BEHAVIORAL PREPARATION FOR TREATING FIBROMYALGIA

描述：纤维肌痛综合征(FMS)是一种流行的慢性肌肉骨骼疼痛疾病。尽管没有治疗方法被证明是普遍有效的，但研究表明，包括积极体育锻炼和应对技能训练在内的多模式康复方法可以减少FMS的各种症状。然而，治疗反应有很大的变异性。由于康复方法需要患者采用一套新的视角和行为，这种方法的临床益处在很大程度上取决于患者的准备和遵守方案的意愿。过去的研究表明，成功的结果需要患者有改变的意图，对改变有有效的信念，并有能力进行改变的过程。在这一修改的应用中，我们建议评估应对技能训练和动机增强疗法的临床效果，为久坐的FMS患者准备康复方法。总共将对300名患者进行筛查。符合条件的患者将接受每周10次2小时的治疗，包括积极锻炼、物理治疗教育，以及三种行为准备计划之一：应对技能培训计划(CST)、动机增强计划(MET)或教育讲座(EDS)。前6周的10个小时的治疗时间和计划结束时额外的1个小时将专门用于行为准备。所有患者从第5周到第10周接受1小时的积极体育锻炼，在第7周到第9周接受1小时的体育课。在治疗前、治疗后和6个月的随访阶段，将进行综合评估，包括在诊所进行医学、身体和心理评估，以及为期一周的家庭评估方案，检查日常症状、活动水平和睡眠质量。在12个月的随访中，每个患者都将接受家庭评估方案和问卷评估。我们还将为每个准备计划描绘与临床有意义的结果相关的因素，并测试调解途径，以更好地了解通过康复改善临床的机制。我们期望这项研究的结果将有助于更好地理解动力增强如何在许多慢性疼痛情况下增加康复方法的临床益处。

DESCRIPTION: Fibromyalgia syndrome (FMS) is a prevalent, chronic musculoskeletal pain disorder. Although no treatment has been shown to be universally effective, research suggests that a multimodal rehabilitative approach including active physical exercise and coping skill training reduces various symptoms of FMS. Nevertheless, there is large variability in treatment response. Since the rehabilitative approach requires patients to adopt a set of new perspectives and behaviors, the clinical benefit of such approach largely depends upon patient readiness and willingness to comply with the regimen. Past research suggests that successful outcomes require patient intent to change, efficacious beliefs about change, and ability to undertake process of change. In this amended application, we propose to evaluate the clinical efficacy of coping skill training and motivation enhancement therapy to prepare sedentary FMS patients to a rehabilitative approach. A total of 300 patients will be screened. Eligible patients will undergo a 10 2-hour weekly treatment sessions consisting of active exercise, physical therapy education, and one of the three behavioral preparation programs: Coping Skill Training program (CST), Motivation Enhancement program (MET), or Educational Lectures (EDS). Ten hours of the therapy hours across the first 6 weeks and one additional hour at the end of the program will be dedicated to behavioral preparation. All patients will receive one hour active physical exercise from Week 5 to Week10 and one hour physical education in Week 7 through Week 9. A comprehensive evaluation including medical, physical, and psychological assessments at the clinic and a home assessment protocol examining daily symptoms, activity levels, and sleep quality for one week will be performed at pre-treatment, post-treatment, and 6 month follow-up phases. At 12 month follow-up, each patient will undergo the home assessment protocol and questionnaire assessment. We will also delineate factors associated with clinically meaningful outcomes for each preparation program and to test mediation paths to better understand the mechanisms of clinical improvement via rehabilitation. We expect that results from this study will facilitate better understanding of how motivation enhancement augments clinical benefit of rehabilitative approach for many chronic pain conditions.