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Author, Year Country Pain Duration Study Design Study Quality Comparison |
Intervention (n) Comparator (n) Duration/Intensity Session Format Setting | Population |
Primary Outcomes: Pain, Function, and Opioid Use |
Secondary Outcomes: HRQOL, Psychological Measures, Global Improvement |
Harms Utilization Patient Satisfaction |
|---|---|---|---|---|---|
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Bendix 1995, 1997, 1998a, 1998b (PROJECT B) Denmark Duration of pain: ≥6 months (NOS) Fair Higher vs. Lower Total Program Hours |
A. CPMP – 135 hours (n=46) 3 weeks full time, 39 hours/week + 1 day (6 hours) weekly for 3 (135 hours total), group, outpatient rheumatology clinic B. CPMP – 24 hours (n=43) 6 weeks, 4 hours/week (24 hours total), group, outpatient rheumatology clinic |
Mean age: 42 years % Male: 25% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability: 68% (working incapable) Comorbidities: Smoker: 64% Prior back surgery: 16% |
A vs. B median (IQR) VAS back pain (0-10) Baseline: 5.3 (NR) vs. 5.9 (NR) Short term: 2.7 (1.4 to 4.3) vs. 5.6 (3.8 to 7.6), p≤0.001 Long term (12 months): 3.3 (2.1 to 5.6) vs. 6.5 (4.8 to 7.7), p≤0.001 Long term (24 months): 3 (2 to 6) vs. 6 (4 to 8), p≤0.001 Long term (60 months): 4 (NR) vs. 6 (NR), p≤0.001 VAS leg pain (0-10) Baseline: 2.9 (NR) vs. 3.7 (NR) Short term: 0.4 (0 to 2.3) vs. 3.1 (0.5 to 5.9), p=0.01 Long term (12 months): 2.1 (0.2 to 4.13) vs. 4.8 (2.3 to 7.3) p=0.001 Long term (24 months): 2 (0 to 5) vs. 5 (1 to 6), p=0.003 Long term (60 months): 3 (NR) vs. 4 (NR), p=NS Patient subjective disability due to back pain (0-30) Baseline: 15.5 (NR) vs. 15.3 (NR) Short term: 8.5 (5 to 15) vs. 16.1 (11 to 19), p=0.002 Long term (12 months): 8.9 (5 to 13) vs. 16.4 (14 to 19), p<0.001 Long term (24 months): 10 (6 to 14) vs. 17 (9 to 21), p=0.002 Long term (60 months): 8 (NR) vs. 16 (NR), p=0.03 |
A vs. B, median (IQR) Global improvement (1-5) Long term (24 months): 2 (1 to 3) vs. 3 (2 to 3), p=0.003 Long term (60 months): 2 (NR) vs. 3 (NR), p=0.003 |
A vs. B, % (n/N) Harms: NR Proportion of patients hospitalized due to low back pain Long term (60 months): 22% (8/37) vs. 23% (7/31); RR 0.96 (95% CI 0.39 to 2.34) Proportion of patients who underwent back surgery during the study period, % ( Long term (60 months): 5% (2/37) vs. 10% (3/31); RR 0.56 (95% CI 0.10 to 3.13) Proportion of patients taking prescription pain medications (opioids not specified), % (n/N) Baseline: 75% (30/40) vs. 66% (23/35) Long term (24 months): 50% (20/40) vs. 67% (23/34); RR 0.74 (95% CI 0.50 to 1.09) |
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Rose 1997 (Part 2)a UK Mean duration of pain: 97 months Poor Higher vs. Lower Total Program Hours |
A. CPMP – 60 hours: 10 consecutive workdays, 60 hours total, group, outpatient B. CPMP – 30 hours: 5 consecutive full days, 30 hours total, group, outpatient C. CPMP – 15 hours: 5 consecutive half days, 15 hours total, group, outpatient |
Mean age: 42 years % Male: 41% Race/Ethnicity: NR Pain etiology/type: Chronic LBP and/or referred leg pain Disability or sickness benefit: 64% (completers only) Comorbidities: NR Prior spinal surgery: 13% |
