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Self-management of persistent neck pain: 2-year follow-up of a randomized controlled trial of a multi-component group intervention in primary health care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
Karolinska Institutet, Department of Neurobiology, Care Science and Society.
2011 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, no 25, 2105-2115 p.Article in journal (Refereed) Published
Abstract [en]

Study design

A 2-year follow-up of a randomized controlled trial.

Objective

To compare long-term effects of a) a multi-component pain and stress self-management group intervention (PASS) and b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting.

Summary of Background Data

In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, e.g. maintenance of improvement and adherence to coping skills are sparsely investigated.

Methods

Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures.

Results

The study included 156 participants (PASS n=77, IAPT n=79). Between baseline, 10-week, 20-week, 1-year and 2-year follow-up, significant time by group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (p<0.001) and self-efficacy for performing activities in spite of pain (p=0.002), and the secondary outcome catastrophic thinking (p<0.001) but not in neck pain related disability.

Conclusions

The initial treatment effects of a self-management group intervention were largely maintained over a 2 year follow-up period and with a tendency to have superior long-term effects as compared to individually administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy and catastrophizing.

Place, publisher, year, edition, pages
2011. Vol. 36, no 25, 2105-2115 p.
Keyword [en]
coping, neck pain, randomized controlled trial, self-assessment questionnaire, self-management
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-134519DOI: 10.1097/BRS.0b013e3182028b04ISI: 000297270000010PubMedID: 21358487OAI: oai:DiVA.org:uu-134519DiVA: diva2:372800
Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Self-management of Persistent Neck Pain: A Multi-component Group Intervention in Primary Health Care
Open this publication in new window or tab >>Self-management of Persistent Neck Pain: A Multi-component Group Intervention in Primary Health Care
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate effects of a multi-component pain and stress self-management group intervention (PASS) and to explore plausible predictors associated with short-term and long-term treatment effects among patients with persistent tension-type neck pain in primary health care (PHC).

Study I was a pilot study in order to explore feasibility of the study design and methods. It included 37 participants randomly assigned to the intervention (n=18) or treatment-as-usual (n=19). Study II-III was a pragmatic randomized controlled trial that compared effects of the PASS and individually administered physiotherapy (IAPT) on patients with persistent tension-type neck pain in PHC. Study II evaluated short-term effects over a 20-week follow-up. Study III evaluated long-term effects on maintenance over a follow-up period of 2 years. Studies included 156 participants randomly assigned to PASS (n=77) or IAPT (n=79). Study IV explored predictive factors for favorable outcome in disability regarding participants assigned to PASS.

The results showed that PASS had better effects than IAPT regarding coping with pain, in terms of patients’ ability to control pain, self-efficacy regarding activities interfered with by pain, disability and catastrophizing, over the 20-week follow-up, and treatment effects were largely maintained over a 2-year follow-up. Post-treatment scores in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability 2 years post-treatment following PASS. Pre-treatment characteristics explained only a minor proportion of variance in disability, and were assumed weakly associated with treatment success and long-term outcome.

Key components for enhancement of long-term efficacy in pain self-management coping efforts were adequately targeted by PASS. It is suggested important to strengthen self-efficacy beliefs in regard to pain coping, to reduce disability and enhance pain self-management in the treatment of persistent neck pain, and to induce long-term maintenance of treatment gains on disability following a pain self-management intervention.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 629
Keyword
coping, neck pain, physiotherapy, predictors, randomized controlled trial, self-assessment questionnaire, self-management
National Category
Medical and Health Sciences Physiotherapy
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-134522 (URN)978-91-554-7965-7 (ISBN)
Public defence
2011-01-21, Centrum för Klinisk Forskning, Föreläsningssalen Falu lasarett, Nissers väg 3, Falun, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-12-22 Created: 2010-11-29 Last updated: 2011-01-13Bibliographically approved

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Gustavsson, CatharinaDenison, Eva

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