Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care

被引:53
作者
Asenlof, Pernilla [1 ]
Denison, Eva [3 ]
Lindberg, Per [2 ]
机构
[1] Uppsala Univ, Dept Neurosci, Sect Physiotherapy, S-75185 Uppsala, Sweden
[2] Uppsala Univ, Dept Psychol, S-75185 Uppsala, Sweden
[3] Malardalen Univ, Dept Caring & Publ Hlth Sci, Vasteras, Sweden
关键词
Chronic pain; Behavioural medicine; Tailored treatment; Physical exercise; Primary care; LOW-BACK-PAIN; SELF-EFFICACY; FEAR-AVOIDANCE; DISABILITY INDEX; INTENSITY; PROGRAM; VALIDITY; BELIEFS; MODEL; STATE;
D O I
10.1016/j.ejpain.2009.01.010
中图分类号
R614 [麻醉学];
学科分类号
100217 [麻醉学];
摘要
This study examined long-term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One-hundred and twenty-two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow-up assessments two-year post-treatment were completed by 65 participants. According to per-protocol analyses, short-term effects were maintained in both groups for the primary outcome, pain-related disability. The TBT-group reported lower disability levels compared with the EBT-group. Intention-to-treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self-efficacy were maintained over the 2-year post-treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT-group, and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT. The study supports tailoring of treatments in concordance with patients' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability, for successful immediate outcomes and their maintenance in the long run. Exercise-based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period. (C) 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:1080 / 1088
页数:9
相关论文
共 55 条
[1]
ROLE OF SELF-EFFICACY IN REHABILITATION OUTCOME AMONG CHRONIC LOW-BACK-PAIN PATIENTS [J].
ALTMAIER, EM ;
RUSSELL, DW ;
KAO, CF ;
LEHMANN, TR ;
WEINSTEIN, JN .
JOURNAL OF COUNSELING PSYCHOLOGY, 1993, 40 (03) :335-339
[2]
[Anonymous], 1997, SELF EFFICACY
[3]
[Anonymous], 1989, STAT POWER ANAL BEHA
[4]
Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients [J].
Arnstein, P ;
Caudill, M ;
Mandle, CL ;
Norris, A ;
Beasley, R .
PAIN, 1999, 80 (03) :483-491
[5]
Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability:: A randomized controlled trial in patients with musculoskeletal pain [J].
Åsenlöf, P ;
Denison, E ;
Lindberg, P .
JOURNAL OF PAIN, 2005, 6 (09) :588-603
[6]
Idiographic outcome analyses of the clinical significance of two interventions for patients with musculoskeletal pain [J].
Asenlof, Pernilla ;
Denison, Eva ;
Lindberg, Per .
BEHAVIOUR RESEARCH AND THERAPY, 2006, 44 (07) :947-965
[7]
Asenlof Pernilla, 2004, Physiotherapy Theory and Practice, V20, P243, DOI 10.1080/09593980490887957
[8]
Pain self-efficacy beliefs and pain behaviour. A prospective study [J].
Asghari, A ;
Nicholas, MK .
PAIN, 2001, 94 (01) :85-100
[9]
The role of self-efficacy and fear-avoidance beliefs in the prediction of disability [J].
Ayre, M ;
Tyson, GA .
AUSTRALIAN PSYCHOLOGIST, 2001, 36 (03) :250-253
[10]
Bandura A., 1986, SOCIAL FDN THOUGHT A, DOI DOI 10.5465/AMR.1987.4306538