Mean (SDs NR) VAS pain (0-10) A vs. B Baseline: 5.0 vs. 6.0 Postintervention: 5.0 vs. 4.3 Intermediate term: 5.1 vs. 5.2 p=ns for all comparisons A vs. C Baseline: 5.0 vs. 5.3 Postintervention: 5.0 vs. 4.9 Intermediate term: 5.1 vs. 4.3 p=ns for all comparisons RMDQ (0-24) A vs. B Baseline: 10.7 vs. 14.0 Postintervention: 8.4 vs. 9.9 Intermediate term: 9.5 vs. 11.5 p=ns for all comparisons A vs. C Baseline: 10.7 vs. 10.8 Postintervention: 8.4 vs. 8.8 Intermediate term: 9.5 vs. 10.0 p=ns for all comparisons |
Mean (SDs NR) The Modified Zung Depression Inventory (Scale NR) A vs. B Baseline: 25.0 vs. 26.0 Postintervention: 22.0 vs. 21.0 Intermediate term: 21.1 vs. 22.0 p=ns for all comparisons A vs. C Baseline: 25.0 vs. 24.0 Postintervention: 22.0 vs. 21.1 Intermediate term: 21.1 vs. 21.1 p=ns for all comparisons | NR |
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Saral 2016 Turkey Mean duration of pain 90 months Fair Higher vs. Lower Total Program Hours |
A. CPMP – 75 hours (n=22) 10 weeks, ~75 hours total, group, outpatient B. CPMP – 10 hours (n=22) 2 days, ~10 hours total, group, outpatient |
Mean age: 40 years % Female: 100% Race/ethnicity: NR Pain etiology/type: Fibromyalgia Disability: NR Comorbidities: NR
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A vs. B, Mean (SD) VAS pain (0 to 10) Baseline: 8.2 (0.9) vs. 7.6 (0.8) Intermediate term: 5.1 (2.4) vs. 5.8 (1.0), difference −0.70 (95% CI – 1.82 to 0.42) FIQ (0-100) Baseline: 71.6 (14.2) vs. 67.7 (12.0) Intermediate term: 53.9 (19.3) vs. 54.5 (14.2), difference −0.03 (95% CI −0.66 to 0.59) |
A vs. B, Mean (SD) Baseline: 32.8 (7.9) vs. 36.5 (8.7) Intermediate term: 39.9 (7.5) vs. 39.6 (8.1), difference 0.30 (95% CI −4.69 to 5.29) Baseline: 30.4 (11.7) vs. 33.2 (8.9) Intermediate term: 40.7 (12.3) vs. 40.2 (10.0), difference 0.50 (95% CI −6.72 to 7.72) BDI (0-63) Baseline: 23.4 (11.0) vs. 20.7 (6.6) Intermediate term: 16.6 (9.6) vs. 15.0 (10.2) , difference 0.16 (95% CI −0.46 to 0.78) | Harms: None reported; occasional mild increases in pain after some exercise sessions in both groups A and B. |
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Reneman, 2020 The Netherlands Mean duration of pain: NR (>1 year = 74%) Fair Higher vs. Lower Total Program Hours |
A. CPMP – Higher hours (n=81) Intended duration: 12, 16 or 20 weeks (4 weeks/10 contact hours more than Group B) Actual duration: 12 or 16 weeks: 96.3% (78/81) Mean (SD) number of weeks of treatment: 11.7 (4.5) Mean (SD) number of contact hours with providers: 30.7 (11.3) Outpatient, Individual B. CPMP – Lower hours (n=72) Intended duration: 8, 12 or 16 weeks (4 weeks/10 contact hours less than Group A) 8 or 12 weeks: 98.6% (71/72) Mean (SD) number of weeks of treatment: 10.8 (3.9) Mean (SD) number of contact hours with providers: 29.8 (10.4) Outpatient, Individual |
Mean age: 44 years % Male: 53% Race/ethnicity: NR Pain etiology/type: Chronic MSK pain Disability:
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A vs. B, Mean (SD) Baseline: 5.45 (1.78) vs. 5.44 (1.77) Post-treatment: 6.75 (1.61) vs. 6.76 (1.87), difference −0.01 (95% CI – 0.697 to 0.677) PDI (0-70) Baseline: 36.1 (12.5) vs. 37.9 (14.2) Post-treatment: 25.1 (15.0) vs. 26.6 (17.7), difference −1.5 (95% CI – 7.44 to 4.44) |
EQ5D Index (0-1) Baseline: 0.56 (0.19) vs. 0.54 (0.21) Post-treatment: 0.70 (0.17) vs. 0.70 (0.20), difference 0.00 (95 % CI – 0.073 to 0.073) | Harms: No trial-related adverse events were reported. |
