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Author, Year Country Pain Duration Study Design Study Quality |
Intervention (n) Comparator (n) Duration/Intensity Session Format Setting (IP/OP) | Population |
Primary Outcomes: Pain, Function, and Opioid Use | Secondary Outcomes: HRQOL, Psychological Measures, Global Improvement | Harms, Utilization, Patient Satisfaction |
|---|---|---|---|---|---|
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Alaranta, 1994 Finland Mean duration of pain: NR (≥6 months) Fair |
A. CPMP (n=152) 6 weeks, 52 hours total; group + individual; 3 weeks at home + 3 weeks inpatient B. PA (n=141) 3 weeks 45-60 hours total, session format NR, inpatient |
Mean age: 40 years Male: 45% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability:
|
A vs. B, Mean (SD) MVAS disability (0-100) (f/u data estimated by EPC from Fig 4 of study publication) Baseline: 45.5 (18.8) vs. 45.1 (20.8) Short term: 28.5 (20.9) vs. 35.8 (20.3), difference −7.3 (95% CI −12.1 to 2.5) Intermediate term: 29.6 (23.2) vs. 36.1 (23.9), difference −6.5 (95% CI −12.0 to – 1.0) |
Symptom Check List Pain and Anxiety Subscales: Data not reported (p>0.05) BDI: Data not reported. |
A vs. B Harms: NR Decrease (%) in the number of yearly visits Physician: 74% vs. 67% Outpatient PT: 69% vs. 77% |
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Bendix, 1995, 1997, 1998a, 1998b (PROJECT B) Denmark Mean duration of pain: NR (≥6 months) Fair |
A. CPMP, high intensity (n=46) 3 weeks (39 hours/week + one 6hour session /week for 3 weeks, group, outpatient B. CPMP, lower intensity (n=43) Twice weekly for 6 weeks (total 24 hours), group, outpatient C. PA (n=43) Twice weekly for 6 weeks (total 24 hours), group, outpatient |
Mean age: 42 years Male: 25% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability: Patient’s perception of disability due to back pain (0-30): 15 Comorbidities: Smoker: 66% Prior back surgery: 21% Disability Index (from LBP Rating Scale, 0-30) Baseline: 15.5 (NR) vs. 15.3 (NR) vs. 14.4 (NR) Short term: 8.5 (5 to 15) vs. 16.1 (11 to 19) vs. 13.5 (10 to 17), p=0.002 for A vs. B and A vs. C Long term (12 months): 8.9 (5 to 13) vs. 16.4 (14 to 19) vs. 13.7 (9 to 17), p<0.001 for A vs. B and A vs. C Long term (24 months): 10 (6 to 14) vs. 17 (9 to 21) vs. 14 (9 to 17), p=0.002 for A vs. B, p=0.02 for A vs. C Long term (60 months): 8 (NR) vs. 16 (NR) vs. 14 (NR), p=0.03 for A vs. B, p=0.01 for A vs. C |
A vs. B vs. C, Median (IQR) Back pain VAS (0-10) Baseline: 5.3 (NR) vs. 5.9 (NR) vs. 5.4 (NR) Short term: 2.7 (1.4 to 4.3) vs. 5.6 (3.8 to 7.6) vs. 4.4 (2.4 to 6.2), p<0.001 for A vs. B and A vs. C Long term (12 months): 3.3 (2.1 to 5.6) vs. 6.5 (4.8 to 7.7) vs. 5.3 (3.3 to 7.6), p=0.005 for A vs. B and A vs. C Long term (24 months): 3 (2 to 6) vs. 6 (4 to 8) vs. 5 (3 to 7), p=0.003 for A vs. B, p=0.07 for A vs. C Long term (60 months): 4 (NR) vs. 6 (NR) vs. 5 (NR), p=0.3 Leg pain VAS (0-10) Baseline: 2.9 (NR) vs. 3.7 (NR) vs. 3.7 (NR) Short term: 0.4 (0 to 2.3) vs. 3.1 (0.5 to 5.9) vs. 2.6 (0.1 to 4.6), p=0.01 for A vs. B and A vs. C Long term (12 months): 2.1 (0.2 to 4.13) vs. 4.8 (2.3 to 7.3) vs. 2.8 (1.4 to 7.0), p=0.001 for A vs. B, p=0.04 for A vs. C Long term (24 months): 2 (0 to 5) vs. 5 (1 to 6) vs. 4 (2 to 6), p=0.08 Long term (60 months): 3 (NR) vs. 4 (NR) vs. 4 (NR), p=0.07 | NR |
