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

John McBeth, Gordon Prescott, Graham Scotland, Karina Lovell, Philip Keeley, Phil Hannaford, Paul McNamee, Deborah P M Symmons, Steve Woby, Chrysa Gkazinou, Marcus Beasley, Gary J. Macfarlane

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Abstract

Background: The clinical impact of telephonedelivered 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 9months, respectively, wereTAUgroup, 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 costeffectiveness were sensitive to missing data. Conclusion: TCBT was associated with substantial, statistically significant, and sustained improvements in patient global assessment. Trial Registration: clinicaltrials.gov Identifier: ISRCTN67013851.

Original languageEnglish
Pages (from-to)48-57
Number of pages10
JournalArchives of Internal Medicine
Volume172
Issue number1
DOIs
Publication statusPublished - 9 Jan 2012
Externally publishedYes

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Cognitive Therapy
Chronic Pain
Odds Ratio
Exercise
Health
Random Allocation
Primary Health Care
Logistic Models
Therapeutics

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McBeth, J., Prescott, G., Scotland, G., Lovell, K., Keeley, P., Hannaford, P., ... Macfarlane, G. J. (2012). Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Archives of Internal Medicine, 172(1), 48-57. https://doi.org/10.1001/archinternmed.2011.555
McBeth, John ; Prescott, Gordon ; Scotland, Graham ; Lovell, Karina ; Keeley, Philip ; Hannaford, Phil ; McNamee, Paul ; Symmons, Deborah P M ; Woby, Steve ; Gkazinou, Chrysa ; Beasley, Marcus ; Macfarlane, Gary J. / Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. In: Archives of Internal Medicine. 2012 ; Vol. 172, No. 1. pp. 48-57.
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McBeth, J, Prescott, G, Scotland, G, Lovell, K, Keeley, P, Hannaford, P, McNamee, P, Symmons, DPM, Woby, S, Gkazinou, C, Beasley, M & Macfarlane, GJ 2012, 'Cognitive behavior therapy, exercise, or both for treating chronic widespread pain', Archives of Internal Medicine, vol. 172, no. 1, pp. 48-57. https://doi.org/10.1001/archinternmed.2011.555

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; Macfarlane, Gary J.

In: Archives of Internal Medicine, Vol. 172, No. 1, 09.01.2012, p. 48-57.

Research output: Contribution to journalArticle

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T1 - Cognitive behavior therapy, exercise, or both for treating chronic widespread pain

AU - McBeth, John

AU - Prescott, Gordon

AU - Scotland, Graham

AU - Lovell, Karina

AU - Keeley, Philip

AU - Hannaford, Phil

AU - McNamee, Paul

AU - Symmons, Deborah P M

AU - Woby, Steve

AU - Gkazinou, Chrysa

AU - Beasley, Marcus

AU - Macfarlane, Gary J.

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N2 - Background: The clinical impact of telephonedelivered 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 9months, respectively, wereTAUgroup, 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 costeffectiveness were sensitive to missing data. Conclusion: TCBT was associated with substantial, statistically significant, and sustained improvements in patient global assessment. Trial Registration: clinicaltrials.gov Identifier: ISRCTN67013851.

AB - Background: The clinical impact of telephonedelivered 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 9months, respectively, wereTAUgroup, 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 costeffectiveness were sensitive to missing data. Conclusion: TCBT was associated with substantial, statistically significant, and sustained improvements in patient global assessment. Trial Registration: clinicaltrials.gov Identifier: ISRCTN67013851.

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