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Harkapaa, 1989, 1990 Finland Mean duration of pain: 173 months Poor Inpatient vs. Outpatient Setting |
A. CPMP - Inpatient (n=156) 2x/week for 2 months (15 sessions) + 2-week refresher sessions after 1.5 years, group, inpatient B. CPMP - Outpatient (n=150) 2x/week for 2 months (15 sessions) + 8 refresher sessions after 1.5 years, group, outpatient |
Mean age: 45 years % Male: 62% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability: NR Comorbidities: NR Other characteristics: |
Pain Index (0-400) Baseline (mean, SD): 184.9 (76.9) vs. 178.6 (81.8) [4.6 (1.9) vs. 4.5 (2.0) on a 0-10 scale] Short term: 128 (NR) vs. 146 (NR) [3.2 (1.3) vs. 3.6 (1.8) on a 0-10 scale] Intermediate term: 158 (NR vs. 160 (NR) [3.9 (NR) vs. 4.0 (NR) on a 0-10 scale] Long term (18 months): 156.5 (NR) vs. 174 (NR) [3.9 (1.6) vs. 4.3 (2.2) on a 0-10 scale] Long term (22 months): 149 (NR) vs. 164 (NR) [3.7 (NR) vs. 4.1 (NR) on a 0-10 scale] Long term (30 months): 161.5 (NR) vs. 168 (NR) [4.0 (1.7) vs. 4.2 (2.1) on a 0-10 scale] LBP Disability Index (0-45) Baseline (mean SD): 16.7 (7.9) vs. 17.6 (7.4) Short term: 13.6 (9.7) vs. 14.7 (7.7) Intermediate term: 15.7 (NR) vs. 16 (NR) Long term (18 months): 15.6 (11.1) vs. 17.1 (9.0) Long term (22 months): 14.5 (NR) vs. 15.65 (NR) Long term (30 months): 15.4 (11.0) vs. 16.55 (8.7) | NR | NR |
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Peters, 1990, 1992 New Zealand Mean duration of pain: NR (6 to 48 months, 49%; 48 to ≥240 months, 51%) Poor Inpatient vs. Outpatient Setting |
A. CPMP – Inpatient Setting (n=23) 4 weeks, intensity NR, group, inpatient B. CPMP – Outpatient Setting (n=29) 9 weeks, 2 hours/week (18 hours total), outpatient |
Mean age: 44 years % Male: 38% Race/Ethnicity:
Comorbidities: NR
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Mean (SD) or % (n/N) Proportion of patients demonstrating treatment success (using medication appropriately + active + no pain increase), % (n/N) Long term (mean 12 months)c: 68% (15/22) vs. 61% (11/18), RR 1.12 (95% CI 0.70 to 1.78) VAS pain (0-10) Baseline: 5.12 (2.56) vs. 5.25 (2.46) Postintervention: 3.92 (2.33) vs. 4.25 (2.18), difference −0.33 (95% CI −1.80 to 1.14) Data NR – “mean scores indicate Group A’s scores reflect a trend towards greater reduction of pain intensity, in comparison with Group B” Baseline: 204.31 (75.43) vs. 137.78 (105.49) Postintervention: 122.89 (80.84) vs. 96.00 (77.84), difference 26.89 (95% CI −22.39 to 76.17) Proportion of patients taking an opioid, % (n/N) Baseline: Any opioid: 31.8% (7/22) vs. 33% (6/18), RR 0.95 (95% CI 0.39 to 2.34)
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Mean (SD) Baseline: 19.18 (9.34) vs. 13.55 (6.03) Postintervention: 12.25 (15.64) vs. 10.73 (6.16), difference 1.52 (95% CI −5.59 to 8.63) General Health Questionnaire Baseline: 15.52 (8.58) vs. 8.67 (7.23) Postintervention: 5.96 (7.11) vs. 5.91 (6.42), difference 0.05 (95% CI −4.09 to 4.19) | NR |
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Ronzi, 2017 France Mean duration of pain: NR (>5 years: 60%) Poor Inpatient vs. Outpatient Setting |
