
keyword criteria were modified to better evaluate the selected SR
2.1.4. Study design of this study. In addition, we calculated the kappa coefficient (κ)
We selected SR (with or without a meta-analysis) of randomized and percentage (%) agreement scores to assess reliability before
controlled trials (RCTs) or controlled clinical trials (CCTs) and any consensus.
excluded SR that included RCTs or CCTs in combination with non- 2.5. Risk of bias assessment
experimental designs. There were no restrictions for any specific
language, as recommended by the international criteria [26]. We assessed the risk of bias with the Risk of bias in SR tool
(ROBIS) [28], which consists of three phases: (1) Relevance
2.2. Search strategy assessment (optional); (2) identification of concerns with the
We conducted the search for published scientific articles review process through four domains related to study eligibility
between 1950 and August 6, 2022, in the following databases: criteria, identification and selection of studies, data collection and
MEDLINE (PubMed), EMBASE, PEDro, CINAHL, Psicodoc, study appraisal and synthesis and findings; and (3) judgment on
and SPORTDiscus. An additional manual search was realized in the risk of bias.
Google Scholar. The reference sections of the included studies 2.6. Grading of evidence
and original studies were screened manually, and the authors were
contacted for further information if necessary. The search strategy The physical activity guidelines advisory committee grading
combined Medical Subjects’ Headings (MeSH [“Fibromyalgia”]) criteria (PAGAC) were used to assess the grading of evidence. The
or [“Patient Education as topic”], and non-MeSH terms criteria used to assess the quality of the evidence were as follows:
(“fibrositis”, “fibromyositis”, “rheumatism muscular”, (1) Applicability of the study sample, exposures, and outcomes
“fibromyalgias”, “fibromyalgia secondary”, “fibromyalgia to the research question, (2) generalizability to the population
primary”, “PNE”, “therapeutic neuroscience education”, “pain of interest, (3) risk of bias/study limitations, (4) quantity and
neurophysiology education”, or “patient education”) adding a consistency of findings across studies, and (5) magnitude and
Boolean operator (AND and/or OR) to combine them. Appendix 1 precision of the effect. With these data, final evidence grades
shows the search strategy, which was adapted for each database. and conclusion statements for each research question were
The search was conducted by two independent reviewers using developed [29].
the same methodology. Differences that emerged during this phase
were resolved by consensus. The reference sections of the original 3. Results
studies were screened manually, and the authors were contacted 3.1. Study selection
for further information if necessary.
The initial search revealed 99 records. Through the title and
2.3. Selection criteria and data extraction
abstract screening and the full-text assessment, five SRs were
Initially, the two independent reviewers conducted a screening eligible according to our criteria. The study screening strategy is
assessing the relevance of the SR (with and without a meta- shown in the form of a flow chart (Figure 1).
DOI: http://dx.doi.org/10.18053/jctres.09.202306.23-00108