Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises
Abstract
Objectives: To study the efficacy of tailored behavioural medicine treatment within a physical therapy framework. Methods: The study was a randomized controlled study (RCT): tailored behavioural medicine treatment (EXT) delivered by physical therapists (PT s) was compared with exercise‐based treatment (CT). Thirty‐two adolescents (mean age 14.3 years) with persistent pain participated. Data on pain‐related disability and school attendance (primary outcomes), pain intensity, catastrophizing, fear of movement and self‐efficacy were collected. Results: The pain‐related disability measured by the Functional Disability Inventory (FDI) resulted in mean score change of EXT = −18 and CT = −11, respectively. A significant change within both groups was found (EXT p = 0.003, CT p = 0.001), and a large effect size for FDI between the conditions was demonstrated (AUC of 0.77). For school attendance post‐treatment, no difference was found between conditions. For secondary outcomes, a significant improvement in pain intensity and pain catastrophizing was found for the EXT and self‐efficacy for the CT groups but no statistically significant difference between the two conditions was detected. Caution should be given to the small sample size, as it may affect the interpretation and generalizability of the results. Conclusion: In this study, differences between tailored behavioural medicine treatment delivered by PT s and exercise‐based treatment could not be demonstrated, although the effect size was large. Patients who received either treatment demonstrated significant changes over time in pain‐related disability. The low number of participants and suboptimal tailoring of the psychological components may partly explain the failure to demonstrate differences between groups, and future studies are warranted.
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The adolescents in the study presented with relatively higher scores of depressive symptoms.
“Furthermore, the adolescents in our study presented with relatively higher scores of depressive symptoms [57].”
Cites
Using Effect Size—or Why the P Value Is Not Enough
Sullivan, G. M., & Feinn, R. (2012) · Journal of Graduate Medical Education · doi:10.4300/jgme-d-12-00156.1 · Cited by 5,553 · see citing works
Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.
Vlaeyen, J. W. S., & Linton, S. J. (2000) · Pain · doi:10.1016/s0304-3959(99)00242-0 · Cited by 4,931 · see citing works
Self-citationSelf-Efficacy Beliefs of Adolescents
Pajares, F., & Urdan, T. (2006) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-60752-750-3 · Cited by 3,544 · see citing works
Dworkin, R. H., Turk, D. C., Wyrwich, K. W., Beaton, D., Cleeland, C. S., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Kerns, R. D., Ader, D. N., et al. (2008) · The Journal of Pain · doi:10.1016/j.jpain.2007.09.005 · Cited by 3,471 · cited 1× · see citing works
“Combining PT and cognitive behavioural therapy has been reported to improve functioning in children and adolescents with chronic pain (Sherry et al., 1999; Lee et al., 2002; Eccleston, 2004; Ayling Campos et al., 2011).”