A. CPMP – Inpatient setting (n=49) 5 weeks, 30 hours/week (150 hours total), combo, inpatient B. CPMP – Outpatient setting (n=56) 5 weeks, 11 hours/week (55 hours total), combo, outpatient |
Median age: 40 years % Male: 59% Race/ethnicity: NR Pain etiology/type: Chronic LBP (≥3 months) Disability: NR Sick leave: “almost all patients on sick leave”; median days in past year: 233 Comorbidities:
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A vs. B VAS pain (0-10) Baseline (median, IQR): 5.4 (4.5 to 6.5) vs. 5.5 (3.6 to 6.8) Long term (mean, SD): 4.5 (2.5) vs. 3.7 (3.4), difference 0.80 (95% CI – 0.48 to 2.08) DPQ daily activity (%; lower = lower impact of pain on QOL) Baseline (median, IQR): 63.0% (51.0% to 72.0%) vs. 57.0% (48.0% to 66.0%) Long term (mean, SD): 51.0% (38.9%) vs. 39.0% (24.5%); difference 0.36% (95% CI −0.06% to 0.79%) |
A vs. B, Median (IQR) Baseline: 35.7 (29.4 to 39.5) vs. 34.5 (30.7 to 39.2) Long term: 39.1 (33.8 to 50.4) vs. 41.6 (34.2 to 49.9) p=NS for all Baseline: 43.3 (32.1 to 49.8) vs. 43.4 (35.9 to 51.1) Long term: 48.3 (42.1 to 53.4) vs. 46.6 (38.7 to 56.6) p=NS for all HADS (0-100) Baseline: 17.0 (12.0 to 21.0) vs. 14.0 (11.0 to 18.0) Long term: 11.5 (7.5 to 18.0) vs. 12.0 (7.0 to 15.0) p=NS for all DPQ anxiety and depression (%; lower = lower impact of pain on QOL) Baseline: 45.0% (20.0% to 60.0%) vs. 35.0% (25.0% to 45.0%) Long term: 30.0% (5.0% to 45.0%) vs. 25.0% (5.0% to 45.0%) p=NS for all | Harms: None reported |
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Williams, 1996 UK Mean duration of pain: 94 months Poor Inpatient vs. Outpatient Setting |
A. CPMP – Inpatient setting (n=43) 4 weeks, 4.5 days/week (~144 hours total), group, inpatient B. CPMP – Outpatient setting (n=45) 8 weeks, 3.5 hours/week (28 hours total), group, outpatient |
Mean age: 50 years % Male: 49% Race/ethnicity: white, ~85% Pain etiology/type:
Disability: 60% Opioid use: 65% Excess drug use: 58% ≥1 prior surgery: 40% |
A vs. B, mean (SD) VAS pain intensity (0-10) Baseline: 7.11 (1.90) vs. 6.86 (1.49) Short term: 6.00 (2.17) vs. 6.34 (1.96), difference −0.34 (95% CI −1.65 to 0.67) Long term (12 months): 6.52 (2.11) vs. 7.46 (1.88), difference −0.94 (95% CI −19.5 to 0.07) SIP (0-100) Baseline: 29.53 (12.55) vs. 28.48 (9.49) Short term: 15.81 (11.20) vs. 20.95 (10.29), difference −5.14 (95% CI – 10.41 to 0.13) Long term (12 months): 19.40 (13.05) vs. 20.84 (9.58), difference −0.12 (95% CI −0.63 to 0.38) Proportion of patients not using opioids, % (n/N) Baseline: 47% (18/38) vs. 33% (11/33), RR 1.4 (95% CI 0.79 to 2.56) Short term: 82% (31/38) vs. 57% (19/33), RR 1.42 (95% CI 1.02 to 1.97) Long term (12 months): 63% (24/38) vs. 52% (17/33), RR 1.23 (95% CI 0.81 to 1.85) Proportion of patients taking an opioid dose equivalent to >10 mg morphine per day Baseline: 34.2% (13/38) vs. 48.5% (16/33), RR 0.71 (95% CI 0.40 to 1.24) Short term: 10.5% (4/38) vs. 33.3% (11/33), RR 0.32 (95% CI 0.11 to 0.90) Long term (12 months): 10.5% (4/38) vs.18.2% (6/33), RR 0.58 (95% CI 0.18 to 1.88) Mean opioid dose per day (mg morphine equivalents) Baseline: 30 mg vs. 22 mg Short term: NR Long term (12 months): 22 mg vs.15 mg, p=NS |
