Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care.
This study examined long-term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One-hundred and twenty-two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow-up assessments two-year post-treatment were completed by 65 participants. According to per-protocol analyses, short-term effects were maintained in both groups for the primary outcome, pain-related disability. The TBT-group reported lower disability levels compared with the EBT-group. Intention-to-treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self-efficacy were maintained over the 2-year post-treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT-group, and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT. The study supports tailoring of treatments in concordance with patients' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability, for successful immediate outcomes and their maintenance in the long run. Exercise-based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period.
Senlöf
Pernilla
P
Department of Neuroscience, Section of Physiotherapy, Uppsala University, 751 85 Uppsala, Sweden. pernilla.asenlof@neuro.uu.se
Denison
Eva
E
Lindberg
Per
P
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D001521:Behavior Therapy; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005081:Exercise Therapy; D005239:Fear / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D009068:Movement / Q000502:physiology; D009140:Musculoskeletal Diseases / Q000523:psychology* / Q000628:therapy*; D010146:Pain / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D010349:Patient Compliance; D010352:Patient Dropouts; D017060:Patient Satisfaction; D011320:Primary Health Care; D020377:Self Efficacy; D018582:Sick Leave; D013548:Sweden
D000700:Analgesics