S. Flowers

Clinical utility and validity of the Functional Disability Inventory among a multicenter sample of youth with chronic pain.

&NA; The Functional Disability Inventory (FDI) is a well‐established and commonly used measure of physical functioning and disability in youth with chronic pain. Further validation of the measure has been called for, in particular, examination of the clinical utility and factor structure of the measure. To address this need, we utilized a large multicenter dataset of pediatric patients with chronic pain who had completed the FDI and other measures assessing pain and emotional functioning. Clinical reference points to allow for interpretation of raw scores were developed to enhance clinical utility of the measure, and exploratory factor analysis was performed to examine its factor structure. Participants included 1300 youth ages 8 to 18 years (mean = 14.2 years; 76% female) with chronic pain. Examination of the distribution of FDI scores and validation with measures of depressive symptoms and pain intensity yielded 3 distinct categories of disability: No/Minimal Disability, Moderate Disability, and Severe Disability. Factor analysis of FDI scores revealed a 2‐factor solution representing vigorous Physical Activities and non‐physically strenuous Daily Activities. The 3‐level classification system and factor structure were further explored via comparison across the 4 most commonly encountered pain conditions in clinical settings (head, back, abdominal, and widespread pain). Our findings provide important new information regarding the clinical utility and validity of the FDI. This will greatly enhance the interpretability of scores for research and clinical use in a wide range of pediatric pain conditions. In particular, these findings will facilitate use of the FDI as an outcome measure in future clinical trials. Clinical reference points and a preliminary factor structure for the Functional Disability Inventory (FDI) increase the clinical and research utility of the measure.

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

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.

A Survey of Conventional and Complementary Therapies Used by Youth with Juvenile-Onset Fibromyalgia

Little is known regarding treatment choices of youth diagnosed with juvenile-onset fibromyalgia (JFM) as they move into young adulthood. Additionally, there is little empirical evidence to guide youth with FM into appropriate treatment options, leading to a variety of therapies used to manage FM symptoms. The purpose of this descriptive study was to examine all therapies used by individuals with JFM as they entered young adulthood and the perceived effectiveness of these treatments. As part of a larger follow-up study, participants completed a web-based survey of all current and past treatments received for FM symptoms 2 years after their initial presentation and diagnosis at a pediatric rheumatology clinic. One hundred ten out of 118 eligible patients participated in the follow-up assessment as young adults (mean age 18.97 years; 93.6% female). A majority of participants reported use of conventional medications (e.g., antidepressants, anticonvulsants) and nondrug therapies (e.g., psychotherapy). Currently and within the past 2 years, antidepressant medications were the most commonly used to manage FM. Complementary treatments were used less often, with massage being the most popular choice. Although currently used treatments were reported as being effective, past treatments, especially medications, were viewed as being more variably effective. This is a potential reason why young adults with JFM might try more complementary and alternative approaches to managing their symptoms. More controlled studies are needed to investigate the effectiveness of these complementary methods to assist treatment providers in giving evidence-based treatment recommendations.

Measures of juvenile fibromyalgia: Functional Disability Inventory (FDI), Modified Fibromyalgia Impact Questionnaire–Child Version (MFIQ-C), and Pediatric Quality of Life Inventory (PedsQL) 3.0 Rheumatology Module Pain and Hurt Scale

Juvenile fibromyalgia (FM) is a chronic noninflammatory musculoskeletal pain condition typically diagnosed in adolescence. Juvenile FM is characterized by diffuse widespread pain, multiple painful tender points, sleep difficulty, fatigue, and other associated symptoms (1). Juvenile FM is also associated with considerable difficulty in physical, social, and emotional functioning (2–9). At present, there are no specific medical tests or disease markers to diagnose this condition, and assessment of symptoms and their impact is primarily by patient report. As noted by the Outcome Measures in Rheumatology Clinical Trials Fibromyalgia Syndrome Workgroup (10), a multidimensional assessment of FM syndrome is essential. Such an assessment should include measures of pain, fatigue, sleep, overall functioning, and quality of life. In patients with juvenile FM, research studies have traditionally utilized more generic pediatric measures that are applicable for many pain conditions. Only one measure has been specifically modified for use in juvenile FM: the Modified Fibromyalgia Impact Questionnaire– child version. In the following sections, we discuss 3 measures that can be used for assessment in juvenile FM, i.e., the Functional Disability Inventory (FDI), the Modified Fibromyalgia Impact Questionnaire– child version, and the Pediatric Quality of Life 3.0 Rheumatology Module Pain and Hurt scale. Measures used to assess pain characteristics, fatigue, and sleep used in pediatric pain disorders, including juvenile FM, are discussed in detail in the Measures of Pathology and Symptoms section in this issue.