A vs. B, mean (SD) BDI (0-63) Baseline: 17.8 (8.0) vs. 16.8 (5.6) Short term: 9.5 (7.8) vs. 12.2 (6.3), difference −2.70 (95% CI −6.20 to 0.80) Long term (12 months): 10.8 (8.9) vs. 14.7 (6.6), difference −3.90 (95% CI −7.79 to 0.172) STAI (20-80) Baseline: 45.1 (10.7) vs. 45.7 (8.2) Short term: 36.8 (13.6) vs. 42.3 (10.6), difference −5.50 (95% CI – 11.53 to 0.53) Long term (12 months):: NR VAS pain distress (0-10) Baseline: 6.64 (2.24) vs. 7.03 (2.10) Short term: 4.16 (2.90) vs. 5.42 (2.75), difference −1.26 (95% CI −2.64 to 0.12) Long term (12 months): 4.57 (2.94) vs. 7.37 (2.27), difference −2.80 (95% CI −4.16 to −1.44) |
A vs. B Harms: NR Subsequent treatments
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Rose 1997 (Part 1)a UK Mean duration of pain 97 months Poor Group vs. Individual Session Format |
A. CPMP – Group format (n=26) Duration and intensity NR, group, outpatient B. CPMP – Individual format (n=24) Duration and intensity NR, individual, outpatient |
Mean age: 42 years % Male: 41% Race/Ethnicity: NR Pain etiology/type: Chronic LBP (and/or referred leg pain) Disability or sickness benefit: 64% (completers only) Comorbidities: NR Prior spinal surgery: 13% Unsuccessful PT: 91% |
VAS-pain Baseline: 6.6 vs. 6.0 Postintervention: 5.8 vs. 4.7 Intermediate term: 6.5 vs. 6.0 p=NS for all RDQ (0-24) Baseline: 15.8 vs. 17.0 Postintervention: 13.3 vs. 11.1 Intermediate term: 13.3 vs. 11.1 p=NS for all |
A vs. B, Mean (SDs NR) The Modified Zung Depression Inventory (scale NR) Baseline: 33.1 vs. 32.0 Postintervention: 27.0 vs. 27.0 Intermediate term: 28.0 vs. 26.1 p=NS for all | NR |
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Abbasi 2012 Iran Mean duration of pain: 74 months Poor CPMP + additional components vs. standard CPMP |
A. CPMP – Spouse-assisted (n=9) 7 weeks, 2 hours/week (14 hours total), combo (primarily group, individual if needed), outpatient B. CPMP – Conventional, patient-oriented (n=10) 7 weeks, 2 hours/week (14 hours total), combo (primarily group, individual if needed), outpatient |
Mean age: 45 years % Male: 12% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability: NR Comorbidities:
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A vs. B, Mean (SD) VAS pain in last week (0-10) Baseline: 5 (2.7) vs. 4.6 (2) Postintervention: 3 (1.8) vs. 2.6 (2), difference 0.40 (95% CI −1.45 to 2.25) Long term: 2.8 (2.7) vs. 3.7 (2.5), difference −0.90 (95% CI −3.42 to 1.62) RDQ (0-24) Baseline: 11.2 (4.3) vs. 12.1 (5.7) Postintervention: 5.8 (3) vs. 6.2 (4.4), difference −0.40 (95% CI −4.10 to 3.30) Long term: 8.2 (5.4) vs. 8.8 (5.9), difference −0.60 (95% CI −6.01 to 4.90) | NR | NR |
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Altmaier 1992 US Mean duration of pain: NR Fair CPMP + additional components vs. standard CPMP |
A. CPMP + additional psychological components (n=24) 3 weeks, duration NR, intensity NR, inpatient B. Standard CPMP (n=21) 3 weeks, duration NR, intensity NR, inpatient |
Mean age: 40 % Male: 27% Race/Ethnicity: NR Mean duration of pain: NR Pain etiology/type: Chronic LBP Disability: 100% (inclusion criteria: disabled and not working due to pain for ≥3 to ≤30 months) Comorbidities: NR
