title: Cognitive behavior therapy, exercise, or both for treating chronic widespread pain.
abstract: BACKGROUND
  The clinical impact of telephone-delivered cognitive behavioral therapy (TCBT), exercise, or a combined intervention in primary care patients with chronic widespread pain (CWP) is unclear.
  
  
  METHODS
  A total of 442 patients with CWP (meeting the American College of Rheumatology criteria) were randomized to receive 6 months of TCBT, graded exercise, combined intervention, or treatment as usual (TAU). The primary outcome, using a 7-point patient global assessment scale of change in health since trial enrollment (range: very much worse to very much better), was assessed at baseline and 6 months (intervention end) and 9 months after randomization. A positive outcome was defined as "much better" or "very much better." Data were analyzed using logistic regression according to the intention-to-treat principle.
  
  
  RESULTS
  The percentages reporting a positive outcome at 6 and 9 months, respectively, were TAU group, 8% and 8%; TCBT group, 30% and 33%; exercise group, 35% and 24%; and combined intervention group, 37% and 37% (P < .001). After adjustment for age, sex, center, and baseline predictors of outcome, active interventions improved outcome compared with TAU: TCBT (6 months: odds ratio [OR], 5.0 [95% CI, 2.0-12.5]; 9 months: OR, 5.4 [95% CI, 2.3-12.8]), exercise (6 months: OR, 6.1 [95% CI, 2.5-15.1]; 9 months: OR, 3.6 [95% CI, 1.5-8.5]), and combined intervention (6 months: OR, 7.1 [95% CI, 2.9-17.2]; 9 months: OR, 6.2 [95% CI, 2.7-14.4]). At 6 and 9 months, combined intervention was associated with improvements in the 36-Item Short Form Health Questionnaire physical component score and a reduction in passive coping strategies. Conclusions on cost-effectiveness were sensitive to missing data.
  
  
  CONCLUSIONS
  TCBT was associated with substantial, statistically significant, and sustained improvements in patient global assessment.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: ISRCTN67013851.
authors.affiliation: Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, England. john.mcbeth@manchester.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: McBeth
authors.forename: Gordon
authors.initials: G
authors.lastname: Prescott
authors.forename: Graham
authors.initials: G
authors.lastname: Scotland
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.forename: Philip
authors.initials: P
authors.lastname: Keeley
authors.forename: Phil
authors.initials: P
authors.lastname: Hannaford
authors.forename: Paul
authors.initials: P
authors.lastname: McNamee
authors.forename: Deborah P M
authors.initials: DP
authors.lastname: Symmons
authors.forename: Steve
authors.initials: S
authors.lastname: Woby
authors.forename: Chrysa
authors.initials: C
authors.lastname: Gkazinou
authors.forename: Marcus
authors.initials: M
authors.lastname: Beasley
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D015444:Exercise; D005260:Female; D005356:Fibromyalgia / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D016896:Treatment Outcome