title: A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia.
abstract: BACKGROUND
  Adolescents with juvenile fibromyalgia (JFM) tend to be very sedentary and avoid participation in physical activity. A prior study suggested that JFM patients show altered biomechanics compared to healthy adolescents which may make them more prone to pain/injury during exercise. A new intervention combining well established cognitive behavioral therapy (CBT) techniques with specialized neuromuscular exercise -Fibromyalgia Integrative Training for Teens (FIT Teens) was developed and shown to be promising in improving functioning in adolescents with JFM. In contrast to traditional exercise programs such as aerobic or resistance training, neuromuscular training is a tailored approach which targets gait, posture, balance and movement mechanics which form the foundation for safe exercise participation with reduced risk for injury or pain (and hence more tolerable by JFM patients). The aim of this pilot feasibility study was to establish whether objective biomechanical assessment including sophisticated 3-D motion analysis would be useful in measuring improvements in strength, balance, gait, and functional performance after participation in the 8-week FIT Teens program.
  
  
  METHODS
  Eleven female participants with JFM (ages 12-18 years) completed pre- and post-treatment assessments of biomechanics, including walking gait analysis, lower extremity strength assessment, functional performance, and dynamic postural stability.
  
  
  RESULTS
  Descriptive data indicated that mechanics of walking gait and functional performance appeared to improve after treatment. Hip abduction strength and dynamic postural control also demonstrated improvements bilaterally.
  
  
  CONCLUSIONS
  Overall, the results of this pilot study offer initial evidence for the utility of biomechanical assessment to objectively demonstrate observable changes in biomechanical performance after an integrated training intervention for youth with JFM. If replicated in larger controlled studies, findings would suggest that through the FIT Teens intervention, adolescents with JFM can progress towards normalized strength and biomechanics, which may enhance their ability to engage in physical exercise.
authors.affiliation: Department of Psychology, DePaul University, Chicago, IL, USA.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Tran
authors.affiliation: Division of Sports Medicine, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Staci
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Division of Sports Medicine, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: DiCesare
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology- MLC 7039, Cincinnati Children's Hospital Medical Center, 45229, Cincinnati, OH, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Pfeiffer
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, Atlanta, GA, USA.
authors.forename: Soumitri
authors.initials: S
authors.lastname: Sil
authors.affiliation: Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
authors.forename: Tracy V
authors.initials: TV
authors.lastname: Ting
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology- MLC 7039, Cincinnati Children's Hospital Medical Center, 45229, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Williams
authors.affiliation: Division of Sports Medicine, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.|Department of Orthopaedic Surgery, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.|The Sports Health and Performance Institute, OSU Sports Medicine, Ohio State University Medical Center, Columbus, OH, USA.|The Micheli Center for Sports Injury Prevention, Boston, MA, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology- MLC 7039, Cincinnati Children's Hospital Medical Center, 45229, Cincinnati, OH, USA. susmita.kashikar-zuck@cchmc.org.|Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA. susmita.kashikar-zuck@cchmc.org.
authors.forename: Susmita
authors.identifier: http://orcid.org/0000-0002-8321-9723
authors.initials: S
authors.lastname: Kashikar-Zuck
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology / Q000534:rehabilitation*; D005684:Gait; D006801:Humans; D053580:Muscle Strength; D010865:Pilot Projects; D004856:Postural Balance; D011187:Posture
keywords: Adolescents; Biomechanical assessment; Chronic pain; Juvenile fibromyalgia; Physical activity