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A vs. B, Mean (SD) MPQ Present Pain Intensity (1-5) Baseline: 2.24 (0.77) vs. 2.52 (0.81) Postintervention: 2.05 (0.74) vs. 2.00 (0.89), difference 0.05 (95% CI −0.46 to 0.56) Intermediate term: 2.33 (0.80) vs. 2.00 (0.95), difference 0.33 (95% CI −0.22 to 0.88) MPQ Pain Rating Index (0-78) Baseline: 22.00 (10.41) vs. 17.81 (9.06) Postintervention: 21.71 (9.16) vs. 16.05 (9.31), difference 5.66 (95% CI −0.10 to 11.42) Intermediate term: 20.33 (11.91) vs. 16.19 (12.48), difference 4.14 (95% CI −3.47 to 11.75) WHYMPI Pain Interference Subscale (scale NR) Baseline: 65.38 (13.23) vs. 65.10 (17.10) Postintervention: 57.33 (15.06) vs. 57.67 (16.37), difference −0.34 (95% CI −10.2 to 9.47) Intermediate term: 52.19 (19.58) vs. 50.71 (25.95), difference 1.48 (95% CI −12.86 to 15.82) Low Back Pain Rating Scale Total Score (scale 0-130) Baseline: 57.00 (9.89) vs. 60.19 (14.03) Postintervention: 67.05 (11.01) vs. 71.19 (9.92), difference −4.14 (95% CI −10.68 to 2.39) Intermediate term: 64.86 (12.56) vs. 70.76 (15.70), difference −5.90 (95% CI −14.77 to 2.97) |
A vs. B, Mean (SD) WHYMPI Negative Mood Subscale (scale NR) Baseline: 17.24 (6.68) vs. 17.05 (6.72) Postintervention: 14.19 (5.61) vs. 14.00 (5.92), difference 0.19 (95% CI −3.41 to 3.79) Intermediate term: 16.24 (4.22) vs. 15.00 (6.15), difference 1.24 (95% CI −2.05 to 4.53) | NR |
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Van der Maas 2015 The Netherlands Mean duration of pain: NR (≥2 years: 75%) Fair CPMP + additional components vs. standard CPMP |
A. CPMP + Psychomotor Therapy (n=49) 3 days a week for 12 weeks, 104 hours total, group, outpatient B. Standard CPMP (n=45) 3 days a week for 12 weeks, 94 hours total, group, outpatient |
Mean age: 42 years % Male: 14% Race/ethnicity: NR Pain etiology/type: Chronic MSK pain (≥3 months) Disability: NR Comorbidities: NR
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PDI disability (0-70) Baseline: 40.00 (8) vs. 40.34 (11) Postintervention: 33.26 (7) vs. 36.63 (11), difference −3.37 (95% CI −7.12 to 0.38) Short term: 31.33 (11) vs. 35.46 (12), difference −4.13 (95% CI −8.84 to 0.58) Intermediate term: 31.82 (12) vs. 33.71 (14), difference −1.89 (95% CI −7.22 to 3.44) Long term: 32.10 (12) vs. 32.40 (15), difference −0.30 (95% CI – 5.84 to 5.24) |
A vs. B, Mean (SD) RAND-36 physical component (0-100) Baseline: 32.42 (7) vs. 31.51 (7) Postintervention: 34.83 (8) vs. 32.62 (9), difference 2.21 (95% CI – 1.27 to 5.69) Short term: 36.86 (8) vs. 34.36 (9), difference 2.50 (95% CI −0.98 to 5.98) Intermediate term: 35.82 (8) vs. 32.17 (9), difference 3.65 (95% CI – 0.04 to 7.34) Long term: 36.99 (7) vs. 33.90 (7), difference 3.09 (95% CI 0.22 to 5.96) RAND-36 mental component (0-100) Baseline: 39.89 (10) vs. 39.59 (11) Postintervention: 43.45 (11) vs. 39.90 (12) Short term: 42.33 (11) vs. 39.84 (10), difference 2.49 (95% CI −1.83 to 6.81) Intermediate term: 45.59 (10) vs. 45.03 (10), difference 0.56 (95% CI −3.54 to 4.66) Long term: 43.60 (11) vs. 44.59 (9), difference −0.99 (95% CI −5.13 to 3.15) BDI (0-63) Baseline: 20.23 (8) vs. 18.68 (4) Postintervention: 12.81 (8) vs. 15.92 (9), difference −3.11 (95% CI −6.59 to 0.37) Short term: 12.72 (6) vs. 15.33 (10), difference −2.61 (95% CI −5.96 to 0.74) Intermediate term: 13.11 (8) vs. 13.76 (9), difference −0.65 (95% CI −4.13 to 2.83) Long term: 13.32 (8) vs. 13.56 (9), difference −0.24 (95% CI −3.72 to 3.24) | NR |
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Kool, 2005, 2007 Switzerland Mean duration of pain: NR (“nonacute”) Fair Different philosophical approaches to CPMP |
