title: Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review.
abstract: OBJECTIVE
  The objective of the study was to report the evidence for effectiveness of different self-management course characteristics and components for chronic musculoskeletal pain.
  
  
  METHODS
  We searched 9 relevant electronic databases for randomized, controlled trials (RCTs). Two reviewers selected studies against inclusion criteria and assessed their quality. We classified RCTs according to type of course delivery (group, individual, mixed or remote), tutor (healthcare professional, lay or mixed), setting (medical, community or occupational), duration (more or less than 8 weeks), and the number and type of components (psychological, lifestyle, pain education, mind body therapies, and physical activity). We extracted data on pain intensity, physical function, self-efficacy, global health, and depression and compared these outcomes for self-management and usual care or waiting list control. We used random effects standardized mean difference meta-analysis. We looked for patterns of clinically important and statistically significant beneficial effects for courses with different delivery characteristics and the presence or absence of components across outcomes over 3 follow-up intervals.
  
  
  RESULTS
  We included 46 RCTs (N=8539). Group-delivered courses that had healthcare professional input showed more beneficial effects. Longer courses did not necessarily give better outcomes. There was mixed evidence of effectiveness for components of courses, but data for courses with a psychological component showed slightly more consistent beneficial effects over each follow-up period.
  
  
  CONCLUSIONS
  Serious consideration should be given to the development of short (<8 weeks) group and healthcare professional-delivered interventions but more research is required to establish the most effective and cost-effective course components.
authors: Barts and London School of Medicine and Dentistry, Centre for Health Sciences, Queen Mary University of London, UK. d.carnes@qmul.ac.uk
authors: Dawn
authors: D
authors: Carnes
authors: Kate E
authors: KE
authors: Homer
authors: Clare L
authors: CL
authors: Miles
authors: Tamar
authors: T
authors: Pincus
authors: Martin
authors: M
authors: Underwood
authors: Anisur
authors: A
authors: Rahman
authors: Stephanie J C
authors: SJ
authors: Taylor
mesh_terms: D059350:Chronic Pain / Q000628:therapy; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D006801:Humans; D059352:Musculoskeletal Pain / Q000523:psychology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012648:Self Care