Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial.
OBJECTIVE
The MUSICIAN study has previously shown short-term benefit but only marginal cost-effectiveness for two non-pharmacological interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness.


METHODS
A 2×2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their general practitioner. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health.


RESULTS
884 persons were eligible, 442 were randomised and 81.7% were followed up 24 months post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI (1.8 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs. Cost per quality adjusted life year was £3957-£5917 depending on method of analysis.


CONCLUSIONS
A short course of tCBT for people with CWP was effective long-term and was highly cost-effective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage for patients receiving both interventions.


BACKGROUND
ISRCTN67013851.
Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Marcus
M
Beasley
Medical Statistics Team , Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Gordon J
GJ
Prescott
Health Economic Research Unit , Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Graham
G
Scotland
Arthritis Research UK Centre of Excellence in Primary Care, Keele University , Keele, Staffordshire , UK.
John
J
McBeth
School of Nursing, Midwifery and Social Work, The University of Manchester , Manchester , UK.
Karina
K
Lovell
School of Nursing, Midwifery and Social Work, The University of Manchester , Manchester , UK.
Phil
P
Keeley
Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Philip C
PC
Hannaford
Arthritis Research UK Centre for Epidemiology, The University of Manchester , Manchester , UK.
Deborah P M
DP
Symmons
Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Ross I R
RI
MacDonald
Research and Development Department , The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital , Manchester , UK.
Steve
S
Woby
Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Gary J
0000-0003-2322-3314
GJ
Macfarlane
Economic Evaluations; Fibromyalgis/Pain Syndromes; Psychology