Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: Long-term results from the MUSICIAN randomised controlled trial

Marcus Beasley, Gordon J Prescott, Graham Scotland, John McBeth, Karina Lovell, Phil Keeley, Philip C Hannaford, Deborah P. M. Symmons, Ross Macdonald, Gary J Macfarlane

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Abstract

Objectives: The MUSICIAN study has previously shown short term benefit but only marginal cost-effectiveness for two non-pharmacological interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness.
Methods: A 2x2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their GP. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health.
Results: 884 persons were eligible, 442 were randomised and 81.7% were followed up 24 months post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI 1.8, 8.0), exercise (29.3%; OR 2.8 95% CI (1.3, 6.0) and both interventions (31.2%; OR 3.1 95% CI (1.3, 6.0)) were significantly more effective. There was no significant decrease in effectiveness over time for either individual treatment. Those with more intense/disabling pain, higher distress and who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs. Cost per Quality Adjusted Life Year was £3957-£5917 depending on method of analysis.
Conclusions: A short course of tCBT for people with CWP was effective long-term and was highly cost-effective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage of patients receiving both interventions.
Original languageEnglish
Article numbere000026
Number of pages13
JournalRMD Open
Volume1
Issue number1
Early online date18 Feb 2015
DOIs
Publication statusPublished - 18 Feb 2015

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Keywords

  • pain management
  • chronic pain
  • primary care
  • exercise
  • cognitive behavioural therapy
  • long-term follow-up
  • combined therapy

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