Review: Can we identify how programmes aimed at promoting self‐management in musculoskeletal pain work and who benefits? A systematic review of sub‐group analysis within RCTs
Abstract
Background:There are now several systematic reviews of RCTs testing self‐management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self‐management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub‐groups of patients SM is optimally effective. Aims:To systematically review randomized controlled trials of self‐management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome. Method:We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta‐regression analyses for age and gender, as potential moderators. Results:Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self‐efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self‐management. There was insufficient data on moderators of treatment. Conclusions:The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power.
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In patients with musculoskeletal pain, higher baseline depression predicted poorer physical functioning at 6 months, according to one study in a review.
“In the review on self-management programs in musculoskeletal pain [41], one study showed that higher levels of depression at baseline predicted poorer physical functioning at 6 months [44].”
From Acceptance and commitment therapy for chronic pain: Protocol of a systematic review and individual participant data meta-Analysis (2019) · cites this paper as [41]
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- Authors
- Milesl, C. L., Pincusl, T., Carnesl, D., Homerl, K. E., Taylorl, S. J. C., Bremnerl, S. A., Rahmanl, A., & Underwoodl, M.
- Affiliations
- Royal Holloway University of London (GB)
- Queen Mary University of London (GB)
- University College London (GB)
- Venue
- European Journal of Pain
- Publisher
- Wiley
- Published
- 2011-09
- Volume
- 15
- Issue
- 8
- Pages
- 775.e1-11
- ISSN
- 1090-3801 (ISSN-L)
- 1532-2149
- OpenAlex
- W1601295127
- Cited by
- 119
- References
- 43
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 12 · 2023: 5 · 2022: 8 · 2021: 8 · 2020: 5 · 2019: 13 · 2018: 7 · 2017: 11 · 2016: 8 · 2015: 13 · 2014: 8 · 2013: 8 · 2012: 4
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Royal Holloway Digital Repository (Royal Holloway University of London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Keywords
- self-management, chronic musculoskeletal pain, predictors of treatment outcome, treatment moderators, self-efficacy, depression, pain catastrophizing, physical activity, age and gender moderators, meta-regression
- MeSH terms
- Humans, Pain Measurement, Predictive Value of Tests, Self Care, Randomized Controlled Trials as Topic, Musculoskeletal Pain, Pain Management
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