Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial
Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial
Objectives: the MUSICIAN study has previously shown short-term benefit but only marginal cost-effectiveness for two non-pharmacological interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness.
Methods: a 2×2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their general practitioner. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health.
Results: 884 persons were eligible, 442 were randomised and 81.7% were followed up 24 months post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI (1.8 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs. Cost per quality adjusted life year was £3957–£5917 depending on method of analysis.
Conclusions: a short course of tCBT for people with CWP was effective long-term and was highly cost-effective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage for patients receiving both interventions.
Trial registration number ISRCTN67013851.
Beasley, Marcus
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Prescott, Gordon J.
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Scotland, Graham
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McBeth, John
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Lovell, Karina
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Keeley, Phil
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Hannaford, Philip C.
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Symmons, Deborah P.M.
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MacDonald, Ross I.R.
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Woby, Steve
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Macfarlane, Gary J.
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25 October 2017
Beasley, Marcus
a40436eb-bd78-4d2a-889f-6b99d7755091
Prescott, Gordon J.
8d0985a4-5168-4279-9d5f-bbecf4b8b9d7
Scotland, Graham
af689445-91cd-4e94-8aa8-ab47f815dfad
McBeth, John
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Lovell, Karina
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Keeley, Phil
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Hannaford, Philip C.
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Symmons, Deborah P.M.
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MacDonald, Ross I.R.
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Woby, Steve
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Macfarlane, Gary J.
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Beasley, Marcus, Prescott, Gordon J., Scotland, Graham, McBeth, John, Lovell, Karina, Keeley, Phil, Hannaford, Philip C., Symmons, Deborah P.M., MacDonald, Ross I.R., Woby, Steve and Macfarlane, Gary J.
(2017)
Patient-reported improvements in health are maintained 2 years after completing a short course of cognitive behaviour therapy, exercise or both treatments for chronic widespread pain: long-term results from the MUSICIAN randomised controlled trial.
RMD Open, 1 (1), [e000026].
(doi:10.1136/rmdopen-2014-000026).
Abstract
Objectives: the MUSICIAN study has previously shown short-term benefit but only marginal cost-effectiveness for two non-pharmacological interventions for chronic widespread pain (CWP). We wished to determine their long-term effectiveness and cost-effectiveness.
Methods: a 2×2 factorial randomised controlled trial based in primary care in the UK. People were eligible if they were aged ≥25 years with CWP for which they had consulted their general practitioner. The interventions were a 6-month telephone cognitive behaviour therapy (tCBT) and/or a tailored exercise programme, in comparison to usual care. The primary outcome was patient-reported change in health.
Results: 884 persons were eligible, 442 were randomised and 81.7% were followed up 24 months post-treatment. In comparison to usual care (positive outcome 12.8%), tCBT (35.4%; OR 3.7 95% CI (1.8 to 8.0)), exercise (29.3%; OR 2.8 95% CI (1.3 to 6.0)) and both interventions (31.2%; OR 3.1 95% CI (1.3 to 6.0)) were significantly more effective. There was only a small decrease in effectiveness over time for individual and combined treatments. Those with more intense/disabling pain, higher distress and those who exhibited passive coping at baseline were more likely to have a positive outcome with tCBT than persons without these characteristics. tCBT was associated with the greatest increase in quality of life and lowest costs. Cost per quality adjusted life year was £3957–£5917 depending on method of analysis.
Conclusions: a short course of tCBT for people with CWP was effective long-term and was highly cost-effective. Exercise was also effective but delivered positive outcome for fewer patients at greater cost, and there was no advantage for patients receiving both interventions.
Trial registration number ISRCTN67013851.
Text
e000026.full
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Accepted/In Press date: 23 December 2014
e-pub ahead of print date: 18 February 2015
Published date: 25 October 2017
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Local EPrints ID: 491429
URI: http://eprints.soton.ac.uk/id/eprint/491429
ISSN: 2056-5933
PURE UUID: 1f7d8a14-f5bf-4a19-8b59-ce597285c27f
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Date deposited: 24 Jun 2024 16:30
Last modified: 12 Jul 2024 02:17
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Contributors
Author:
Marcus Beasley
Author:
Gordon J. Prescott
Author:
Graham Scotland
Author:
John McBeth
Author:
Karina Lovell
Author:
Phil Keeley
Author:
Philip C. Hannaford
Author:
Deborah P.M. Symmons
Author:
Ross I.R. MacDonald
Author:
Steve Woby
Author:
Gary J. Macfarlane
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