Cohen Ezra M, Morley-Fletcher Alessio, Mehta Darshan H, Lee Yvonne C
Division of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Department of Rheumatology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Pediatr Rheumatol Online J. 2017 Jan 17;15(1):6. doi: 10.1186/s12969-016-0133-1.
To assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases.
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.
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.
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.
评估心理社会疗法对风湿性疾病患儿疼痛和功能影响的证据质量。
我们检索了MEDLINE和PsycINFO数据库，以查找1969年1月至2015年9月期间针对风湿性疾病患儿疼痛和残疾的心理社会干预随机临床试验。样本量少于10名受试者的研究被排除。使用Jadad评分评估研究质量。
五篇文章符合纳入标准，共有229名年龄在5至18岁之间的患者。两项研究纳入了纤维肌痛患儿。三项研究纳入了幼年特发性关节炎患儿。纤维肌痛的两项研究均未报告功能或疼痛组间前后即时变化的统计学意义。一项研究考察了基于网络的心理社会干预对幼年特发性关节炎患儿的影响，报告干预后疼痛评分有显著差异（p = 0.03）。然而，两项研究未显示心理社会干预治疗的幼年特发性关节炎患儿与等待名单对照组或积极对照组（按摩）相比，疼痛评分有所改善。没有研究报告幼年特发性关节炎患儿功能结局的组间显著差异。
现有数据因随机试验稀缺而受限。由于未报告治疗后变化评分的组间比较，无法就心理社会干预对纤维肌痛患儿疼痛和功能的即时效果得出明确结论。对于幼年特发性关节炎患儿，不同研究的疼痛组间比较结果存在差异，而残疾分析显示组间无显著差异。
