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.
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 language | English |
|---|---|
| Article number | e000026 |
| Number of pages | 13 |
| Journal | RMD Open |
| Volume | 1 |
| Issue number | 1 |
| Early online date | 18 Feb 2015 |
| DOIs | |
| Publication status | Published - 18 Feb 2015 |
Bibliographical note
Funding The study was funded by Arthritis Research UK, Chesterfield, UK (Grant award number 17292).This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Acknowledgements
The authors are grateful to the following practices and their patients for participating in the study: in Aberdeen: Carden Medical Centre, Elmbank Medical Practice, Great Western Medical Practice, Garthdee Medical Group, and in East Cheshire: Readesmoor Medical Group Practice, Lawton House Surgery, Bollington Medical Centre, Park Lane Surgery. The Scottish Primary Care Research Network facilitated access to patient information at the practices in Aberdeen city. Charlie Stockton was the study manager during the setting up and for part of the conduct of the study and Chrysa Gkazinou for the remainder of the study. John Norrie was originally an investigator of the MUSICIAN study while Director of the Centre for Health Care Randomised Trials (CHART) at the University of Aberdeen. They are grateful for the input of members of the Health Services Research Unit (HSRU) at The University of Aberdeen in the conduct of the study: Alison MacDonald and Gladys McPherson, and also to Dr Paul McNamee for advice in relation to health economic data collection. Finally, they acknowledge the support and advice received from the Trial Steering Committee during the course of the study: Professors Matthew Hotopf (Institute of Psychiatry), Martin Underwood (University of Warwick) and Tracey Howe (Glasgow Caledonian University).
Keywords
- pain management
- chronic pain
- primary care
- exercise
- cognitive behavioural therapy
- long-term follow-up
- combined therapy
Access to Document
- RMD Open-2015-Beasley-
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by/4.0/
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Dive into the research topics of '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'. Together they form a unique fingerprint.Profiles
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Gary Macfarlane
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Clinical Chair in Epidemiology
- School of Medicine, Medical Sciences & Nutrition, MRC/Versus Arthritis Centre for Musculoskeletal Health and Work
- School of Medicine, Medical Sciences & Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health (ACAMH)
- School of Medicine, Medical Sciences & Nutrition, Epidemiology Group
Person: Clinical Academic
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Graham Scotland
- School of Medicine, Medical Sciences & Nutrition, Health Economics Research Unit - Personal Chair
- Institute of Applied Health Sciences
Person: Academic
Impacts
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Understanding the burden of chronic pain and enhancing service provision through improved pain management
Blair Smith (Participant), Alison Margaret Elliott (Participant), Phil Hannaford (Participant), Paul McNamee (Participant), Gary Macfarlane (Participant), Gareth Jones (Participant), Tatiana MacFarlane (Participant), Patricia Avril Schofield (Participant), Graham Scotland (Participant), Margaret Camilla Watson (Participant) & Gordon James Prescott (Participant)
Impact: Health and Wellbeing