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Cognitive behavior therapy, exercise, or both for treating chronic widespread pain

McBeth, John, Prescott, Gordon, Scotland, Graham, Lovell, Karina, Keeley, Philip, Hannaford, Phil, McNamee, Paul, Symmons, Deborah P. M., Woby, Steve, Gkazinou, Chrysa, Beasley, Marcus and Macfarlane, Gary J. (2012) Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Archives of Internal Medicine, 172 (1). pp. 48-57. ISSN 0003-9926

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Abstract

Background
The clinical impact of telephone-delivered cognitive behavioral therapy (TCBT), exercise, or a combined intervention in primary care patients with chronic widespread pain (CWP) is unclear.

Methods
A total of 442 patients with CWP (meeting the American College of Rheumatology criteria) were randomized to receive 6 months of TCBT, graded exercise, combined intervention, or treatment as usual (TAU). The primary outcome, using a 7-point patient global assessment scale of change in health since trial enrollment (range: very much worse to very much better), was assessed at baseline and 6 months (intervention end) and 9 months after randomization. A positive outcome was defined as “much better” or “very much better.” Data were analyzed using logistic regression according to the intention-to-treat principle.

Results
The percentages reporting a positive outcome at 6 and 9 months, respectively, were TAU group, 8% and 8%; TCBT group, 30% and 33%; exercise group, 35% and 24%; and combined intervention group, 37% and 37% (P < .001). After adjustment for age, sex, center, and baseline predictors of outcome, active interventions improved outcome compared with TAU: TCBT (6 months: odds ratio [OR], 5.0 [95% CI, 2.0-12.5]; 9 months: OR, 5.4 [95% CI, 2.3-12.8]), exercise (6 months: OR, 6.1 [95% CI, 2.5-15.1]; 9 months: OR, 3.6 [95% CI, 1.5-8.5]), and combined intervention (6 months: OR, 7.1 [95% CI, 2.9-17.2]; 9 months: OR, 6.2 [95% CI, 2.7-14.4]). At 6 and 9 months, combined intervention was associated with improvements in the 36-Item Short Form Health Questionnaire physical component score and a reduction in passive coping strategies. Conclusions on cost-effectiveness were sensitive to missing data.

Conclusion
TCBT was associated with substantial, statistically significant, and sustained improvements in patient global assessment.

Item Type: Article
Subjects: R Medicine > R Medicine (General)
Schools: School of Human and Health Sciences
Related URLs:
Depositing User: Sally Hughes
Date Deposited: 24 Apr 2017 14:55
Last Modified: 24 Apr 2017 14:55
URI: http://eprints.hud.ac.uk/id/eprint/31804

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