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Cited by 44Musculoskeletal pain and rehabilitationPediatric Pain Management TechniquesHealth Policy Implementation Science

The DOI matches its Crossref record; 350 of the 352 references it cites were found in a registry or an index.

Improving the self-management of chronic pain: COping with persistent Pain, Effectiveness Research in Self-management (COPERS)

Open access
Taylor, Stephanie JC, Carnes, Dawn, Homer, Kate, Pincus, Tamar, Kahan, Brennan C, Hounsome, Natalia, Eldridge, Sandra, Spencer, Anne, Diaz-Ordaz, Karla, Rahman, Anisur, Mars, Tom S, Foell, Jens, Griffiths, Chris J, Underwood, Martin R·2016·Programme Grants for Applied Research
DOI 10.3310/pgfar04140
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Abstract

Background: Chronic musculoskeletal pain is a common problem that is difficult to treat. Self-management support interventions may help people to manage this condition better; however, there is limited evidence showing that they improve clinical outcomes. Our overarching research question was ‘Does a self-management support programme improve outcomes for people living with chronic musculoskeletal pain?’. Aim: To develop, evaluate and test the clinical effectiveness and cost-effectiveness of a theoretically grounded self-management support intervention for people living with chronic musculoskeletal pain. Methods: In phase 1 we carried out two systematic reviews to synthesise the evidence base for self-management course content and delivery styles likely to help those with chronic pain. We also considered the psychological theories that might underpin behaviour change and pain management principles. Informed by these data we developed the Coping with persistent Pain, Evaluation Research in Self-management (COPERS) intervention, a group intervention delivered over 3 days with a top-up session after 2 weeks. It was led by two trained facilitators: a health-care professional and a layperson with experience of chronic pain. To ensure that we measured the most appropriate outcomes we reviewed the literature on potential outcome domains and measures and consulted widely with patients, tutors and experts. In a feasibility study we demonstrated that we could deliver the COPERS intervention in English and, to increase the generalisability of our findings, also in Sylheti for the Bangladeshi community. In phase 2 we ran a randomised controlled trial to test the clinical effectiveness and cost-effectiveness of adding the COPERS intervention to a best usual care package (usual care plus a relaxation CD and a pain toolkit leaflet). We recruited adults with chronic musculoskeletal pain largely from primary care and musculoskeletal physiotherapy services in two localities: east London and Coventry/Warwickshire. We collected follow-up data at 12 weeks (self-efficacy only) and 6 and 12 months. Our primary outcome was pain-related disability (Chronic Pain Grade disability subscale) at 12 months. We also measured costs, health utility (European Quality of Life-5 Dimensions), anxiety, depression [Hospital Anxiety and Depression Scale (HADS)], coping, pain acceptance and social integration. Data on the use of NHS services by participants were extracted from NHS electronic records. Results: We recruited 703 participants with a mean age of 60 years (range 19–94 years); 81% were white and 67% were female. Depression and anxiety symptoms were common, with mean HADS depression and anxiety scores of 7.4 [standard deviation (SD) 4.1] and 9.2 (SD 4.6), respectively. Intervention participants received 85% of the course content. At 12 months there was no difference between treatment groups in our primary outcome of pain-related disability [difference –1.0 intervention vs. control, 95% confidence interval (CI) –4.9 to 3.0]. However, self-efficacy, anxiety, depression, pain acceptance and social integration all improved more in the intervention group at 6 months. At 1 year these differences remained for depression (–0.7, 95% CI –1.2 to –0.2) and social integration (0.8, 95% CI, 0.4 to 1.2). The COPERS intervention had a high probability (87%) of being cost-effective compared with usual care at a threshold of £30,000 per quality-adjusted life-year. Conclusions: Although the COPERS intervention did not affect our primary outcome of pain-related disability, it improved psychological well-being and is likely to be cost-effective according to current National Institute for Health and Care Excellence criteria. The COPERS intervention could be used as a substitute for less well-evidenced (and more expensive) pain self-management programmes. Effective interventions to improve hard outcomes in chronic pain patients, such as disability, are still needed. Trial registration: Current Controlled Trials ISRCTN22714229. Funding: The project was funded by the National Institute for Health Research Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research ; Vol. 4, No. 14. See the NIHR Journals Library website for further project information.

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Authors
Taylor, S. J., Carnes, D., Homer, K., Pincus, T., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Diaz-Ordaz, K., Rahman, A., Mars, T. S., Foell, J., Griffiths, C. J., & Underwood, M. R.
Affiliations
  • Queen Mary University of London (GB)
  • Royal Holloway University of London (GB)
  • University of Exeter (GB)
  • Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
  • University College Hospital (GB)
  • University of Warwick (GB)
Corresponding author
Taylor, Stephanie JC
ORCID
Venue
Programme Grants for Applied Research
Publisher
National Institute for Health and Care Research
Published
2016-09
Volume
4
Issue
14
Pages
1-440
ISSN
  • 2050-4322 (ISSN-L)
  • 2050-4330
DOI
10.3310/pgfar04140
OpenAlex
W2521165122
Cited by
44
References
352
Citations by year
2026: 1 · 2025: 5 · 2024: 5 · 2023: 7 · 2022: 1 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 6 · 2017: 3
FWCI
4.05
Type
journal article
Language
en
Open access
Licence
www.nationalarchives.gov.uk/doc/non-commercial-government-licence/non-commercial-government-licence.htm (unspecified)
Locations
  • Programme Grants for Applied Research (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Sussex Research Online (University of Sussex) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Figshare (submittedVersion)
  • Open Research Exeter (University of Exeter) (submittedVersion)
Funders
National Institute for Health Research (RP-PG-0707-10189)
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Keywords
chronic musculoskeletal pain, self-management support, group intervention, pain-related disability, cost-effectiveness, pain acceptance, coping, anxiety and depression, self-efficacy, Bangladeshi community, primary care, physiotherapy, health care utilization, behaviour change theory, EQ-5D

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