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 Prescott, Graham Scotland, John McBeth, Karina Lovell, Philip Keeley, Philip Hannaford, Deborah P M Symmons, Ross I. R. Macdonald, Steve Woby, Gary J. Macfarlane

Research output: Contribution to journalArticle

17 Citations (Scopus)

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 2×2 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 general practitioner. 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 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those 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 for patients receiving both interventions.
LanguageEnglish
Number of pages13
JournalRMD Open
Volume1
Issue number1
DOIs
Publication statusPublished - 1 Jan 2015
Externally publishedYes

Fingerprint

Cognitive Therapy
Telephone
Chronic Pain
Randomized Controlled Trials
Exercise
Health
Costs and Cost Analysis
Cost-Benefit Analysis
Therapeutics
Quality-Adjusted Life Years
varespladib methyl
General Practitioners
Primary Health Care
Quality of Life
Pain

Cite this

Beasley, Marcus ; Prescott, Gordon ; Scotland, Graham ; McBeth, John ; Lovell, Karina ; Keeley, Philip ; Hannaford, Philip ; Symmons, Deborah P M ; Macdonald, Ross I. R. ; Woby, Steve ; Macfarlane, Gary J. / 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. In: RMD Open. 2015 ; Vol. 1, No. 1.
@article{d5fba4b4e4414182956cfa472bd847ba,
title = "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",
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 2×2 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 general practitioner. 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 to 8.0)), exercise (29.3{\%}; OR 2.8 95{\%} CI (1.3 to 6.0)) and both interventions (31.2{\%}; OR 3.1 95{\%} CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those 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 for patients receiving both interventions.",
author = "Marcus Beasley and Gordon Prescott and Graham Scotland and John McBeth and Karina Lovell and Philip Keeley and Philip Hannaford and Symmons, {Deborah P M} and Macdonald, {Ross I. R.} and Steve Woby and Macfarlane, {Gary J.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1136/rmdopen-2014-000026",
language = "English",
volume = "1",
journal = "RMD Open",
issn = "2056-5933",
publisher = "BMJ Publishing Group",
number = "1",

}

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. / Beasley, Marcus; Prescott, Gordon; Scotland, Graham; McBeth, John; Lovell, Karina; Keeley, Philip; Hannaford, Philip; Symmons, Deborah P M; Macdonald, Ross I. R.; Woby, Steve; Macfarlane, Gary J.

In: RMD Open, Vol. 1, No. 1, 01.01.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

T2 - RMD Open

AU - Beasley, Marcus

AU - Prescott, Gordon

AU - Scotland, Graham

AU - McBeth, John

AU - Lovell, Karina

AU - Keeley, Philip

AU - Hannaford, Philip

AU - Symmons, Deborah P M

AU - Macdonald, Ross I. R.

AU - Woby, Steve

AU - Macfarlane, Gary J.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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 2×2 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 general practitioner. 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 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those 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 for patients receiving both interventions.

AB - 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 2×2 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 general practitioner. 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 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those 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 for patients receiving both interventions.

UR - http://rmdopen.bmj.com/

U2 - 10.1136/rmdopen-2014-000026

DO - 10.1136/rmdopen-2014-000026

M3 - Article

VL - 1

JO - RMD Open

JF - RMD Open

SN - 2056-5933

IS - 1

ER -