A Qualitative Examination of a New Combined Cognitive Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia
Objectives: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. Materials and 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. Discussion: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.
The Clinical journal of pain