title: A 9-year follow-up of a self-management group intervention for persistent neck pain in primary health care: a randomized controlled trial.
abstract: OBJECTIVE
  In previous short-term and 2-year follow-ups, a pain and stress self-management group intervention (PASS) had better effect on pain-related disability, self-efficacy, catastrophizing, and perceived pain control than individually administered physiotherapy (IAPT) for patients with persistent tension-type neck pain. Studies that have evaluated long-term effects of self-management approaches toward persistent neck pain are sparse. The objective of this study was to compare pain-related disability, self-efficacy for activities of daily living (ADL), catastrophizing, pain, pain control, use of analgesics, and health care utilization in people with persistent tension-type neck pain 9 years after they received the PASS or IAPT.
  
  
  METHODS
  Of 156 people (PASS, n = 77; IAPT, n = 79) originally included in a randomized controlled trial, 129 people (PASS, n = 63; IAPT, n = 66) were eligible and were approached for the 9-year follow-up. They were sent a self-assessment questionnaire, comprising the Neck Disability Index, the Self-Efficacy Scale, the Coping Strategies Questionnaire, and questions regarding pain, analgesics, and health care utilization. Mixed linear models for repeated measures analysis or generalized estimating equations were used to evaluate the differences between groups and within groups over time (baseline, previous follow-ups, and 9-year follow-up) and the interaction effect of "time by group".
  
  
  RESULTS
  Ninety-four participants (73%) responded (PASS, n = 48; IAPT, n = 46). At 9 years, PASS participants reported less pain-related disability, pain at worst, and analgesics usage, and a trend toward better self-efficacy compared to IAPT participants. There was a difference between groups in terms of change over time for disability, self-efficacy for ADL, catastrophizing, perceived pain control, and health care visits in favor of PASS. Analyses of simple main effects at 9 years showed that the PASS group had less disability (p= 0.006) and a trend toward better self-efficacy (p= 0.059) than the IAPT group.
  
  
  CONCLUSIONS
  The favorable effects on pain-related disability of PASS were sustained 9 years after the intervention.
authors.affiliation: Center for Clinical Research Dalarna, Department of Public Health and Caring Science, Uppsala University, Uppsala; School of Education, Health and Social Studies, Dalarna University, Falun.
authors.forename: Catharina
authors.initials: C
authors.lastname: Gustavsson
authors.affiliation: Center for Clinical Research Dalarna, Department of Public Health and Caring Science, Uppsala University, Uppsala; Department of Neurobiology, Care Science and Society, Karolinska Institutet; Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
keywords: activities of daily living; disability; musculoskeletal pain; self-efficacy; self-management; tension-type neck pain