Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Torunn Hatlen Nøst, Aslak Steinsbekk, Ola Bratås, Kjersti Grønning, Torunn Hatlen Nøst, Aslak Steinsbekk, Ola Bratås, Kjersti Grønning

Abstract

Background: To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care.

Methods: An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model.

Results: After twelve months, there were no statistically significant differences between the intervention group (n = 60) and the control group (n = 61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p = 0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test.

Conclusions: No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.

Trial registration: ClinicalTrials.gov: NCT02531282 . Registered on August 212,015.

Keywords: Chronic pain; Long-term effect; Patient activation; Primary health care; Self-management.

Conflict of interest statement

Competing interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

All informants signed an informed consent form after receiving oral and written information to enable them to make an informed choice regarding participation. The trial was approved by the director for health and social affairs in the municipality, and by the Regional Committee for Medical and Health Research Ethics in South East Norway (REK) (2015/ 1030/ REK sørøst).

Consent for publication

Not applicable.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Participants flow through the study

References

    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333. doi: 10.1016/j.ejpain.2005.06.009.
    1. Reid KJ, Harker J, Bala MM, Truyers C, Kellen E, Bekkering GE, Kleijnen J. Epidemiology of chronic non-cancer pain in Europe: narrative review of prevalence, pain treatments and pain impact. Curr Med Res Opin. 2011;27(2):449–462. doi: 10.1185/03007995.2010.545813.
    1. Landmark T, Romundstad P, Dale O, Borchgrevink PC, Vatten L, Kaasa S. Chronic pain: one year prevalence and associated characteristics (the HUNT pain study) Scand J Pain. 2013;4(4):182–187. doi: 10.1016/j.sjpain.2013.07.022.
    1. Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003–1007.
    1. O'Brien T, Breivik H. The impact of chronic pain-European patients' perspective over 12 months. Scand J Pain. 2012;3(1):23–29. doi: 10.1016/j.sjpain.2011.11.004.
    1. Breivik H, Eisenberg E, O'Brien T. The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC Public Health. 2013;13:1229. doi: 10.1186/1471-2458-13-1229.
    1. Newman S, Steed L, Mulligan K. Self-management interventions for chronic illness. Lancet. 2004;364(9444):1523–1537. doi: 10.1016/S0140-6736(04)17277-2.
    1. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48(2):177–187. doi: 10.1016/S0738-3991(02)00032-0.
    1. Nicholas MK, Blyth FM. Are self-management strategies effective in chronic pain treatment? Pain management. 2016;6(1):75–88. doi: 10.2217/pmt.15.57.
    1. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;1:Cd011279.
    1. Van Huet H, Innes E, Whiteford G. Living and doing with chronic pain: narratives of pain program participants. Disabil Rehabil. 2009;31(24):2031–2040. doi: 10.3109/09638280902887784.
    1. Eccleston C, Morley SJ, Williams AC. Psychological approaches to chronic pain management: evidence and challenges. Br J Anaesth. 2013;111(1):59–63. doi: 10.1093/bja/aet207.
    1. Hibbard J, Gilburt H. Supporting people to manage their health. In. London. 2014.
    1. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003;26(1):1–7. doi: 10.1207/S15324796ABM2601_01.
    1. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2004;39(4 Pt 1):1005–1026. doi: 10.1111/j.1475-6773.2004.00269.x.
    1. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff (Millwood) 2013;32(2):207–214. doi: 10.1377/hlthaff.2012.1061.
