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Self-management of Persistent Neck Pain: 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.
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. , p. 89
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 629
Keywords [en]
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: urn:nbn:se:uu:diva-134522ISBN: 978-91-554-7965-7 (print)OAI: oai:DiVA.org:uu-134522DiVA, id: diva2:372811
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
List of papers
1. Applied relaxation in the treatment of long-lasting neck pain: a randomized controlled pilot study.
Open this publication in new window or tab >>Applied relaxation in the treatment of long-lasting neck pain: a randomized controlled pilot study.
2006 (English)In: J Rehabil Med, ISSN 1650-1977, Vol. 38, no 2, p. 100-7Article in journal (Other scientific) Published
Keywords
Adaptation; Psychological, Adolescent, Adult, Aged, Chronic Disease, Comparative Study, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neck Pain/psychology/rehabilitation/*therapy, Patient Participation, Physical Therapy Modalities, Pilot Projects, Questionnaires, Relaxation Techniques, Research Support; Non-U.S. Gov't, Self Concept, Stress; Psychological/therapy, Treatment Outcome
Identifiers
urn:nbn:se:uu:diva-81992 (URN)16546766 (PubMedID)
Available from: 2006-09-06 Created: 2006-09-06 Last updated: 2011-01-13
2. Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care
Open this publication in new window or tab >>Self-management of persistent neck pain: a randomized controlled trial of a multi-component group intervention in primary health care
2010 (English)In: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 14, no 6, p. 630.e1-630.e11Article in journal (Refereed) Published
Abstract [en]

Studies regarding self-management of persistent neck pain are infrequent. Objective: to compare treatment effects of (a) a multi-component pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) for patients with persistent musculoskeletal tension-type neck pain. Methods: Persons seeking physical therapy treatment due to persistent tension-type neck pain at nine primary health care centers in Sweden were randomly assigned to either PASS or IAPT. Before treatment (baseline) and at 10- and 20-weeks 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, the Fear-Avoidance Beliefs Questionnaire and questions regarding neck pain, analgesics and utilization of health care. Intention-to-treat analyses were performed using repeated measures analysis of variance between baseline, 10-week and 20-week follow-up. Results: One hundred and fifty six participants were included (PASS n=77, IAPT n=79). On average participants receiving PASS attended seven treatment sessions and participants receiving IAPT 11 sessions over the 20-week follow-up period. Repeated measures ANCOVA showed significant time x group interaction effects for ability to control pain (p<0.001), self-efficacy regarding pain-interfering activities (p=0.005), disability due to neck pain (p=0.001) and levels of catastrophic thinking (p<0.001) in favour of PASS. Conclusion: PASS had a better effect than IAPT in the treatment of persistent musculoskeletal tension-type neck pain regarding coping with pain, in terms of patients' self-reported pain control, self-efficacy, disability and catastrophizing, over the 20-week follow-up.

Keywords
Coping, Neck pain, Randomized controlled trial, Self-assessment questionnaire, Self-management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-134517 (URN)10.1016/j.ejpain.2009.10.004 (DOI)000280062700010 ()19939717 (PubMedID)
Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2017-12-12Bibliographically approved
3. 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
Open this publication in new window or tab >>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
2011 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 36, no 25, p. 2105-2115Article 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.

Keywords
coping, neck pain, randomized controlled trial, self-assessment questionnaire, self-management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-134519 (URN)10.1097/BRS.0b013e3182028b04 (DOI)000297270000010 ()21358487 (PubMedID)
Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2017-12-12Bibliographically approved
4. Predictive factors for disability outcome at 20 weeks and 2 years following a pain self-management group intervention in patients with persistent neck pain in primary health care
Open this publication in new window or tab >>Predictive factors for disability outcome at 20 weeks and 2 years following a pain self-management group intervention in patients with persistent neck pain in primary health care
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Study design. An explorative, longitudinal, prospective study, with measurement at baseline, 20 weeks and 2 years.

Objective. To explore plausible predictors associated with short-term (20 weeks) and long-term (2 years) treatment success in terms of pain-related disability for patients with persistent tension-type neck pain following a multi-component pain and stress self-management group intervention (PASS).

Summary of Background Data. In previously reported short-term and long-term follow-up, PASS had better effect on pain control, pain-related self-efficacy, disability and catastrophizing than a control treatment; individually administered physical therapy (IAPT). Identification of patients who are likely to benefit from particular interventions is required.

Methods. Data collected from 77 participants assigned to PASS in a randomized controlled trial were explored in order to identify plausible predictors of favorable outcome regarding pain-related disability as measured by the Neck Disability Index (NDI), by use of Pearson correlation analysis, factor analysis (FA) and partial least squares (PLS) and ordinary least squares (OLS) regression analyses. Data from self-assessment questionnaires completed by the participants before intervention, post-treatment (20 weeks) and at 2 years after the intervention, were used. The questionnaire comprised: the Self-Efficacy Scale (SES), the NDI, the Coping Strategies Questionnaire(CSQ), the Hospital Anxiety and Depression Scale (HADS) and questions regarding neck pain and analgesics.

Results. Multivariate PLS regression analysis showed that baseline scores in NDI, SES and pain intensity explained only 31% of the variance in disability (NDI) immediately post-treatment (20-week follow-up). PLS regression analysis showed that post-treatment scores in NDI, SES and pain intensity explained 68% of the variance in disability (NDI) at 2 years. Univariate OLS linear regression analyses indicated that each variable contributed significantly to the latter PLS regression model (NDI p<0.001, SES p<0.001, pain intensity p<0.001).

Conclusions. Treatment gains, as measured by immediate post-treatment scores at 20-week follow-up, in disability, self-efficacy and pain intensity were associated with long-term outcome in pain-related disability two years post-treatment, in patients with persistent neck pain participating in a self-management group intervention in PHC. Pre-treatment characteristics explained only a small proportion of variance in disability post-treatment. Thus, the intervention appears to be feasible for the majority of persons seeking PHC due to persistent tension-type neck pain.

Keywords
coping, neck pain, predictors, randomized controlled trial, self-assessment questionnaire, self-management
Identifiers
urn:nbn:se:uu:diva-134520 (URN)
Available from: 2010-11-29 Created: 2010-11-29 Last updated: 2011-01-13

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