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Long‐term follow‐up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care
Author(s) -
Åsenlöf Pernilla,
Denison Eva,
Lindberg Per
Publication year - 2009
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2009.01.010
Subject(s) - physical therapy , medicine , randomized controlled trial , concordance , physical medicine and rehabilitation
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 TT‐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 TT. 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.