    1. Boger E, Ellis J, Latter S, Foster C, Kennedy A, Jones F, Fenerty V, Kellar I, Demain S. Self-Management and Self-Management Support Outcomes: A Systematic Review and Mixed Research Synthesis of Stakeholder Views. PLoS One. 2015;10(7):e0130990. doi: 10.1371/journal.pone.0130990.
    1. Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act. 2017;14(1):42. doi: 10.1186/s12966-017-0494-y.
    1. Devan H, Hale L, Hempel D, Saipe B, Perry MA. What Works and Does Not Work in a Self-Management Intervention for People With Chronic Pain? Qualitative Systematic Review and Meta-Synthesis. Phys Ther. 2018;98(5):381–397. doi: 10.1093/ptj/pzy029.
    1. Elbers S, Wittink H, Pool JJM, Smeets R. The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: a systematic review and meta-analysis. Eur J Pain. 2018;22(9):1577–1596. doi: 10.1002/ejp.1253.
    1. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444. doi: 10.1136/bmj.h444.
    1. Kroon FP, van der Burg LR, Buchbinder R, Osborne RH, Johnston RV, Pitt V. Self-management education programmes for osteoarthritis. Cochrane Database Syst Rev. 2014;1:CD008963.
    1. Carnes D, Homer KE, Miles CL, Pincus T, Underwood M, Rahman A, Taylor SJ. Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. Clin J Pain. 2012;28(4):344–354. doi: 10.1097/AJP.0b013e31822ed2f3.
    1. Du S, Yuan C, Xiao X, Chu J, Qiu Y, Qian H. Self-management programs for chronic musculoskeletal pain conditions: a systematic review and meta-analysis. Patient Educ Couns. 2011;85(3):e299–e310. doi: 10.1016/j.pec.2011.02.021.
    1. Stenberg U, Haaland-Overby M, Fredriksen K, Westermann KF, Kvisvik T. A scoping review of the literature on benefits and challenges of participating in patient education programs aimed at promoting self-management for people living with chronic illness. Patient Educ Couns. 2016;99(11):1759–1771. doi: 10.1016/j.pec.2016.07.027.
    1. Nost TH, Steinsbekk A, Bratas O, Gronning K. Short-term effect of a chronic pain self-management intervention delivered by an easily accessible primary healthcare service: a randomised controlled trial. BMJ Open. 2018;8(12):e023017. doi: 10.1136/bmjopen-2018-023017.
    1. Nost TH, Steinsbekk A, Bratas O, Gronning K. Expectations, effect and experiences of an easily accessible self-management intervention for people with chronic pain: study protocol for a randomised controlled trial with embedded qualitative study. Trials. 2016;17(1):325. doi: 10.1186/s13063-016-1462-6.
    1. The Norwegian Directorate of Health . Guidelines for municipal Healthy Life Centres (Veileder for kommunale frisklivssentraler. Etablering, organisering og tilbud) Oslo: The Norwegian Directorate of Health; 2016.
    1. Denison EUV, Berg RC, Vist GE. Effects of more than three months organized follow-up on physical activity and diet for people with increased risk of lifestyle related disease. Rapport fra Kunnskapssenteret ISBN 978–82–8121-888-8 ISSN 1890–1298. Oslo: Kunnskapssenteret; 2014.
    1. Solberg HS, Steinsbekk A, Solbjor M, Granbo R, Garasen H. Characteristics of a self-management support programme applicable in primary health care: a qualitative study of users' and health professionals' perceptions. BMC Health Serv Res. 2014;14:562. doi: 10.1186/s12913-014-0562-9.
    1. Thorn B. Cognitive therapy for chronic pain. A step-by-step guide. New York: Guilford Press; 2004.
    1. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol. 2002;70(3):678–690. doi: 10.1037/0022-006X.70.3.678.
    1. McCracken LM, Eccleston C. Coping or acceptance: what to do about chronic pain? Pain. 2003;105(1–2):197–204. doi: 10.1016/S0304-3959(03)00202-1.
    1. Dragesund T, Raheim M. Norwegian psychomotor physiotherapy and patients with chronic pain: patients' perspective on body awareness. Physiother Theory Pract. 2008;24(4):243–254. doi: 10.1080/09593980701738400.
    1. Williams AC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012;11:Cd007407.