BackgroundThe biopsychosocial approach to chronic pain: Scientific advances and future directions.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.4.581 · Cited by 3,392 · see citing works
Doyle, C., Lennox, L., & Bell, D. (2013) · BMJ Open · doi:10.1136/bmjopen-2012-001570 · Cited by 2,358 · see citing works
The functional disability inventory: Measuring a neglected dimension of child health status
Walker, L. S., & Greene, J. W. (1991) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/16.1.39 · Cited by 881 · see citing works
McGrath, P. J., Walco, G. A., Turk, D. C., Dworkin, R. H., Brown, M. T., Davidson, K., Eccleston, C., Finley, G. A., Goldschneider, K., Haverkos, L., et al. (2008) · The Journal of Pain · doi:10.1016/j.jpain.2008.04.007 · Cited by 851 · see citing works
Self-citationPsychological therapies for the management of chronic and recurrent pain in children and adolescents
Eccleston, C., Palermo, T. M., Williams, A. C. D. C., Lewandowski Holley, A., Morley, S., Fisher, E., & Law, E. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003968.pub4 · Cited by 745 · see citing works
The child version of the pain catastrophizing scale (PCS-C): a preliminary validation
Crombez, G., Bijttebier, P., Eccleston, C., Mascagni, T., Mertens, G., Goubert, L., & Verstraeten, K. (2003) · Pain · doi:10.1016/s0304-3959(03)00121-0 · Cited by 652 · see citing works
Faulstich, M. E., Carey, M. P., Ruggiero, L., Enyart, P., & Gresham, F. M. (1986) · American Journal of Psychiatry · doi:10.1176/ajp.143.8.1024 · Cited by 634 · see citing works
von Baeyer, C. L., Spagrud, L. J., McCormick, J. C., Choo, E., Neville, K., & Connelly, M. A. (2009) · Pain · doi:10.1016/j.pain.2009.03.002 · Cited by 575 · see citing works
Darlow, B. J. S., Fullen, B. M., Dean, S. G., Hurley, D. A., Baxter, D. G., & Dowell, A. C. (2011) · European Journal of Pain · doi:10.1016/j.ejpain.2011.06.006 · Cited by 496 · see citing works
Palermo, T. M., Eccleston, C., Lewandowski, A. S., de C. Williams, A. C., & Morley, S. (2010) · Pain · doi:10.1016/j.pain.2009.10.004 · Cited by 489 · see citing works
Recurrent abdominal pain, anxiety, and depression in primary care
Campo, J. V., Bridge, J., Ehmann, M., Altman, S., Lucas, A., Birmaher, B., Lorenzo, C. D., Iyengar, S., & Brent, D. A. (2004) · Pediatrics · doi:10.1542/peds.113.4.817 · Cited by 467 · cited 1× · see citing works
“PTs who treat pain should be aware of the existing comorbidity between pain and depression (Campo et al., 2004; Bohman et al., 2010), know how to screen for severe depressive symptoms and know where to refer the patients who need assessment for depression and/or other mental disorders.”
BackgroundA biopsychosocial formulation of pain communication.
Hadjistavropoulos, T., Craig, K. D., Duck, S., Cano, A., Goubert, L., Jackson, P. L., Mogil, J. S., Rainville, P., Sullivan, M. J. L., Williams, A. C. D. C., et al. (2011) · Psychological Bulletin · doi:10.1037/a0023876 · Cited by 466 · see citing works
RELATIONSHIP OF SIGNIFICANCE OF WOUND TO PAIN EXPERIENCED
Beecher, H. K. (1956) · JAMA · doi:10.1001/jama.1956.02970170005002 · Cited by 454 · see citing works
Clinical trials: The challenge of recruitment and retention of participants
Gul, R. B., & Ali, P. A. (2010) · Journal of Clinical Nursing · doi:10.1111/j.1365-2702.2009.03041.x · Cited by 449 · see citing works
Claar, R. L., & Walker, L. S. (2006) · Pain · doi:10.1016/j.pain.2005.12.002 · Cited by 421 · see citing works
Eccleston, C., Crombez, G., Scotford, A., Clinch, J., & Connell, H. (2004) · Pain · doi:10.1016/j.pain.2003.11.008 · Cited by 418 · see citing works
Kreuter, M. W. (2000) · Health Education Research · doi:10.1093/her/15.1.1 · Cited by 414 · see citing works
