CBT ‘has no impact’ on juvenile fibromyalgia physical activity (contrasts with subjective outcomes)

Dolphin

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People aware of the contrasting results with CBT in CFS, where patients report improvements over control groups without activity increases, may be interested in the following. I don't have the CBT protocol but it sounds like it could be based on encouraging activity.


CBT ‘has no impact’ on juvenile fibromyalgia physical activity
Published on October 1, 2012 at 5:15 PM

By medwireNews Reporters

Cognitive behavior therapy (CBT) is not associated with increased physical activity levels in adolescents with juvenile fibromyalgia (JFM), research shows.

Overall, there was a very low engagement in moderate-to-vigorous activity in patients undergoing CBT, with more than 95% of participants not meeting the guideline-recommended exercise requirements.

Patients did report significant improvements in daily physical functioning and overall wellbeing.
Article continues at:
http://www.news-medical.net/news/20...-juvenile-fibromyalgia-physical-activity.aspx
 

Dolphin

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Here's the abstract - abstracts can be harder to read for some people.

Physical activity monitoring in adolescents with juvenile fibromyalgia: Findings from a clinical trial of cognitive behavioral therapy.

Arthritis Care Res (Hoboken). 2012 Sep 12. doi: 10.1002/acr.21849. [Epub ahead of print]

Phd SK, Flowers SR, Strotman D, Sil S, Ting TV, Schikler KN.

Source
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati College of Medicine. Susmita.Kashikar-Zuck@cchmc.org.

Abstract*

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.

Objectives:

To analyze secondary data from a randomized clinical trial of CBT to examine if CBT was associated with improvement in objectively measured physical activity and whether actigraphy indices corresponded with self-reported functioning among adolescents with JFM.

Methods:

Participants were 114 adolescents (ages 11-18) 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 one week as part of their baseline and post-treatment assessments.

Results:

The final sample included 68 subjects (94% female; mean age = 15.2 years) for whom complete actigraphy data was 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 post-treatment.

Conclusions:

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.

PMID: 22972753 [PubMed - as supplied by publisher]

*I gave each sentence its own paragraph
 

Dolphin

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I was searching for this online and I see that previously released data from the same trial claiming all sorts of success with the treatment - seems very like what happens in ME/CFS

This is their own press release:
http://www.rheumatology.org/about/newsroom/2011/2011_01_36.asp



Psychological Intervention Reduces Disability and Depression in Adolescents with Fibromyalgia

Cognitive-Behavioral Therapy is Safe and Effective Treatment for Juvenile Fibromyalgia

Keywords for this release: pain, disability, depression, fibromyalgia, rheumatology, rheumatologist
A recent trial shows cognitive-behavioral therapy (CBT) reduces functional disability and depressive symptoms in adolescents with juvenile fibromyalgia. The psychological intervention was found to be safe and effective, and proved to be superior to disease management education. Full findings from this multi-site clinical trial are published in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).


Medical evidence reports that juvenile fibromyalgia syndrome affects 2% to 7% of school age children. Similar to adult cases, the juvenile form of the disorder primarily strikes adolescent girls. Both adult and juvenile fibromyalgia patients experience widespread musculoskeletal pain, fatigue, as well as sleep and mood disturbances. Previous studies show that juvenile fibromyalgia patients are burdened with substantial physical, school, social and emotional impairments. However, studies investing treatment for the juvenile form of the disorder are limited.

For the current trial, led by Dr. Susmita Kashikar-Zuck from the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center in Ohio, investigators recruited 114 adolescents between the ages of 11 and 18 years who were diagnosed with juvenile fibromyalgia. The trial was conducted at four pediatric rheumatology centers between December 2005 through 2009, with participants randomized to cognitive-behavioral therapy or fibromyalgia education, receiving eight weekly individual therapy sessions and two additional sessions in the six months following the end of active therapy.

Analyses showed that both patient groups displayed significant reduction in functional disability, pain, and depressive symptoms at the end of the trial. Pediatric participants in the cognitive-behavioral therapy group reported a significantly greater reduction in functional disability compared to those receiving fibromyalgia education. The therapy group had a 37% improvement in disability compared to 12% in the education cohort. Both groups had scores in the non-depressed range by the end of the study, but pain reduction was not clinically significant—a decrease in pain of less than 30% for either group.