    1. Sullivan AB, Scheman J, Venesy D, Davin S. The role of exercise and types of exercise in the rehabilitation of chronic pain: specific or nonspecific benefits. Curr Pain Headache Rep. 2012;16(2):153–161. doi: 10.1007/s11916-012-0245-3.
    1. Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015;29(1):120–130. doi: 10.1016/j.berh.2015.04.022.
    1. O'Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, McDonough SM. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil. 2015;96(4):724–734.e723. doi: 10.1016/j.apmr.2014.12.003.
    1. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6 Pt 1):1918–1930. doi: 10.1111/j.1475-6773.2005.00438.x.
    1. Insignia . Health. Patient activation measure. Oregon: Insignia Health; 2015.
    1. Greene J, Hibbard JH, Sacks R, Overton V, Parrotta CD. When patient activation levels change, health outcomes and costs change, too. Health Aff (Millwood) 2015;34(3):431–437. doi: 10.1377/hlthaff.2014.0452.
    1. Hibbard JH, Mahoney ER, Stock R, Tusler M. Do increases in patient activation result in improved self-management behaviors? Health Serv Res. 2007;42(4):1443–1463. doi: 10.1111/j.1475-6773.2006.00669.x.
    1. Moljord IEO, Lara-Cabrera ML, Salvesen O, Rise MB, Bjorgen D, Antonsen DO, Olso TM, Evensen GH, Gudde CB, Linaker OM, et al. Twelve months effect of self-referral to inpatient treatment on patient activation, recovery, symptoms and functioning: A randomized controlled study. Patient Educ Couns. 2017;100(6):1144–1152. doi: 10.1016/j.pec.2017.01.008.
    1. Solomon M, Wagner SL, Goes J. Effects of a Web-based intervention for adults with chronic conditions on patient activation: online randomized controlled trial. J Med Internet Res. 2012;14(1):e32. doi: 10.2196/jmir.1924.
    1. Turner A, Anderson JK, Wallace LM, Bourne C. An evaluation of a self-management program for patients with long-term conditions. Patient Educ Couns. 2015;98(2):213–219. doi: 10.1016/j.pec.2014.08.022.
    1. Steinsbekk A. Patient Activation Measure. Tidsskr Nor Laegeforen. 2008;128(20):2316–2318.
    1. Gronning K, Skomsvoll JF, Rannestad T, Steinsbekk A. The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis--a randomised controlled trial. Patient Educ Couns. 2012;88(1):113–120. doi: 10.1016/j.pec.2011.12.011.
    1. Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrar JT, Galer BS, et al. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106(3):337–345. doi: 10.1016/j.pain.2003.08.001.
    1. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1–2):9–19. doi: 10.1016/j.pain.2004.09.012.
    1. Du S, Yuan C. Evaluation of patient self-management outcomes in health care: a systematic review. Int Nurs Rev. 2010;57(2):159–167. doi: 10.1111/j.1466-7657.2009.00794.x.
    1. Turk DC, Dworkin RH, Revicki D, Harding G, Burke LB, Cella D, Cleeland CS, Cowan P, Farrar JT, Hertz S, et al. Identifying important outcome domains for chronic pain clinical trials: an IMMPACT survey of people with pain. Pain. 2008;137(2):276–285. doi: 10.1016/j.pain.2007.09.002.
    1. Nicholas MK, Asghari A, Blyth FM, Wood BM, Murray R, McCabe R, Brnabic A, Beeston L, Corbett M, Sherrington C, et al. Self-management intervention for chronic pain in older adults: a randomised controlled trial. Pain. 2013;154(6):824–835. doi: 10.1016/j.pain.2013.02.009.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994;23(2):129–138.
    1. Klepstad P, Loge JH, Borchgrevink PC, Mendoza TR, Cleeland CS, Kaasa S. The Norwegian brief pain inventory questionnaire: translation and validation in cancer pain patients. J Pain Symptom Manag. 2002;24(5):517–525. doi: 10.1016/S0885-3924(02)00526-2.
    1. Dysvik E, Kvaloy JT, Stokkeland R, Natvig GK. The effectiveness of a multidisciplinary pain management programme managing chronic pain on pain perceptions, health-related quality of life and stages of change--A non-randomized controlled study. Int J Nurs Stud. 2010;47(7):826–835. doi: 10.1016/j.ijnurstu.2009.12.001.
