Sil Soumitri, Thomas Staci, DiCesare Christopher, Strotman Daniel, Ting Tracy V, Myer Gregory, Kashikar-Zuck Susmita
Emory University School of Medicine, Children's Healthcare of Atlanta, and Aflac Cancer and Blood Disorders Center, Atlanta, Georgia.
Arthritis Care Res (Hoboken). 2015 Jan;67(1):102-11. doi: 10.1002/acr.22450.
Juvenile fibromyalgia (FM) is characterized by chronic musculoskeletal pain and marked reduction in physical activity. Despite recommendations for exercise to manage juvenile FM pain, exercise adherence is poor. Because of pain and activity avoidance, adolescents with juvenile FM are at risk for altered joint mechanics that may make them susceptible to increased pain and reduced tolerance for exercise. The primary aim of this study was to assess functional deficits in patients with juvenile FM compared to healthy controls using objective biomechanical assessment.
Female adolescent patients with juvenile FM (n = 17) and healthy controls (n = 14) completed biomechanical assessments, including gait analysis and tests of lower extremity strength (isokinetic knee extension/flexion and hip abduction) and functional performance (drop vertical jump test) along with self-reported measures of disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children's Depression Inventory), and fear of movement (Tampa Scale of Kinesiophobia).
Patients with juvenile FM demonstrated mild deficiencies in walking gait and functional performance (P < 0.05 for both) and significantly lower left knee extension and flexion strength (18-22% deficit) and bilateral hip abduction strength (34-38%) compared with healthy controls (P < 0.008 for all). Patients with juvenile FM reported significantly higher functional disability, pain intensity, depressive symptoms, and fear of movement relative to controls (P < 0.01 for all).
This study showed that adolescents with juvenile FM exhibited objective alterations in biomechanics and self-reported fear of movement that may have reinforced their activity avoidance. Interventions for juvenile FM should include a focus on correcting functional deficits and instilling greater confidence in adolescents with juvenile FM to engage in exercise to improve functional outcomes.
青少年纤维肌痛（FM）的特征为慢性肌肉骨骼疼痛和身体活动显著减少。尽管有建议通过运动来管理青少年FM疼痛，但运动依从性较差。由于疼痛和对活动的回避，患有青少年FM的青少年存在关节力学改变的风险，这可能使他们更容易出现疼痛加剧和运动耐受力降低的情况。本研究的主要目的是通过客观的生物力学评估，比较青少年FM患者与健康对照者的功能缺陷。
患有青少年FM的女性青少年患者（n = 17）和健康对照者（n = 14）完成了生物力学评估，包括步态分析、下肢力量测试（等速膝关节伸展/屈曲和髋关节外展）以及功能表现测试（垂直纵跳测试），同时还进行了自我报告的残疾测量（功能残疾量表）、疼痛强度、抑郁症状（儿童抑郁量表）和运动恐惧（坦帕运动恐惧量表）。
与健康对照者相比，青少年FM患者在步幅和功能表现方面存在轻度缺陷（两者均P < 0.05），左膝关节伸展和屈曲力量显著降低（缺陷18 - 22%），双侧髋关节外展力量降低（34 - 38%）（所有均P < 0.008）。与对照者相比，青少年FM患者报告的功能残疾、疼痛强度、抑郁症状和运动恐惧显著更高（所有均P < 0.01）。
本研究表明，患有青少年FM的青少年在生物力学方面存在客观改变，且自我报告有运动恐惧，这可能强化了他们对活动的回避。青少年FM的干预措施应包括关注纠正功能缺陷，并增强患有青少年FM的青少年对参与运动以改善功能结果的信心。