Denison, E., Åsenlöf, P., & Lindberg, P. (2004) · Pain · doi:10.1016/j.pain.2004.07.001 · Cited by 392 · see citing works
Self-citationSherry, D. D., Wallace, C. A., Kelley, C. A., Kidder, M., & Sapp, L. R. (1999) · Clinical Journal of Pain · doi:10.1097/00002508-199909000-00009 · Cited by 345 · see citing works
Kashikar-Zuck, S., Flowers, S. R., Claar, R. L., Guite, J. W., Logan, D. E., Lynch-Jordan, A. M., Palermo, T. M., & Wilson, A. C. (2011) · Pain · doi:10.1016/j.pain.2011.02.050 · Cited by 337 · see citing works
Koller, M. T., Aaronson, N. K., Blazeby, J. M., Bottomley, A., Dewolf, L., Fayers, P. M., Johnson, C. A., Ramage, J. K., SCOTT, N. W., & West, K. (2007) · European Journal of Cancer · doi:10.1016/j.ejca.2007.05.029 · Cited by 302 · see citing works
Economic Evaluation in Health Care
McGuire, A. (2001) · doi:10.1093/oso/9780192631770.001.0001 · Cited by 302 · see citing works
Theoretical aspects of goal-setting and motivation in rehabilitation
Siegert, R. J., & Taylor, W. J. (2003) · Disability and Rehabilitation · doi:10.1080/09638280410001644932 · Cited by 301 · see citing works
Physical therapy and cognitive-behavioral treatment for complex regional pain syndromes
Lee, B. H., Scharff, L., Sethna, N. F., McCarthy, C. F., Scott-Sutherland, J., Shea, A. M., Sullivan, P., Meier, P., Zurakowski, D., Masek, B. J., et al. (2002) · The Journal of Pediatrics · doi:10.1067/mpd.2002.124380 · Cited by 294 · see citing works
School Impairment in Adolescents With Chronic Pain
Logan, D. E., Simons, L. E., Stein, M. J., & Chastain, L. (2008) · Journal of Pain · doi:10.1016/j.jpain.2007.12.003 · Cited by 288 · see citing works
Eccleston, C. (2003) · Archives of Disease in Childhood · doi:10.1136/adc.88.10.881 · Cited by 276 · see citing works
Pediatric fear-avoidance model of chronic pain: Foundation, application and future directions
Asmundson, G. J., Noel, M., Petter, M., & Parkerson, H. A. (2012) · Pain Research and Management · doi:10.1155/2012/908061 · Cited by 237 · see citing works
Vervoort, T., Goubert, L., Eccleston, C., Bijttebier, P., & Crombez, G. (2005) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsj059 · Cited by 217 · see citing works
Logan, D. E., & Scharff, L. (2005) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsj060 · Cited by 202 · see citing works
Evidence for the use of a numerical rating scale to assess the intensity of pediatric pain
Miró, J., Castarlenas, E., & Huguet, A. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2009.07.002 · Cited by 198 · see citing works
Daykin, A. R., & Richardson, B. (2004) · Spine · doi:10.1097/01.brs.0000115135.19082.97 · Cited by 195 · see citing works
Children’s Self‐Report of Pain Intensity: What We Know, Where We Are Headed
von Baeyer, C. L. (2009) · Pain Research and Management · doi:10.1155/2009/259759 · Cited by 181 · see citing works
Psychosocial factors associated with chronic pain in adolescents
Merlijn, V. P. B. M., Hunfeld, J. A. M., van der Wouden, J. C., Hazebroek-Kampschreur, A. A. J. M., Koes, B. W., & Passchier, J. (2002) · Pain · doi:10.1016/s0304-3959(02)00289-0 · Cited by 170 · see citing works
Depression, coping, and functional disability in juvenile primary fibromyalgia syndrome
Kashikar-Zuck, S., Vaught, M. H., Goldschneider, K. R., Graham, T. B., & Miller, J. C. (2002) · The Journal of Pain · doi:10.1054/jpai.2002.126786 · Cited by 164 · see citing works
Oxford Textbook of Paediatric Pain
(2013) · doi:10.1093/med/9780199642656.001.0001 · Cited by 162 · see citing works
Olsson, G., & von Knotting, A. L. (1997) · European Child & Adolescent Psychiatry · doi:10.1007/bf00566670 · Cited by 152 · see citing works
