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Individually tailored treatment targeting activity, motor behavior, and cognitions reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
2005 (English)In: Pain forum, ISSN 1082-3174, The Journal of Pain, Vol. 6, no 9, 588-603 p.Article in journal (Refereed) Published
Abstract [en]

This study compares the outcomes of an individually tailored behavioral medicine intervention (experimental) with physical exercise therapy (control). The experimental intervention was systematically individualized according to each participant’s behavioral treatment goals and functional behavioral analyses. One hundred twenty-two patients seeking care at 3 primary health care clinics because of musculoskeletal pain were randomized. Ninety-seven completed the trial. Data were collected at baseline, immediately after treatment, and at a 3-month follow-up. Analyses of data from completers, as well as intention-to-treat analyses, showed that the experimental group experienced lower levels of disability (P = .01), lower maximum pain intensity (P = .02), higher levels of pain control (P = .001), and lower fear of movement (P = .022) as a result of treatment condition. Self-efficacy (P = .0001) and physical performance (P = .0001) increased over time for both groups. Participants in the experimental group generally reported more positive effects after treatment. Treatment fidelity was maintained during the course of the study. Activity can be resumed and pain might be managed by the patients themselves if treatment incorporates the biopsychosocial explanatory model of pain and strategies are tailored according to individual’s priorities of everyday life activities and empirically derived determinants of pain-related disability.

Place, publisher, year, edition, pages
2005. Vol. 6, no 9, 588-603 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-93014DOI: 10.1016/j.jpain.2005.03.008OAI: oai:DiVA.org:uu-93014DiVA: diva2:166361
Available from: 2005-04-27 Created: 2005-04-27 Last updated: 2015-11-23Bibliographically approved
In thesis
1. Individually Tailored Treatment in the Management of Musculoskeletal Pain: Development and Evaluation of a Behavioural Medicine Intervention in Primary Health Care
Open this publication in new window or tab >>Individually Tailored Treatment in the Management of Musculoskeletal Pain: Development and Evaluation of a Behavioural Medicine Intervention in Primary Health Care
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis deals with clinical pain intervention research from a behavioural medicine perspective. The general aim was to develop and evaluate an individually tailored treatment protocol focused on pain management in everyday life in people who experience persistent musculoskeletal pain. Another aim was to develop and incorporate an idiographic outcome measure for behavioural goal assessment in the formal evaluation of the clinical significance of treatment outcomes.

The studies were conducted in a primary health care setting demonstrating a contribution from physical therapists in the field of behavioural medicine. Two separate samples of patients with musculoskeletal pain with a duration exceeding one month, n = 197 (Study I, descriptive and correlational design), and n = 97/82 (Study III/IV, randomized group-study) were included. In addition, four women were recruited for a series of experimental single-case studies (Study II).

The treatment protocol that was individually tailored to each participant’s behavioural treatment goals and assumed determinants of pain-related disability was more effective in reducing pain-related disability, pain intensity, fear-avoidance, and in increasing pain control when compared to an intervention including physical exercises. The individually tailored treatment was generally more beneficial for resumption of everyday life activity, increasing satisfaction, fulfilling pre-treatment expectations, and in preparing individuals for self-management of pain. The Patient Goal Priority Questionnaire that was elaborated over the course of the project can be used to a) identify and assess behavioural treatment goals, b) elaborate individual functional behavioural analyses relevant for everyday life functioning, and c) determine the clinical significance of treatment outcomes – that is, whether interventions produce outcomes of relevance for each individual’s everyday life. The inclusion of idiographic outcome measures in clinical pain intervention research is necessary and improves the ecological validity of the evaluation of clinical significance.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 94 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 35
Keyword
Caring sciences, behavioural medicine, goal assessment, tailored treatment, chronic pain, physical therapy, primary health care, Vårdvetenskap
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-5781 (URN)91-554-6240-5 (ISBN)
Public defence
2005-05-20, Sal X, Universitetshuset, Uppsala, 13:15
Opponent
Supervisors
Available from: 2005-04-27 Created: 2005-04-27Bibliographically approved

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Åsenlöf, PernillaLindberg, Per

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