    1. Kapstad H, Rokne B, Stavem K. Psychometric properties of the Brief Pain Inventory among patients with osteoarthritis undergoing total hip replacement surgery. Health Qual Life Outcomes. 2010;8:148. doi: 10.1186/1477-7525-8-148.
    1. McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007–1019. doi: 10.1017/S0033291700009934.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Pallant JF, Bailey CM. Assessment of the structure of the Hospital Anxiety and Depression Scale in musculoskeletal patients. Health Qual Life Outcomes. 2005;3:82. doi: 10.1186/1477-7525-3-82.
    1. Mykletun A, Stordal E, Dahl AA. Hospital Anxiety and Depression (HAD) scale: factor structure, item analyses and internal consistency in a large population. Br J Psychiatry. 2001;179:540–544. doi: 10.1192/bjp.179.6.540.
    1. Bandura A. Encyclopedia of human behavior. New York: Academic Press; 1994. Self-efficacy; pp. 71–81.
    1. Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain. 2007;11(2):153–163. doi: 10.1016/j.ejpain.2005.12.008.
    1. Chiarotto A, Vanti C, Cedraschi C, Ferrari S, de Lima ESRF, Ostelo RW, Pillastrini P. Responsiveness and Minimal Important Change of the Pain Self-Efficacy Questionnaire and Short Forms in Patients With Chronic Low Back Pain. J Pain. 2016;17(6):707–718. doi: 10.1016/j.jpain.2016.02.012.
    1. Meisingset I, Woodhouse A, Stensdotter AK, Stavdahl O, Loras H, Gismervik S, Andresen H, Austreim K, Vasseljen O. Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study. BMC Musculoskelet Disord. 2015;16:56. doi: 10.1186/s12891-015-0517-2.
    1. Chumbler NR, Kroenke K, Outcalt S, Bair MJ, Krebs E, Wu J, Yu Z. Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain. Health Qual Life Outcomes. 2013;11:216. doi: 10.1186/1477-7525-11-216.
    1. Eriksson M, Lindstrom B. Validity of Antonovsky’s sense of coherence scale: a systematic review. J Epidemiol Community Health. 2005;59(6):460–466. doi: 10.1136/jech.2003.018085.
    1. Anke A, Damsgard E, Roe C. Life satisfaction in subjects with long-term musculoskeletal pain in relation to pain intensity, pain distribution and coping. J Rehabil Med. 2013;45(3):277–285. doi: 10.2340/16501977-1102.
    1. Lillefjell M, Jakobsen K. Sense of coherence as a predictor of work reentry following multidisciplinary rehabilitation for individuals with chronic musculoskeletal pain. J Occup Health Psychol. 2007;12(3):222–231. doi: 10.1037/1076-8998.12.3.222.
    1. Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhoy M, Borchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143–148. doi: 10.1111/j.1399-6576.2007.01524.x.
    1. EuroQoL: group. EuroQoL Group EuroQol-a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L) Qual Life Res. 2011;20(10):1727–1736. doi: 10.1007/s11136-011-9903-x.
    1. Obradovic M, Lal A, Liedgens H. Validity and responsiveness of EuroQol-5 dimension (EQ-5D) versus short Form-6 dimension (SF-6D) questionnaire in chronic pain. Health Qual LifeOoutcomes. 2013;11:110.
    1. Solberg TK, Olsen JA, Ingebrigtsen T, Hofoss D, Nygaard OP. Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery. Eur Spine J. 2005;14(10):1000–1007. doi: 10.1007/s00586-005-0898-2.
    1. Bell IR, Cunningham V, Caspi O, Meek P, Ferro L. Development and validation of a new global well-being outcomes rating scale for integrative medicine research. BMC Complement Altern Med. 2004;4:1. doi: 10.1186/1472-6882-4-1.
    1. Krokstad S, Langhammer A, Hveem K, Holmen TL, Midthjell K, Stene TR, Bratberg G, Heggland J, Holmen J. Cohort Profile: the HUNT Study, Norway. Int J Epidemiol. 2013;42(4):968–977. doi: 10.1093/ije/dys095.
    1. Landmark T, Romundstad P, Borchgrevink PC, Kaasa S, Dale O. Associations between recreational exercise and chronic pain in the general population: evidence from the HUNT 3 study. Pain. 2011;152(10):2241–2247. doi: 10.1016/j.pain.2011.04.029.