Logan, D. E., Carpino, E. A., Chiang, G., Condon, M., Firn, E., Gaughan, V. J., Hogan, M., Leslie, D. S., Olson, K., Sager, S., et al. (2012) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e3182457619 · Cited by 152 · see citing works
Youth Resistance Training: Past Practices, New Perspectives, and Future Directions
Faigenbaum, A. D., Lloyd, R. S., & Myer, G. D. (2013) · Pediatric Exercise Science · doi:10.1123/pes.25.4.591 · Cited by 140 · see citing works
Psychological therapies for the management of chronic and recurrent pain in children and adolescents
Eccleston, C., Palermo, T. M., Williams, A. C. D. C., Lewandowski, A. S., Morley, S., Fisher, E., & Law, E. F. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003968.pub3 · Cited by 129 · see citing works
Bursch, B., Tsao, J. C. I., Meldrum, M. L., & Zeltzer, L. K. (2006) · Pain · doi:10.1016/j.pain.2006.04.026 · Cited by 118 · see citing works
Overmeer, T., Boersma, K., Main, C. J., & Linton, S. J. (2009) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2008.01089.x · Cited by 113 · see citing works
Self-citationÅsenlöf, P., Denison, E., & Lindberg, P. (2005) · Journal of Pain · doi:10.1016/j.jpain.2005.03.008 · Cited by 107 · see citing works
Self-citationHaynes, S. N., Leisen, M. B., & Blaine, D. D. (1997) · Psychological Assessment · doi:10.1037/1040-3590.9.4.334 · Cited by 101 · see citing works
Söderlund, A., & Lindberg, P. (2001) · Physiotherapy Theory and Practice · doi:10.1080/095939801753385735 · Cited by 100 · see citing works
Self-citationPain-Related Fear: Exposure-Based Treatment of Chronic Pain
Davis, R. B. M. P. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.9480 · Cited by 97 · see citing works
Somatic symptoms as a marker for severity in adolescent depression
Bohman, H., Jonsson, U., von Knorring, A., von Knorring, L., Päären, A., & Olsson, G. (2010) · Acta Paediatrica · doi:10.1111/j.1651-2227.2010.01906.x · Cited by 95 · see citing works
Simons, L. E., Sieberg, C. B., Pielech, M., Conroy, C., & Logan, D. E. (2013) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jss109 · Cited by 94 · see citing works
Hechler, T., Blankenburg, M. R., Dobe, M., Kosfelder, J., Hübner, B., & Zernikow, B. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2009.03.002 · Cited by 78 · see citing works
Åsenlöf, P., Denison, E., & Lindberg, P. (2009) · European Journal of Pain · doi:10.1016/j.ejpain.2009.01.010 · Cited by 59 · see citing works
Self-citationSöderlund, A. (2001) · Disability and Rehabilitation · doi:10.1080/09638280010008870 · Cited by 59 · see citing works
Self-citationSchreiber, J., Stern, P., Marchetti, G., & Provident, I. (2009) · Physical Therapy · doi:10.2522/ptj.20080260 · Cited by 54 · see citing works
Musculoskeletal disorders: primary and secondary interventions
Gatchel, R. J. (2003) · Journal of Electromyography and Kinesiology · doi:10.1016/j.jelekin.2003.09.007 · Cited by 45 · see citing works
Kraemer, H., Frank, E., & Kupfer, D. J. (2011) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.340 · Cited by 44 · see citing works
Clinical Impact and Evidence Base for Physiotherapy in Treating Childhood Chronic Pain
Campos, A. A., Amaria, K., Campbell, F. A., & McGrath, P. A. (2010) · Physiotherapy Canada · doi:10.3138/ptc.2009-59p · Cited by 38 · see citing works
Relaxation Treatment Administered by School Nurses to Adolescents With Recurrent Headaches
Fichtel, Å., & Larsson, B. (2004) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.2004.446002.x · Cited by 30 · see citing works
Pain in children and adolescents in primary care; chronic and recurrent pain is common
