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The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis.

ABSTRACT: Generic self-management programs aim to facilitate behavioural adjustment and therefore have considerable potential for patients with chronic musculoskeletal pain. Our main objective was to collect and synthesize all data on the effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain in terms of physical function, self-efficacy, pain intensity and physical activity. Our secondary objective was to describe the content of these interventions, by means of classification according to the Behaviour Change Technique Taxonomy. We searched PubMed, CENTRAL, Embase and Psycinfo for eligible studies. Study selection, data extraction and risk of bias were assessed by two researchers independently. Meta-analyses were only performed if the studies were sufficiently homogeneous and GRADE was used to determine the quality of evidence. We identified 20 randomized controlled trials that compared a self-management intervention to any type of control group. For post-intervention results, there was moderate quality evidence of a statistically significant but clinically unimportant effect for physical function and pain intensity, both favouring the self-management group. At follow-up, there was moderate quality evidence of a small clinically insignificant effect for self-efficacy, favouring the self-management group. All other comparisons did not indicate an effect. Classification of the behaviour change techniques showed large heterogeneity across studies. These results indicate that generic self-management interventions have a marginal benefit for patients with chronic musculoskeletal pain in the short-term for physical function and pain intensity and for self-efficacy in the long-term, and vary considerably with respect to intervention content. SIGNIFICANCE:This study contributes to a growing body of evidence that generic self-management interventions have limited effectiveness for patients with chronic musculoskeletal pain. Furthermore, this study has identified substantial differences in both content and delivery mode across self-management interventions.

SUBMITTER: Elbers S

PROVIDER: S-EPMC6175326 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis.

Elbers S S Wittink H H Pool J J M JJM Smeets R J E M RJEM

European journal of pain (London, England) 20180627 9

Generic self-management programs aim to facilitate behavioural adjustment and therefore have considerable potential for patients with chronic musculoskeletal pain. Our main objective was to collect and synthesize all data on the effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain in terms of physical function, self-efficacy, pain intensity and physical activity. Our secondary objective was to describe the content of these interventions, by means ...[more]

PMID: 29845678

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Project description:BackgroundIndividuals with persistent musculoskeletal pain (PMP) have an increased risk of developing co-morbid health conditions and for early-mortality compared to those without pain. Despite irrefutable evidence supporting the role of physical activity in reducing these risks; there has been limited synthesis of the evidence, potentially impacting the optimisation of these forms of interventions. This review examines the effectiveness of interventions in improving levels of physical activity and the components of these interventions.MethodsRandomised and quasi-randomised controlled trials were included in this review. The following databases were searched from inception to March 2016: CENTRAL in the Cochrane Library, Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two reviewers independently screened citations, assessed eligibility, extracted data, assessed risk of bias and coded intervention content using the behaviour change taxonomy (BCTTv1) of 93 hierarchically clustered techniques. GRADE was used to rate the quality of the evidence.ResultsThe full text of 276 articles were assessed for eligibility, twenty studies involving 3441 participants were included in the review. Across the studies the mean number of BCTs coded was eight (range 0-16); with 'goal setting' and 'instruction on how to perform the behaviour' most frequently coded. For measures of subjective physical activity: interventions were ineffective in the short term, based on very low quality evidence; had a small effect in the medium term based on low quality evidence (SMD 0.25, 95% CI 0.01 to 0.48) and had a small effect in the longer term (SMD 0.21 95% CI 0.08 to 0.33) based on moderate quality evidence. For measures of objective physical activity: interventions were ineffective - based on very low to low quality evidence.ConclusionsThere is some evidence supporting the effectiveness of interventions in improving subjectively measured physical activity however, the evidence is mostly based on low quality studies and the effects are small. Given the quality of the evidence, further research is likely/very likely to have an important impact on our confidence in effect estimates and is likely to change the estimates. Future studies should provide details on intervention components and incorporate objective measures of physical activity.

Project description:BackgroundMusculoskeletal conditions are the second greatest contributor to disability worldwide and have significant individual, societal, and economic implications. Due to the growing burden of musculoskeletal disability, an integrated and strategic response is urgently required. Digital health interventions provide high-reach, low-cost, readily accessible, and scalable interventions for large patient populations that address time and resource constraints.ObjectiveThis review aimed to investigate if digital health interventions are effective in reducing pain and functional disability in patients with musculoskeletal conditions.MethodsA systematic review was undertaken to address the research objective. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews before commencement of the study. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature, and Scopus from January 1, 2000, to November 15, 2019, using search terms and database specific-medical subject headings terms in various combinations appropriate to the research objective.ResultsA total of 19 English language studies were eligible for inclusion. Of the 19 studies that assessed musculoskeletal pain, 9 reported statistically significant reductions following digital intervention. In all, 16 studies investigated functional disability; 10 studies showed a statistically significant improvement. Significant improvements were also found in a range of additional outcomes. Due to the heterogeneity of the results, a meta-analysis was not feasible.ConclusionsThis review has demonstrated that digital health interventions have some clinical benefits in the management of musculoskeletal conditions for pain and functional disability. Digital health interventions have the potential to contribute positively toward reducing the multifaceted burden of musculoskeletal conditions to the individual, economy, and society.Trial registrationPROSPERO CRD42018093343; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=93343.