    1. Rikli RE, Jones CJ. Development and validation of criterion-referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist. 2013;53(2):255–267. doi: 10.1093/geront/gns071.
    1. Carbonell-Baeza A, Aparicio VA, Sjostrom M, Ruiz JR, Delgado-Fernandez M. Pain and functional capacity in female fibromyalgia patients. Pain Med. 2011;12(11):1667–1675. doi: 10.1111/j.1526-4637.2011.01239.x.
    1. Skou ST, Simonsen ME, Odgaard A, Roos EM. Predictors of long-term effect from education and exercise in patients with knee and hip pain. Dan Med J. 2014;61(7):A4867.
    1. Becofsky K, Baruth M, Wilcox S. Physical functioning, perceived disability, and depressive symptoms in adults with arthritis. Arthritis. 2013;2013:525761. doi: 10.1155/2013/525761.
    1. Mehmetoglu M, Jakobsen T. Applied Statistics using Stata. A Guide for Social Sciences. London: SAGE Publications Ltd; 2017.
    1. Nost TH, Steinsbekk A, Riseth L, Bratas O, Gronning K. Expectations towards participation in easily accessible pain management interventions: a qualitative study. BMC Health Serv Res. 2017;17(1):712. doi: 10.1186/s12913-017-2668-3.
    1. Hibbard JH, Mahoney E. Toward a theory of patient and consumer activation. Patient Educ Couns. 2010;78(3):377–381. doi: 10.1016/j.pec.2009.12.015.
    1. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–526. doi: 10.1007/s11606-011-1931-2.
    1. Fowles JB, Terry P, Xi M, Hibbard J, Bloom CT, Harvey L. Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics. Patient Educ Couns. 2009;77(1):116–122. doi: 10.1016/j.pec.2009.02.018.
    1. Nicholas MK, Asghari A, Sharpe L, Brnabic A, Wood BM, Overton S, Tonkin L, de Sousa M, Finniss D, Beeston L, et al. Cognitive exposure versus avoidance in patients with chronic pain: adherence matters. Eur J Pain. 2014;18(3):424–437. doi: 10.1002/j.1532-2149.2013.00383.x.
    1. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, Haythornthwaite JA, Jensen MP, Kerns RD, Ader DN, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–121. doi: 10.1016/j.jpain.2007.09.005.
    1. Riippa I, Linna M, Ronkko I. The effect of a patient portal with electronic messaging on patient activation among chronically ill patients: controlled before-and-after study. J Med Internet Res. 2014;16(11):e257. doi: 10.2196/jmir.3462.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148(4):295–309. doi: 10.7326/0003-4819-148-4-200802190-00008.
    1. Mohler R, Kopke S, Meyer G. Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2) Trials. 2015;16:204. doi: 10.1186/s13063-015-0709-y.
    1. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, Borges GL, Bromet EJ, Demytteneare K, de Girolamo G, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883–891. doi: 10.1016/j.jpain.2008.05.005.
    1. Rustoen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Gender differences in chronic pain--findings from a population-based study of Norwegian adults. Pain Manag Nurs. 2004;5(3):105–117. doi: 10.1016/j.pmn.2004.01.004.
    1. Mehlsen M, Hegaard L, Ornbol E, Jensen JS, Fink P, Frostholm L. The effect of a lay-led, group-based self-management program for patients with chronic pain: a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Programme. Pain. 2017;158(8):1437–1445. doi: 10.1097/j.pain.0000000000000931.
    1. Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, Gardner C, Gately C, Rogers A. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health. 2007;61(3):254–261. doi: 10.1136/jech.2006.053538.
    1. Galdas P, Darwin Z, Kidd L, Blickem C, McPherson K, Hunt K, Bower P, Gilbody S, Richardson G. The accessibility and acceptability of self-management support interventions for men with long term conditions: a systematic review and meta-synthesis of qualitative studies. BMC Public Health. 2014;14(1):1230. doi: 10.1186/1471-2458-14-1230.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner