{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:02:26Z","timestamp":1790658146653,"version":"4.1.0"},"reference-count":62,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,1,19]],"date-time":"2020-01-19T00:00:00Z","timestamp":1579392000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The study protocol of a prospective and randomized controlled trial for the assessment of the efficacy of nature activity therapy for people with Fibromyalgia (NAT-FM) is described. The primary outcome is the mean change from baseline in the Revised Fibromyalgia Impact Questionnaire (FIQR) score at post-treatment (12 weeks) and at 9 months of follow-up, and secondary outcomes are changes in the positive affect, negative affect, pain, fatigue, self-efficacy, catastrophising, and emotional regulation. A total of 160 patients with fibromyalgia will be divided into two arms: treatment-as-usual (TAU) and NAT-FM+TAU. Pre, during, post, +6, and +9 months assessments will be carried out, as well as an ecological momentary assessment (EMA) of intrasession and intersessions. Results will be subjected to a mixed group (NAT-FM+TAU vs. TAU) \u00d7 phase (pre, post, +6 months, +9 months) general linear model. EMA intrasession measurements will be subjected to a 2 (pre vs. post) \u00d7 5 (type of activity) mixed-effects ANOVA. EMA between-session measurements obtained from both arms of the study will be analysed on both a time-domain and frequency-domain basis. Effect sizes and number needed to treat (NNT) will be computed. A mediation\/moderation analysis will be conducted.<\/jats:p>","DOI":"10.3390\/ijerph17020634","type":"journal-article","created":{"date-parts":[[2020,1,20]],"date-time":"2020-01-20T04:27:09Z","timestamp":1579494429000},"page":"634","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Efficacy of a Multicomponent Intervention for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): Study Protocol of a Randomized Controlled Trial"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5591-9407","authenticated-orcid":false,"given":"Mayte","family":"Serrat","sequence":"first","affiliation":[{"name":"Unitat d\u2019Expertesa en S\u00edndromes de Sensibilitzaci\u00f3 Central, Hospital de la Vall d\u2019Hebron, 08035 Barcelona, Spain"},{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"},{"name":"Escoles Universit\u00e0ries Gimbernat, Universitat Aut\u00f2noma de Barcelona, Sant Cugat del Vall\u00e8s, 08174 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-435X","authenticated-orcid":false,"given":"Juan P.","family":"Sanabria-Mazo","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"},{"name":"Institut de Recerca Sant Joan de D\u00e9u, 08950 Esplugues de Llobregat, Spain"},{"name":"Teaching, Research, &amp; Innovation Unit - Parc Sanitari Sant Joan de D\u00e9u, 08830 St. Boi de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elna","family":"Garc\u00eda-Troiteiro","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Fontcuberta","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corel","family":"Mateo-Canedo","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00edriam","family":"Almirall","sequence":"additional","affiliation":[{"name":"Unitat d\u2019Expertesa en S\u00edndromes de Sensibilitzaci\u00f3 Central, Hospital de la Vall d\u2019Hebron, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2810-7670","authenticated-orcid":false,"given":"Albert","family":"Feliu-Soler","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"},{"name":"Institut de Recerca Sant Joan de D\u00e9u, 08950 Esplugues de Llobregat, Spain"},{"name":"Teaching, Research, &amp; Innovation Unit - Parc Sanitari Sant Joan de D\u00e9u, 08830 St. Boi de Llobregat, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9718-0607","authenticated-orcid":false,"given":"Jorge Luis","family":"M\u00e9ndez-Ulrich","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7952-4477","authenticated-orcid":false,"given":"Antoni","family":"Sanz","sequence":"additional","affiliation":[{"name":"Research Group on Stress and Health, Faculty of Psychology, Universitat Aut\u00f2noma de Barcelona, 08193 Cerdanyola del Vall\u00e8s, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0750-1599","authenticated-orcid":false,"given":"Juan V.","family":"Luciano","sequence":"additional","affiliation":[{"name":"Institut de Recerca Sant Joan de D\u00e9u, 08950 Esplugues de Llobregat, Spain"},{"name":"Teaching, Research, &amp; 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