Background Psychological factors are important predictors in the transition from acute to persistent pain. Evidence accumulates regarding the effectiveness of behavioural medicine treatments in pain rehabilitation. One goal of such treatment is to return to an active life. Graded activity is an ingredient format of behavioural medicine treatment where operant condition principles are used to reinforce health behaviours. When applied in a physiotherapy context, the aim is to increase physical function in relation to individually predefined goals. This study is based on a previous randomised controlled trial (RCT) in a primary care setting, where Tailored Behavioural Medicine Treatment (TBT) was shown to be more effective compared to Exercise Based Treatment (EBT) in patients with musculoskeletal pain regarding pain-related disability (1). These results were maintained over two years (2).
Objectives The aim was to follow-up patients in the former RCT, 10 years after the intervention, regarding pain-related disability, pain intensity and pain control, fear of movement, sickness absence, and self-reported benefit of treatment. An additional aim was to examine whether classification of psychosocial subgroups at baseline was associated with pain-related disability, pain intensity and sickness absence at the 10-year follow-up.
Methods The original study included two conditions 1) TBT, and 2) EBT. It included 97 patients, of which 43 completed the follow-up. The subgroup classification was performed at baseline using the Swedish version of Multidimensional Pain Inventory (MPI-S), where 3 pre-defined clusters were identified; Adaptive Coper (AC), Interpersonally Distressed (ID), and Dysfunctional (DYS).
Results No differences were found between the conditions in any of the outcomes, except for pain intensity, which was significantly higher in the EBT group. The TBT group also reported more confidence in coping with future problem situations. The MPI-s classification could not predict sickness absence over 10 years, but pain-related disability was higher in the ID group, and pain intensity was higher in the DYS group compared to the other sub-groups at the 10-year follow-up.
Conclusions 10 years after treatment most of the previous treatment effects in advantage of the TBT group were levelled out. Irrespective of treatment condition, subgroups of patients in accordance with the MPI-S differed 10 years after treatment. Although frequently called for, long-term follow-ups are rare in pain rehabilitation research. Our study raises important methodological questions whether internally valid conclusions could be reached after such a long time period.
Åsenlöf P, Denison E, Lindberg P. (2005) Individually Tailored Treatment Targeting Activity Motor Behavior, and Cognition Reduces Pain–Related Disability: A Randomized Controlled Trial in Patients With Musculoskeletal Pain. The Journal of Pain, 6, 588-603.
Åsenlöf P, Denison E, Lindberg P. (2009) Long-term follow-up of tailored behavioral treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care. European journal of pain, 13 (10):1080-8.
Disclosure of Interest None declared
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