The drop-out rate was low with over 85% of participants attending all therapy sessions and no study-related adverse events were reported by investigators. “Our trial confirms that cognitive-behavioral therapy is a safe and effective treatment for reducing functional disability and depression in patients with juvenile fibromyalgia,” concludes Dr. Kashikar-Zuck. “When added to standard medical care, cognitive-behavioral therapy helps to improve daily functioning and overall wellbeing for adolescents with fibromyalgia.”
This study was funded by a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Full citation: A Randomized Clinical Trial of Cognitive Behavioral Therapy for the Treatment of Juvenile Fibromyalgia.” Susmita Kashikar-Zuck, Tracy V. Ting, Lesley M Arnold, Judy Bean, Scott W. Powers, T. Brent Graham, Murray H. Passo, Kenneth N. Schikler, Philip J. Hashkes, Steven Spalding, Anne M. Lynch-Jordan, Gerard Banez, Margaret M. Richards and Daniel J. Lovell. Arthritis & Rheumatism; Published Online: November 22, 2011 (DOI: 10.1002/art.30644).http://doi.wiley.com/10.1002/art.30644.

Abstract:

Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial.

Arthritis Rheum. 2012 Jan;64(1):297-305. doi: 10.1002/art.30644.

Kashikar-Zuck S, Ting TV, Arnold LM, Bean J, Powers SW, Graham TB, Passo MH, Schikler KN, Hashkes PJ, Spalding S, Lynch-Jordan AM, Banez G, Richards MM, Lovell DJ.

Source
Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA. Susmita.Kashikar-Zuck@cchmc.org

Abstract*

OBJECTIVE:

Juvenile fibromyalgia syndrome (FMS) is a chronic musculoskeletal pain disorder in children and adolescents for which there are no evidence-based treatments.

The objective of this multisite, single-blind, randomized clinical trial was to test whether cognitive-behavioral therapy (CBT) was superior to fibromyalgia (FM) education in reducing functional disability, pain, and symptoms of depression in juvenile FMS.

METHODS:

Participants were 114 adolescents (ages 11-18 years) with juvenile FMS.

After receiving stable medications for 8 weeks, patients were randomized to either CBT or FM education and received 8 weekly individual sessions with a therapist and 2 booster sessions.

Assessments were conducted at baseline, immediately following the 8-week treatment phase, and at 6-month followup.

RESULTS:

The majority of patients (87.7%) completed the trial per protocol. Intent-to-treat analyses showed that patients in both groups had significant reductions in functional disability, pain, and symptoms of depression at the end of the study, and CBT was significantly superior to FM education in reducing the primary outcome of functional disability (mean baseline to end-of-treatment difference between groups 5.39 [95% confidence interval 1.57, 9.22]).

Reduction in symptoms of depression was clinically significant for both groups, with mean scores in the range of normal/nondepressed by the end of the study.

Reduction in pain was not clinically significant for either group (<30% decrease in pain).

There were no study-related adverse events.

CONCLUSION:

In this controlled trial, CBT was found to be a safe and effective treatment for reducing functional disability and symptoms of depression in adolescents with juvenile FMS.

PMID: 22108765 [PubMed - indexed for MEDLINE]
*I gave each sentence its own paragraph
 
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Here's the abstract
...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.
That's very interesting, thanks

I wonder if anyone has ever been able to find a correlation between self-reported improvements in functioning and actomters in CBT trials?

People aware of the contrasting results with CBT in CFS, where patients report improvements over control groups without activity increases, may be interested in the following. I don't have the CBT protocol but it sounds like it could be based on encouraging activity.
FWIW, from the initial study results:
The CBT protocol was a refined version of the CBT manual for adolescents with juvenile FMS used in our pilot study (13) and modeled after well-tested CBT protocols for pain management in adults (21). The sessions included education about the rationale for behavioral pain management as well as training in muscle relaxation, distraction, activity pacing, problem solving, using calming statements, and relapse prevention strategies.
Just for my notes, more info on the Functional Disability Inventory used to measure self-reported improvements
 

Valentijn

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I wonder if anyone has ever been able to find a correlation between self-reported improvements in functioning and actomters in CBT trials?
I think there's been several negative correlations found (the Dutch CBT trials), but they get buried or dismissed instead of being discussed rationally.
 

Dolphin

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I think there's been several negative correlations found (the Dutch CBT trials), but they get buried or dismissed instead of being discussed rationally.
I presume you are using "negative correlations" in the lay sense? A negative correlation could be a correlation with a negative slope, although I'm guessing that's not what you are referring to.
 

Esther12

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Thanks for pointing this out. The faith some seem to have in questionnaires as a measure of disability does seem worrying. Actometer's aren't perfect either, and probably even less so with FMS than CFS; but if the activity levels of patients were dramatically lower than healthy norms, and were not affected by CBT which is thought to dramatically improve symptoms because of the of the way questionnaires are filled in at the end of RCTs, that would seem to be a problem.
 

Valentijn

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I presume you are using "negative correlations" in the lay sense? A negative correlation could be a correlation with a negative slope, although I'm guessing that's not what you are referring to.
No, I meant it the other way. I was just wrong :) But yes, I should have said that a lack of correlation has been shown.