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Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis

Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis
Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis

Background Chronic widespread pain (CWP) including fibromyalgia has a prevalence of up to 15% and is associated with substantial morbidity. Supporting psychosocial and behavioural self-management is increasingly important for CWP, as pharmacological interventions show limited benefit. We systematically reviewed the effectiveness of interventions applying self-management principles for CWP including fibromyalgia. Methods MEDLINE, Embase, PsycINFO, The Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Registry were searched for studies reporting randomised controlled trials of interventions adhering to self-management principles for CWP including fibromyalgia. Primary outcomes included physical function and pain intensity. Where data were sufficient, meta-analysis was conducted using a random effects model. Studies were narratively reviewed where meta-analysis could not be conducted Evidence quality was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (PROSPERO-CRD42018099212). Results Thirty-nine completed studies were included. Despite some variability in studies narratively reviewed, in studies meta-analysed self-management interventions improved physical function in the short-term, post-treatment to 3 months (SMD 0.42, 95% CI 0.20, 0.64) and long-term, post 6 months (SMD 0.36, 95% CI 0.20, 0.53), compared to no treatment/usual care controls. Studies reporting on pain narratively had greater variability, however, those studies meta-analysed showed self-management interventions reduced pain in the short-term (SMD -0.49, 95% CI -0.70, -0.27) and long-term (SMD -0.38, 95% CI -0.58, -0.19) compared to no treatment/usual care. There were few differences in physical function and pain when self-management interventions were compared to active interventions. The quality of the evidence was rated as low.

1932-6203
Geraghty, Adam
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Maund, Emma
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Newell, David
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Santer, Miriam
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Everitt, Hazel
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Price, Cathy J.
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Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Moore, Michael
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
West, Rachel
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Stuart, Beth
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Geraghty, Adam
2c6549fe-9868-4806-b65a-21881c1930af
Maund, Emma
c9733167-eafe-44e5-b418-5ace79161402
Newell, David
f1a21938-9604-4f10-aac2-bb19337a638e
Santer, Miriam
3ce7e832-31eb-4d27-9876-3a1cd7f381dc
Everitt, Hazel
80b9452f-9632-45a8-b017-ceeeee6971ef
Price, Cathy J.
0d2ee234-41a0-464a-9134-79c6d1c19f75
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Moore, Michael
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
West, Rachel
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Stuart, Beth
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Geraghty, Adam, Maund, Emma, Newell, David, Santer, Miriam, Everitt, Hazel, Price, Cathy J., Pincus, Tamar, Moore, Michael, Little, Paul, West, Rachel and Stuart, Beth (2021) Self-management for chronic widespread pain including fibromyalgia: A systematic review and meta-analysis. PLoS ONE, 16 (7 July), [e0254642]. (doi:10.1371/journal.pone.0254642).

Record type: Review

Abstract

Background Chronic widespread pain (CWP) including fibromyalgia has a prevalence of up to 15% and is associated with substantial morbidity. Supporting psychosocial and behavioural self-management is increasingly important for CWP, as pharmacological interventions show limited benefit. We systematically reviewed the effectiveness of interventions applying self-management principles for CWP including fibromyalgia. Methods MEDLINE, Embase, PsycINFO, The Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Registry were searched for studies reporting randomised controlled trials of interventions adhering to self-management principles for CWP including fibromyalgia. Primary outcomes included physical function and pain intensity. Where data were sufficient, meta-analysis was conducted using a random effects model. Studies were narratively reviewed where meta-analysis could not be conducted Evidence quality was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) (PROSPERO-CRD42018099212). Results Thirty-nine completed studies were included. Despite some variability in studies narratively reviewed, in studies meta-analysed self-management interventions improved physical function in the short-term, post-treatment to 3 months (SMD 0.42, 95% CI 0.20, 0.64) and long-term, post 6 months (SMD 0.36, 95% CI 0.20, 0.53), compared to no treatment/usual care controls. Studies reporting on pain narratively had greater variability, however, those studies meta-analysed showed self-management interventions reduced pain in the short-term (SMD -0.49, 95% CI -0.70, -0.27) and long-term (SMD -0.38, 95% CI -0.58, -0.19) compared to no treatment/usual care. There were few differences in physical function and pain when self-management interventions were compared to active interventions. The quality of the evidence was rated as low.

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Accepted/In Press date: 30 June 2021
Published date: 16 July 2021

Identifiers

Local EPrints ID: 450471
URI: http://eprints.soton.ac.uk/id/eprint/450471
ISSN: 1932-6203
PURE UUID: 967188dd-7df7-4f75-a2ef-99e8c92b7eb7
ORCID for Adam Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Emma Maund: ORCID iD orcid.org/0000-0002-3998-6669
ORCID for David Newell: ORCID iD orcid.org/0000-0003-1462-3586
ORCID for Miriam Santer: ORCID iD orcid.org/0000-0001-7264-5260
ORCID for Hazel Everitt: ORCID iD orcid.org/0000-0001-7362-8403
ORCID for Tamar Pincus: ORCID iD orcid.org/0000-0002-3172-5624
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437

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Date deposited: 29 Jul 2021 16:30
Last modified: 17 Mar 2024 04:11

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Contributors

Author: Adam Geraghty ORCID iD
Author: Emma Maund ORCID iD
Author: David Newell ORCID iD
Author: Miriam Santer ORCID iD
Author: Hazel Everitt ORCID iD
Author: Cathy J. Price
Author: Tamar Pincus ORCID iD
Author: Michael Moore ORCID iD
Author: Paul Little
Author: Rachel West
Author: Beth Stuart ORCID iD

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