A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia.
OBJECTIVE
Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive-behavior therapy (CBT) are beneficial but do not improve exercise participation. The objective of this study was to obtain preliminary information about the feasibility, safety, and acceptability of a new intervention--Fibromyalgia Integrative Training for Teens (FIT Teens), which combines CBT with specialized neuromuscular exercise training modified from evidence-based injury prevention protocols.


METHODS
Participants were 17 adolescent females (aged 12 to 18 y) with JFM. Of these, 11 completed the 8-week (16 sessions) FIT Teens program in a small-group format with 3 to 4 patients per group. Patients provided detailed qualitative feedback via individual semistructured interviews after treatment. Interview content was coded using thematic analysis. Interventionist feedback about treatment implementation was also obtained.


RESULTS
The intervention was found to be feasible, well tolerated, and safe for JFM patients. Barriers to enrollment (50% of those approached) included difficulties with transportation or time conflicts. Treatment completers enjoyed the group format and reported increased self-efficacy, strength, and motivation to exercise. Participants also reported decreased pain and increased energy levels. Feedback from participants and interventionists was incorporated into a final treatment manual to be used in a future trial.


CONCLUSIONS
Results of this study provided initial support for the new FIT Teens program. An integrative strategy of combining pain coping skills via CBT enhanced with tailored exercise specifically designed to improve confidence in movement and improving activity participation holds promise in the management of JFM.
Divisions of *Behavioral Medicine and Clinical Psychology ¶Rheumatology ∥Sports Medicine Biodynamics Center and Human Performance Laboratory, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center Departments of †Pediatrics #Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati **The Sports Health and Performance Institute, OSU Sports Medicine, Ohio State University Medical Center, Columbus, OH ‡Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA §Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA ††The Micheli Center for Sports Injury Prevention, Boston, MA.
Susmita
S
Kashikar-Zuck
Susan T
ST
Tran
Kimberly
K
Barnett
Maggie H
MH
Bromberg
Daniel
D
Strotman
Soumitri
S
Sil
Staci M
SM
Thomas
Naomi
N
Joffe
Tracy V
TV
Ting
Sara E
SE
Williams
Gregory D
GD
Myer
D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005081:Exercise Therapy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005246:Feedback; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D009042:Motivation; D053580:Muscle Strength; D010865:Pilot Projects; D020377:Self Efficacy; D016896:Treatment Outcome