ACR：认知行为疗法与提高躯体功能的干预措施联用可提高少年纤维肌痛综合征疗效

少年纤维肌痛综合征（IFM）是一种与躯体功能减退有关的慢性肌肉骨骼疼痛状态。近来的研究进展证实认识行为疗法（CBT）能有效的改善IFM患儿的日常功能。但是，这些日常功能的改善是否与躯体功能水平的提高有关仍不清楚。针对这一情况，来自美国辛辛那提儿童医院医疗中心和辛辛那提大学医学院行为医学和临床心理学部的SUSMITA KASHIKAR-ZUCK等人进行了一项研究，该研究的目的是分析一项随机CBT临床实验的次级资料来确定是否CBT于客观测量到的躯体功能的提高有关，并明确是否体动记录仪的指标与IFM患儿自我感知功能状态一致。研究结果在线发布在2013年3月的《关节炎护理及研究》（Arthritis Care & Research）杂志上。作者发现，CBT的干预与JFM患儿躯体活动的提高无关，CBT与提高躯体功能的干预措施联合应用能提高治疗效果。
该临床试验招募了114位青少年，年龄在11-18岁，这些研究对象来自儿童风湿病诊所，符合IFM的诊断标准。受试者随机（1：1）接受CBT治疗或者纤维肌痛教育（FE），受试者均穿戴一个臀部式加速度传感器一周，以便对基线和接受治疗后情况进行评价。
上述受试者中，记录检查数据完整的是68位（94%为女性，平均年龄15.2岁）。研究结果揭示体动记录仪的指标与自我感知功能改善不一致。尽管，CBT治疗组的自我感知功能改善与PE治疗组相比，在活动计数、久坐，中度或剧烈活动上均无显著差异；但是，CBT治疗后患儿的活动峰值和轻度活动更低。
能反映患者治疗效果的唯一资料来源是体动记录仪的检测。CBT的干预与JFM患儿躯体活动的提高无关，这一结果提示CBT与提高躯体功能的干预措施联合应用能提高治疗效果。
与纤维肌痛综合征相关的拓展阅读：

• ACR：神经肌肉损伤是纤维肌痛综合征患者功能受限的重要因素
• ACR：综合治疗对患纤维肌痛综合征的低教育水平女性长期有效
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Physical activity monitoring in adolescents with juvenile fibromyalgia: findings from a clinical trial of cognitive-behavioral therapy.
OBJECTIVE
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. Our objective was to analyze secondary data from a randomized clinical trial of CBT to examine whether 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 years) 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 1 week as part of their baseline and posttreatment assessments.
RESULTS
The final sample included 68 subjects (94% female, mean age 15.2 years) for whom complete actigraphy data were 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 posttreatment.
CONCLUSION
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.