Project description:BackgroundClinical guidelines for nonspecific low back pain (LBP) recommend self-management tailored to individual needs and capabilities as a first-line treatment. Mobile health solutions are a promising method for delivering tailored self-management interventions to patients with nonspecific LBP. However, it is not clear if the effectiveness of such self-management interventions depends on patients' initial pain characteristics. High pain intensity and long-term symptoms of LBP have been associated with an unfavorable prognosis, and current best evidence indicates that long-term LBP (lasting more than 3 months) requires a more extensive treatment approach compared to more acute LBP. The artificial intelligence-based selfBACK app supports tailored and evidence-based self-management of nonspecific LBP. In a recent randomized controlled trial, we showed that individuals who received the selfBACK app in addition to usual care had lower LBP-related disability at the 3-month follow-up compared to those who received usual care only. This effect was sustained at 6 and 9 months.ObjectiveThis study aims to explore if the baseline duration and intensity of LBP influence the effectiveness of the selfBACK intervention in a secondary analysis of the selfBACK randomized controlled trial.MethodsIn the selfBACK trial, 461 adults (18 years or older) who sought care for nonspecific LBP in primary care or at an outpatient spine clinic were randomized to receive the selfBACK intervention adjunct to usual care (n=232) or usual care alone (n=229). In this secondary analysis, the participants were stratified according to the duration of the current LBP episode at baseline (≤12 weeks vs >12 weeks) or baseline LBP intensity (≤5 points vs >5 points) measured by a 0-10 numeric rating scale. The outcomes were LBP-related disability measured by the Roland-Morris Disability Questionnaire (0- to 24-point scale), average LBP intensity, pain self-efficacy, and global perceived effect. To assess whether the duration and intensity of LBP influenced the effect of selfBACK, we estimated the difference in treatment effect between the strata at the 3- and 9-month follow-ups with a 95% CI.ResultsOverall, there was no difference in effect for patients with different durations or intensities of LBP at either the 3- or 9-month follow-ups. However, there was suggestive evidence that the effect of the selfBACK intervention on LBP-related disability at the 3-month follow-up was largely confined to people with the highest versus the lowest LBP intensity (mean difference between the intervention and control group -1.8, 95% CI -3.0 to -0.7 vs 0.2, 95% CI -1.1 to 0.7), but this was not sustained at the 9-month follow-up.ConclusionsThe results suggest that the intensity and duration of LBP have negligible influence on the effectiveness of the selfBACK intervention on LBP-related disability, average LBP intensity, pain self-efficacy, and global perceived effect.

Project description:BackgroundChronic musculoskeletal pain is highly prevalent, affecting around one in five people across Europe. Osteoarthritis, low back pain, neck pain and other musculoskeletal disorders are leading causes of disability worldwide and the most common source of chronic pain. Exercise and/or physical activity interventions have the potential to address not only the pain and disability associated with chronic pain but also the increased risk of morbidity and mortality seen in this population. Although exercise and/or physical activity is widely recommended, there is currently a paucity of research that offers an evidence base upon which the development or optimisation of interventions can be based. This systematic review will investigate the components of interventions associated with changes in physical activity levels in adults with chronic musculoskeletal pain.Methods/designThis systematic review will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidance. Randomised and quasi-randomised controlled trials of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain will be included. Articles will be identified through a comprehensive search of the following databases: CENTRAL in the Cochrane Library, the Cochrane Database of Systematic Reviews (CDSR), MEDLINE, Embase, CINAHL, PsycINFO and AMED. Two review authors will independently screen articles retrieved from the search for eligibility, extract relevant data on methodological issues and code interventions according to the behaviour change technique taxonomy (v1) of 93 hierarchically clustered techniques. As complex healthcare interventions can be modified by a wide variety of factors, data will be summarised statistically when the data are available, are sufficiently similar and are of sufficient quality. A narrative synthesis will be completed if there is insufficient data to permit a formal meta-analysis.DiscussionThis review will be of value to clinicians working in chronic pain services and to researchers involved in designing and evaluating interventions.Systematic review registrationPROSPERO reference: CRD42014010640.

Dataset Information

The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis.

Publications

The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis.

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