THU0475-HPR A waitlist controlled trial of the efficacy of a psychological treatment program for children with juvenile idiopathic arthritis and their parents

Abstract

Background Only few studies have examined the efficacy of psychological treatment in children with juvenile idiopathic arthritis (JIA) (1;2). These studies found improvement in functional disability and reduced pain, but were hampered by few participants and lack of a control group. Since JIA impacts children’s psychosocial wellbeing (3;4) improvement of wellbeing should be a goal of psychological treatment as well as improvement in symptoms. Objectives To evaluate the outcome of a psychological treatment program for children with JIA on pain, functional disability, quality of life, and the psychological variables of anxiety, depression and worries about pain in children with JIA. Methods Eighteen children and their parents participated in a 6-session psychological group treatment program. Participants were randomly allocated into either a 3 month wait-list control condition or an immediately treatment condition stratified by child’s age and address, resulting in 2 treatment and 2 waitlist control groups. Results were measured by self-report scales and a 1-week pain diary completed pre- and post-treatment, and at 4- and 12 month follow-ups. Clinical data were continuously collected from the rheumatologist. Results After controlling for disease activity, no differences between the intervention group and the waitlist group were found for measures of pain and functional disability Compared to the waitlist group the intervention group reported increased quality of life and reduction on anxiety, worries, and depression. The differences did not reach statistical significance, but small to moderate effect sizes (partial η2between 0.005–0.10). Quality of life increased and anxiety and worries about pain decreased at each follow-up period. Reductions were non-significant but with small to moderate effect sizes (r between 0.12 -0.53). Conclusions When controlling for disease activity, the children’s symptoms (pain and functional disability) did not change after the treatment. But despite this the participating children experienced an increased quality of life and a reduction in anxiety, depression and worries about pain. There were no statistically significant differences, which could be due to the small sample size. However, the moderate effect sizes indicated a notable change in the variables before and after the treatment. References Walco GA, Varni JW, Ilowite NT. Cognitive-behavioral pain management in children with juvenile arthritis. Pediatrics 1992;89:1075-9. Lavigne JV, Ross CK, Berry SL, Hayford JR, Pachman LM. Evaluation of a psychological treatment package for treating pain in juvenile rheumatoid arthritis. Arthritis Care Res 1992;5(2):101. Schanberg LE, Anthony KK, Gil KM, Maurin EC. Daily pain and symptoms in children with polyarticular arthritis. Arthritis Rheum 2003 May;48(5):1390-7. Sällfors C, Hallberg LRM, Fasth A. Well-being in children with juvenile chronic arthritis. Clinical and Experimental Rheumatology 2004;22(1):125-30. Disclosure of Interest None Declared