Conversion From In-Person to Remote Delivery of Neuromuscular Training to Treat Chronic Pain in Adolescents

Juvenile fibromyalgia (JFM) is a chronic, disabling, and widespread musculoskeletal pain condition accompanied by many comorbid symptoms. Current guidelines recommend multidisciplinary care, including physical therapy and cognitive behavioral therapy (CBT). Regular aerobic training and strengthening exercises are useful in treating fibromyalgia and are often recommended under the care of trained professionals. In 2020, COVID-19 caused nationwide disruption in health care, requiring health care practices to allow for treatment through telehealth platforms. The Fibromyalgia Integrative Training (FIT Teens) program used in-person, group-based CBT combined with neuromuscular training (NMT) for adolescents with fibromyalgia and suspended treatment sessions under COVID-19 restrictions. The behavioral and exercise components were converted to a remotely delivered program to maintain treatment options. This article reviews the process of modifying the NMT protocol, including practical and clinical considerations, and highlights the benefits and limitations of remote delivery. The remote NMT program maintains the principal components of the in-person program and allows continued access to treatment during the pandemic. Many aspects of health care that have been converted to telehealth may likely offer these types of treatment in the future. Hence, the learnings of the FIT Teens project may be useful in designing future remote exercise interventions.