Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
Arthritis Care Res (Hoboken). 2013 Mar;65(3):398-405. doi: 10.1002/acr.21849.
Juvenile fibromyalgia (JFM) is a chronic musculoskeletal pain condition that is associated with reduced physical function. Recent research has demonstrated that cognitive-behavioral therapy (CBT) is effective in improving daily functioning among adolescents with JFM. However, it is not known whether these improvements were accompanied by increased physical activity levels. Our objective was to analyze secondary data from a randomized clinical trial of CBT to examine whether CBT was associated with improvement in objectively measured physical activity and whether actigraphy indices corresponded with self-reported functioning among adolescents with JFM.
Participants were 114 adolescents (ages 11-18 years) recruited from pediatric rheumatology clinics that met criteria for JFM and were enrolled in a clinical trial. Subjects were randomly (1:1) assigned to receive either CBT or fibromyalgia education (FE). Participants wore a hip-mounted accelerometer for 1 week as part of their baseline and posttreatment assessments.
The final sample included 68 subjects (94% female, mean age 15.2 years) for whom complete actigraphy data were obtained. Actigraphy measures were not found to correspond with self-reported improvements in functioning. While self-reported functioning improved in the CBT condition compared to FE, no significant changes were seen in either group for activity counts, sedentary, moderate, or vigorous activity. The CBT group had significantly lower peak and light activity at posttreatment.
Actigraphy monitoring provides a unique source of information about patient outcomes. CBT intervention was not associated with increased physical activity in adolescents with JFM, indicating that combining CBT with interventions to increase physical activity may enhance treatment effects.
青少年纤维肌痛症（JFM）是一种慢性肌肉骨骼疼痛疾病，与身体功能下降有关。最近的研究表明，认知行为疗法（CBT）可有效改善 JFM 青少年的日常功能。然而，目前尚不清楚这些改善是否伴随着身体活动水平的提高。我们的目的是分析 CBT 随机临床试验的二级数据，以检验 CBT 是否与 JFM 青少年身体活动水平的提高有关，以及活动记录仪指数是否与自我报告的功能相一致。
本研究从儿科风湿病诊所招募了符合 JFM 标准并参加临床试验的 114 名青少年（年龄 11-18 岁）作为参与者。受试者被随机（1:1）分配接受 CBT 或纤维肌痛教育（FE）。参与者在基线和治疗后评估期间佩戴了一个髋部加速度计，为期一周。
最终样本包括 68 名患者（94%为女性，平均年龄 15.2 岁），他们获得了完整的活动记录仪数据。活动记录仪测量值与自我报告的功能改善无关。虽然 CBT 组的自我报告功能与 FE 组相比有所改善，但两组的活动计数、久坐、中等强度和剧烈活动均无显著变化。CBT 组在治疗后，其活动峰值和轻度活动明显减少。
活动记录仪监测提供了患者结果的独特信息来源。CBT 干预与 JFM 青少年的身体活动增加无关，这表明将 CBT 与增加身体活动的干预措施相结合可能会增强治疗效果。