A. CPMP - Function-Centered (n=87) 3 weeks, 6 days/week (24 hours/week, 72 hours total), individual inpatient B. CPMP - Pain-Centered (n=87) 3 weeks, 6 days/week (15 hours/week, 45 hours total), individual, inpatient |
Mean age: 42 years % Male: 79% Race/Ethnicity: NR Pain etiology/type: Disability: NRComorbidities: NR Other characteristics:
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A vs. B, mean difference (95%) in change scores from baseline Pain NRS (0-10) Baseline (mean, SD): 5.5 (2.0) vs. 5.7 (2.2) Postintervention: difference in change scores −0.80 (–1.40 to −0.20) Short term: difference in change scores −0.54 (–1.35 to 0.27) PACT (0-200) Baseline (mean, SD): 110 (39) vs. 102 (42) Postintervention: difference in change scores −13.30 (–20.32 to – 6.28) |
A vs. B, Mean (SD) Global improvement (7-point Likert scale) Postintervention: 4.4 (2.0) vs. 3.6 (2.0), difference 0.80 (95% CI 0.19 to 1.40) Short term: no difference between groups (data NR) |
A vs. B, Mean (SD) Harms: NR Patient satisfaction with treatment, median (IQR) Long term (12 months): 6 (4 to 7) vs. 6 (4 to 7) |
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Leeuw, 2008 The Netherlands Mean duration of pain: 108 months Fair Different philosophical approaches to CPMP |
A. CPMP - “Exposure in vivo” (n=42) 8 weeks (2 hours/week, 16 hours total), individual, outpatient B. CPMP - graded activity (n=43) 13 weeks (2 hours/week, 26 hours total), individual, outpatient |
Mean age: 45 years % Male: 52% Race/Ethnicity: NR Pain etiology/type: Chronic LBP
Other characteristics:
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A vs. B, mean (SD) or mean (95% CI) change from baseline MPQ (0-100) Baseline: 52.54 (12.77) vs. 54.66 (11.88) Postintervention: 43.72 (21.24) vs. 44.07 (22.86), difference −0.35 (95% CI −10.37 to 9.67) Intermediate term: 41.15 (22.26) vs. 40.45 (22.25), difference 0.70 (95% CI −9.70 to 11.10) Quebec Back Pain Disability Scale (0-100) Baseline: 53.61 (11.63) vs. 51.88 (13.54) Postintervention: 35.90 (20.45) vs. 41.69 (22.58), difference −5.79 (95% CI −15.56 to 3.98) Intermediate term: 39.00 (20.93) vs. 41.94 (19.29), difference −2.94 (95% CI −12.36 to 6.48) Proportion of patients reporting clinically relevant changes on the RMDQ Postintervention: 54% (22/41) vs. 42% (15/36), RR 1.29 (95% CI 0.80 to 2.08) Intermediate term: 50% (19/38) vs. 34% (12/35), RR 1.46 (0.83 to 2.55) RMDQ (0-24) Baseline: 15.23 (3.64) vs. 14.27 (3.44) Postintervention: difference in change scores from baseline −1.95 (95% CI −4.61 to 0.71) Intermediate term: difference in change scores from baseline −2.11 (95% CI −4.76 to 0.54) | NR | Adverse events/harms: - Deterioration during intervention (i.e., treatment counterproductive): 0% (0/42) vs. 2% (1/43)
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Rothman 2013 Sweden Median duration of pain: 18 months Fair CPMP with vs. without pretreatment assessment |
A. CPMP with “multimodal” pretreatment assessment (n=99) Duration NR, Intensity NR, combo, outpatient B. CPMP using standard process (n=108) Duration NR, Intensity NR, combo, outpatient |
Median age (IQR): Treatment: 40 (32 to 47) years, Control: 40 (33-48) years % Male: 23.6% Race/ethnicity: NR Pain etiology/type: Chronic muscular pain Disability: NR Comorbidities : NR |
