Maintaining Musculoskeletal Health using a behavioural therapy approach: a population-based randomised controlled trial (The MAmMOTH study)

Gary J Macfarlane* (Corresponding Author), Marcus John Beasley, Neil Scott, Huey Yi Chong, Paul McNamee, John McBeth, Neil Basu, Philip Hannaford, Gareth Jones, Philip Keeley, Gordon Prescott, Karina Lovell

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Objective: Cognitive Behaviour Therapy (CBT) has been shown to be effective in the management of Chronic Widespread Pain (CWP); we now test whether it can prevent onset among adults at high risk.
Methods: A population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT. The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EQ-5D-5L) used as part of a health economic assessment.
Results: 996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were female. At 12 months there was no
difference in the onset of CWP (tCBT: 18.0% v. UC: 17.5%; OR 1.05; 95% CI 0.75-1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009-0.040));
and had 0.023 (95% CI 0.007-0.039) more QALYs at an additional cost of £42.30 (95% CI −451.19-597.90), yielding an incremental cost effectiveness ratio of £1,828. Most secondary outcomes showed significant benefit for the intervention.
Conclusions: A short course of tCBT does not prevent onset of CWP in adults at high risk, but did improve quality of life and was cost-effective. A low-cost, short duration, intervention benefits persons at risk of CWP.
Original languageEnglish
JournalAnnals of the Rheumatic Diseases
Publication statusAccepted/In press - 30 Nov 2020

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