title: A systematic review of psychosocial therapies for children with rheumatic diseases.
abstract: BACKGROUND
  To assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases.
  
  
  METHODS
  We conducted a literature search of MEDLINE and PsycINFO for randomized clinical trials of psychosocial interventions for pain and disability in children with rheumatic diseases from January 1969 to September 2015. Studies with a sample size less than 10 subjects were excluded. Study quality was assessed using the Jadad score.
  
  
  RESULTS
  Five articles met inclusion criteria, for a total of 229 patients, aged 5 to 18 years. Two studies included children with fibromyalgia. Three studies included children with juvenile arthritis. Neither study in fibromyalgia reported the statistical significance of immediate between-group pre-post changes in functioning or pain. One study examining the effects of an internet-based psychosocial intervention in children with juvenile arthritis reported significant differences in post-intervention pain scores (p = 0.03). However, 2 studies did not show improvements in pain scores among children with juvenile arthritis treated with psychosocial interventions vs. a wait-list control or vs. an active control (massage). No studies reported significant between-group differences for functional outcomes in children with juvenile arthritis.
  
  
  CONCLUSIONS
  The available data were limited by the scarcity of randomized trials. Definite conclusions about the immediate effect of psychosocial interventions on pain and function in children with fibromyalgia could not be made because between-group comparisons of post-treatment change scores were not reported. For children with juvenile inflammatory arthritis, results of between-group comparisons for pain differed across studies, and analyses examining disability revealed no significant differences between groups.
authors.affiliation: Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. ezra.cohen@childrens.harvard.edu.|Department of Rheumatology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. ezra.cohen@childrens.harvard.edu.
authors.forename: Ezra M
authors.initials: EM
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Morley-Fletcher
authors.affiliation: Benson-Henry Institute for Mind-Body Medicine, Massachusetts General Hospital, 151 Merrimac St., Boston, MA, 02114, USA.
authors.forename: Darshan H
authors.initials: DH
authors.lastname: Mehta
authors.affiliation: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA.
authors.forename: Yvonne C
authors.initials: YC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D019122:Meditation / Q000379:methods; D026441:Mind-Body Therapies / Q000379:methods; D059352:Musculoskeletal Pain / Q000517:prevention & control; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
keywords: Juvenile arthritis; Juvenile fibromyalgia; Meditation; Mind-body therapies; Psychological therapies