A vs. B, Median (IQR) VAS pain (0-10) Baseline: 6.95 (5.90 to 8.00) vs. 7.45 (6.00 to 8.10) Long term: 6.0 (3.0 to 8.1) vs. 6.55 (3.80 to 8.00), adjusted OR of improvement from baseline 1.20 (0.63 to 2.30)f ODI (0-100) Baseline: 40 (28 to 50) vs. 38 (28 to 50) Long term: 36 (22 to 49) vs. 38 (28 to 50), adjusted OR of improvement from baseline 1.61 (0.84 to 3.07)f |
A vs. B, Median (IQR) Zung SDS (1-4) Baseline: 3 (2 to 3) vs. 2 (1 to 3) Long term: 2 (2 to 3) vs. 2 (2 to 3), adjusted OR 1.31 (0.69 to 2.47)f Stress and Crisis Inventory (SCI-93) (0-140) Baseline: 60 (45 to 79) vs. 54.5 (33 to 76) Long term: 56 (38 to 75) vs. 51 (33 to 76), adjusted OR 1.10 (0.58 to 2.08)f Baseline: 30 (NR) vs. 30 (NR) Long term: 31 (NR) vs. 30 (NR) Baseline: 35 (NR) vs. 39 (NR) Long term: 40 (NR) vs. 39 (NR) |
Harms: NR Patient Satisfaction (1-7), median (IQR)
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Streibelt 2014 Germany Mean duration of pain: NR Fair CPMP with vs. without pretreatment assessment |
A. CPMP plus pretreatment functional capacity evaluation (FCE) (n=109) 3 weeks, 3 to 4 hours/day (total 50 to 60 hours), individual, inpatient B. CPMP alone (n=113) 3 weeks, 3 to 4 hours/day (total 50 to 60 hours), individual, inpatient |
Mean age: 46 years % Male: 83% Race/ethnicity: NR Pain etiology/type: Chronic MSK disorders
Currently sick-listed: 81% Duration of sick leave last year: 15 weeks Comorbidities: NR
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A vs. B, mean PDI (0-70) Baseline: 37.4 (14.4) vs. 33.2 (13.6) Long term: 27.0 vs. 33.5, adjusted difference −6.5 (95% CI −12.6 to – 0.4)h | NR | NR |
BDI = Beck Depression Inventory; CI = confidence interval; CPMP = comprehensive pain management program; IQR – interquartile range; LBP = low back pain; MCS = Mental Component Score; MPQ = McGill Pain Questionnaire; MSK = musculoskeletal; NR = not reported; NOS = not otherwise specified; ODI = Oswestry Disability Index; OR = odds ratio; PCS = Physical Component Score; PDI = Pain Disability Index; PT = physical therapy; RCT = randomized controlled trial; RDQ = Roland-Morris Disability Index; RR = risk ratio; SD = standard deviation; SF-36 = Short Form 36 Questionnaire; SIP = Sickness Impact Profile; VAS = visual analog scale; WHYMPI = West Haven-Yale Multidimensional Pain Inventory.
Demographics data include information for patients in both Part 1 and 2 of this study (demographics were not reported separately by the authors).
All followup scores were estimated from graphs in the article. For data included in the meta-analyses, the standard deviation was imputed using average CV of studies under same outcome category. Where means and standard deviations are reported in this table, they came from the results of the meta-analyses.
Range of 9 to 18 months with the majority at 12 months.
Data were estimated by the EPC from figures in the article.
Standard deviations estimated from Figure 2 of article.
Multivariate regression adjusted for sex, age, smoking status, nationality, education level, and relationship status.
Adjusted for baseline score of the outcome, baseline employment status, baseline work ability, baseline PDI and diagnosis.
From: Appendix B, Results Overview
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