A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia

Abstract

Objectives Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive behavioral 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. Methods Participants were 17 adolescent females (ages 12–18) with JFM. Of these, 11 completed the 8-week (16-session) FIT Teens program in a small-group format with 3–4 patients per group. Patients provided detailed qualitative feedback via individual semi-structured 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.

Experiences of interventions aiming to improve the mental health and well‐being of children and young people with a long‐term physical condition: A systematic review and meta‐ethnography

“…During the program, all participants noted that they had increased their overall daily physical activity, incorporated planned physical activities into their daily schedules (Table 7), and experienced increased motivation to go out or be with their friends even if they had pain (Kashikar-Zuck et al, 2016). Empowerment Several participants also discussed the benefits of skills-based education and learning strategies to manage diabetes in public (Serlachius, Northam, Frydenberg, & Cameron, 2012).…”

Preliminary Outcomes of a Cross‐Site Cognitive–Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia

“…In order to address the need for an integrated intervention which offers training in both fundamental movement and pain coping skills, we developed a program combining established pain‐focused CBT with neuromuscular training . The new Fibromyalgia Integrative Training for Teens program (FIT Teens) is an 8‐week (16‐session) group‐based intervention.…”

How can group‐based multidisciplinary rehabilitation for patients with fibromyalgia influence patients' self‐efficacy and ability to cope with their illness: a grounded theory approach

“…In another recent grounded theory study of patients' experiences of a combined cognitive‐behavioural and neuromuscular training intervention for juvenile fibromyalgia, participants reported to benefit from the group format and expressed increased confidence and self‐efficacy, strength and motivation to exercise and thus, coinciding with our findings (Kashikar‐Zuck et al . ). However, the shortcomings identified and assumed to affect the outcome, were not reflected nor addressed in the previous studies.…”