title: Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness: A Cluster-randomized Trial.
abstract: BACKGROUND
  Because of methodological flaws and a lack of theoretical foundation of body awareness (BA) in previous effect studies of interventions directed to stimulate BA, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluated short-term and long-term effects of a multidisciplinary pain rehabilitation program with and without psychomotor therapy (PMT), which focused on BA (measured by the scale of body connection) as a primary target of intervention.
  
  
  METHODS
  Ninety-four patients clustered in 20 treatment groups were cluster randomized, using a biased-coin design, to multidisciplinary treatment as usual with or without PMT. Outcome variables were health-related quality of life, disability, and depression. BA, catastrophizing, and self-efficacy were measured as potential process variables. Assessments were performed at baseline, directly after treatment, and at 3, 6, and 12 month follow-ups. The data were analyzed by linear mixed-model analysis according to the intention-to-treat principle.
  
  
  RESULTS
  Data of all 94 patients were used for analyses. After treatment, significant differences favoring PMT were found between conditions on depression (regression coefficient [RC]=-5.01; 95% confidence interval [CI], -8.81 to -1.21), BA (RC=0.23; 95% CI, 0.04 to 0.42) and catastrophizing (RC=-4.76; 95% CI, -8.03 to -1.48). These differences were no longer significant for depression at the 3-month follow-up and for catastrophizing at the 6-month follow-up.
  
  
  CONCLUSIONS
  No clinical meaningful differences were found between treatment conditions in the primary outcome measures health-related quality of life and disability. However, this is the first long-term RCT that has shown that PMT improves BA in patients with chronic pain and shows good effect size and a significant decrease for catastrophizing.
authors.affiliation: *Human Movement and Education Division ¶Health Care and Social Work Division, University of Applied Sciences Windesheim, Zwolle †Reade, Centre of Rehabilitation and Rheumatology ‡Amsterdam Rehabilitation Research Centre Reade §MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences **Department of Health Sciences, VU University #Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam ∥Adelante Expertise Centre Pain Rehabilitation, Hoensbroek ††Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
authors.forename: Lia C C
authors.initials: LC
authors.lastname: Van der Maas
authors.forename: Albère
authors.initials: A
authors.lastname: Köke
authors.forename: Menno
authors.initials: M
authors.lastname: Pont
authors.forename: Ruud J
authors.initials: RJ
authors.lastname: Bosscher
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.forename: Thomas W J
authors.initials: TW
authors.lastname: Janssen
authors.forename: Madelon L
authors.initials: ML
authors.lastname: Peters
mesh_terms: D000328:Adult; D001364:Awareness; D058443:Catastrophization / Q000628:therapy; D059350:Chronic Pain / Q000523:psychology / Q000534:rehabilitation*; D003863:Depression / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000523:psychology / Q000534:rehabilitation*; D009426:Netherlands; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D012047:Rehabilitation Centers; D012649:Self Concept; D013997:Time Factors; D016896:Treatment Outcome