BackgroundLow back pain is the highest reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have no clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain.Patient education is a way to provide information and advice aimed at changing patients’ cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver health care information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool.Several studies have demonstrated that websites can change and improve chronic patients’ knowledge and have a positive impact on patients’ attitudes and behaviors. The aim of this project is to identify chronic low back pain patients’ beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques.Methods/designThis study has a mixed-method sequential exploratory design. The participants are chronic low back pain patients between 18–65 years of age who are attending a primary care setting. For the qualitative phase, subjects will be contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase will be a randomized controlled trial. Subjects will be randomly allocated using a simple random sample technique. The intervention group will be provided access to the web site where they will find information related to their chronic low back pain. This information will be provided in different formats. All of this material will be based on the information obtained in the qualitative phase. The control group will follow conventional treatment provided by their family physician.DiscussionThe main outcome of this project is to identify chronic low back pain patients’ beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques.Trial registrationClinicalTrials.gov NCT02369120 Date: 02/20/2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-015-0220-0) contains supplementary material, which is available to authorized users.

Aims:To evaluate cognitive and behavioural factors related to pain and poor sleep quality in women diagnosed with fibromyalgia and to develop and test the effects of a web-based therapeutic education intervention on pain intensity, pain catastrophizing, chronic pain self-efficacy, sleep quality, dysfunctional beliefs and attitudes about sleep and quality of life and health status related to fibromyalgia. Design:The project will employ a sequential exploratory mixed methods research design.Methods: For the qualitative phase, a theoretical sample living in the community will be recruited to participate in personal, semi-structured interviews. For the quantitative phase, a sample of adult women with fibromyalgia will be recruited from secondary care centres and randomly allocated an intervention or a control group. The study protocol was approved in 2019. Discussion: Fibromyalgia is the most common central sensitivity syndrome and one of the principal worldwide causes of chronic widespread pain among the adult population. Poor sleep quality is a highly prevalent and troublesome symptom for people with fibromyalgia. Psychosocial and behavioural factors have been shown to relate intimately with the symptom experiences of people with fibromyalgia; pain catastrophizing and dysfunctional beliefs and attitudes about sleep can perpetuate those and other fibromyalgia symptoms. Conclusion: It is imperative to reflect people's actual symptom experiences to develop effective symptom management strategies. In the Internet era, this project's proposed web-based therapeutic education intervention could offer women with fibromyalgia a new avenue for treatment as part of standard fibromyalgia management programs in primary and secondary healthcare services.Impact: Pain and poor sleep quality are highly prevalent and troublesome symptoms for people with fibromyalgia. The web-based therapeutic education intervention

Poor sleep quality is a common concern and a troublesome symptom among patients suffering from fibromyalgia. The purpose of this review was to identify and describe the available patient reported outcome measures (PROMs) of sleep quality validated in adult people diagnosed with fibromyalgia. The COSMIN and PRISMA recommendations were followed. An electronic systematized search in the electronic databases PubMed, Scopus, CINAHL Plus, PsycINFO, and ISI Web of Science was carried out. Validation studies of PROMs of sleep quality in fibromyalgia published in English or Spanish were included. The selection of the studies was developed through a peer review process through the online software "COVIDENCE". The quality of the studies was assessed using the COSMIN Risk of Bias checklist. A total of 5 PROMs were found validated in patients with fibromyalgia: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Jenkins Sleep Scale (JSS), (3) Sleep Quality Numeric Rating Scale (SQ-NRS), (4) Medical Outcomes Study-Sleep Scale (MOS-SS), and (5) Fibromyalgia Sleep Diary (FSD). The quality of the evidence was very good and the quality of the results ranged from moderate to high. All the included PROMs, except for the FSD, showed adequate psychometric properties and, therefore, are valid and reliable tools for assessing sleep quality in the context of FM. However, none of the studies analyzed all the psychometric properties of the included PROMs as established in the COSMIN guidelines, highlighting that this is a potential field of research for future investigations. out in all experimental studies about FM. These results are in line with a previous internet survey, including 2596 people with FM [4], showing that poor sleep quality, together with pain, fatigue and morning stiffness, are the symptoms with greater severity and impact in these patients. Specifically, 79% of the participants perceived that sleep problems were one of the most common factors in the exacerbation of FM symptoms [4].In terms of prevalence, the studies indicate that between 65% and 99% of people diagnosed with FM report poor sleep quality [5][6][7]. Other authors [8] state that 63% of these patients report two or more symptoms of difficulty sleeping, while only 11.2% report having no problem sleeping. A recent meta-analysis of case-control studies indicated that, in comparison with healthy controls, people with FM show significantly lower sleep efficiency and sleep quality, shorter sleep duration, longer wake time after sleep onset and more percentage of light sleep stages when assessed with polysomnography. Subjective assessment showed that patients with FM have more difficulties falling asleep and worse sleep efficiency. Therefore, and although there are no conclusive data regarding the prevalence of poor sleep quality in FM, the results presented reveal that it is a recurrent and a concerning symptom among these patients [9]. Furthermore, poor sleep quality has been shown to be related with increases in the intensity of pain, and it is an aggravating factor o...