Holm, S. K., Ljungman, G., & Söderlund, A. (2012) · Acta Paediatrica · doi:10.1111/j.1651-2227.2012.02829.x · Cited by 24 · see citing works
Self-citationInterdisciplinary management of adolescent chronic pain: Developing the role of physiotherapy
Eccleston, Z., & Eccleston, C. (2004) · Physiotherapy · doi:10.1016/s0031-9406(03)00011-7 · Cited by 24 · see citing works
Adolescent chronic pain and disability: A review of the current evidence in assessment and treatment
Eccleston, C., & Clinch, J. (2007) · Paediatrics & Child Health · doi:10.1093/pch/12.2.117 · Cited by 21 · see citing works
Sandborgh, M., Åsenlöf, P., Lindberg, P., & Denison, E. (2010) · Advances in Physiotherapy · doi:10.3109/14038190903480672 · Cited by 21 · see citing works
Self-citationAsk the Experts: Peripheral and Central Mechanisms of Chronic Musculoskeletal Pain
Sluka, K. A. (2013) · Pain Management · doi:10.2217/pmt.12.81 · Cited by 8 · see citing works
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“Furthermore, the adolescents in our study presented with relatively higher scores of depressive symptoms [57].”
BackgroundPsychologically informed health care
Dekker, J., Sears, S. F., Åsenlöf, P., & Berry, K. (2023) · Translational Behavioral Medicine · doi:10.1093/tbm/ibac105 · Cited by 26 · see citing works
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Söderlund, A., Elvén, M., Sandborgh, M., & Fritz, J. (2020) · PAIN Reports · doi:10.1097/pr9.0000000000000844 · Cited by 20 · see citing works
Self-citationBorg, S., Öberg, B. E., Nilsson, L., Söderlund, A., & Bäck, M. (2017) · BMC Cardiovascular Disorders · doi:10.1186/s12872-017-0557-7 · Cited by 11 · see citing works
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Self-citationFors, A., Wallbing, U., Alfvén, G., Kemani, M. K., Lundberg, M., Wigert, H., & Nilsson, S. (2020) · European Journal of Pain · doi:10.1002/ejp.1614 · Cited by 9 · see citing works
Borg, S., Öberg, B. E., Nilsson, L. E., Söderlund, A., & Bäck, M. (2020) · Patient Preference and Adherence · doi:10.2147/ppa.s285905 · Cited by 9 · see citing works
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Nilsson, S., Wallbing, U., Alfvén, G., Dalenius, K., Fors, A., Golsäter, M., Rosvall, P., Wigert, H., & Lundberg, M. (2019) · Children · doi:10.3390/children6090095 · Cited by 6 · see citing works
Zetterberg, H., Flink, I. K., Spörndly-Nees, S., Wagner, S., Karlsten, R., & Åsenlöf, P. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031509 · Cited by 5 · see citing works
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- Authors
- Holm, S., Ljungman, G., Åsenlöf, P., Linton, S. J., & Söderlund, A.
- Affiliations
- Uppsala University (SE)
- Örebro University (SE)
- Mälardalen University (SE)
- Corresponding author
- Holm, S.
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2015-09-24
- Volume
- 20
- Issue
- 4
- Pages
- 626-638
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W1910242146
- Cited by
- 15
- References
- 64
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 4 · 2019: 3 · 2017: 1 · 2016: 2
- FWCI
- 0.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Vetenskapsrådet
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- pediatric chronic pain, adolescents, behavioral medicine, tailored treatment, physiotherapy, exercise therapy, pain-related disability, school attendance, pain catastrophizing, kinesiophobia, self-efficacy, primary care
- MeSH terms
- Adolescent, Age Factors, Behavioral Medicine, Fear, Female, Humans, Male, Movement, Pain, Primary Health Care, Exercise, Self Efficacy, Physical Therapy Modalities, Pain Management
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