A vs. B vs. C, Median (IQR) Harms: NR Number contacts to any health-care professional Short term: 0.5 (0 to 2.4) vs. 2.8 (0.4 to 4.6) vs. 1.3 (0.1 to 3.1), p=NS for A vs. B, p<0.05 for A vs. C Long term (12 months): 4.5 (0.3 to 12.3) vs. 12.0 (0.8 to 23.3) vs. 11.8 (4.0 to 25.0), p=0.002 for A vs. B and A vs. C Long term (24 months): 5 (0 to 19) vs. 21 (3 to 34) vs. 14 (7 to 27), p=0.03 Long term (60 months): 15 (NR) vs. 10 (NR) vs. 24 (NR), p=0.20 Proportion of patients hospitalized due to LBP, % (n/N) Long term (60 months): 22% (8/37) vs. 23% (7/31) vs. 24% (7/29), p=1.0 Proportion who underwent back surgery during study period, % (n/N) Long term (60 months): 5% (2/37) vs. 10% (3/31) vs. 10% (3/29), p=0.70 |
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Bendix, 2000 Denmark Mean duration of pain: NR (≥6 months) Fair |
A. CPMP (n=59) 3 weeks (40 hours/week), then 1 day weekly for 3 weeks + a 6-hour follow-up, group, outpatient B. PA (n=68) 8 weeks (1.5 hour per day, 3x/week, 36 hours total), group, outpatient |
Median age: 41 years Male: 35% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability:
Comorbidities: NR |
A vs. B, Median (IQR) Back pain VAS (0-10) Baseline: 5.1 (4 to 7) vs. 6.0 (5 to 7) Long term: 5.1 (2 to 7) vs. 5.7 (3 to 7.3) Leg pain VAS (0-10) Baseline: 2.2 (0 to 5) vs. 3.2 (0 to 6) Long term: 2.8 (0 to 7) vs. 3.5 (1 to 6.3) (ns) Disability Index (from LBP Rating Scale, 0-30) Baseline: 16 (12 to 20) vs. 16 (12 to 21) Long term: 12 (6 to 21) vs. 13 (9 to 19) |
A vs. B, Median (IQR) Overall assessment of how much the treatment influenced the QoL (0-5) Long term: 1.7 (1 to 3) vs. 2.7 (2 to 3.3) (P=0.03) |
A vs. B, Median (IQR) Harms: NR Number contacts to any health-care professional Long term: 2.5 (0 to 10) vs. 4 (0 to 12.3) (ns) |
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Henchoz, 2010 Switzerland Mean duration of pain: NR (>6 weeks) Fair |
A. CPMP (n=40) 3 weeks (~31 hours/week, 93 hours total), group + individual, outpatient B. PA (n=27) 9 weeks (1.5 hours/week, 13.5 hours total), individual, outpatient |
Mean age: 40 years Male: 67% Race/Ethnicity: NR Pain etiology/type: LBP Disability: NR Comorbidities: NR |
A vs. B, Mean (SD) ODI (0-100) Baseline: 37.6 (15.8) vs. 39.1 (14.7) Postintervention: 30.1 (16.5) vs. 37.2 (13.5), difference −7.1 (95% CI −14.75 to 0.55) Short term: 25.7 (15.8) vs. 35.0 (12.3), difference −9.3 (95% CI −16.51 to −2.09) Intermediate term (6 months): 28.6 (18.4) vs. 35.4 (15.0), difference −6.8, (95% CI – 15.32 to 1.72) Intermediate term (9 months): 29.6 (17.9) vs. 39.8 (17.3), difference −10.2, (95% CI −18.99 to −1.41) Long term (12 months): 26.2 (18.0) vs. 38.0 (18.4), difference −11.8 (95% CI – 20.83 to −2.77) | NR | NR |
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Jensen, 2001 Sweden Mean duration of pain: 31 months Fair |
A. CPMP (n=63) 4 weeks (20 hours/week, 80 hours total, plus six 90-minute booster sessions over 1 year after treatment), group, outpatient B. PA (n=54) Duration: 4 weeks (20 hours/week, 80 hours total, plus six 90-minute booster sessions over 1 year after treatment), group + individual, outpatient |
Mean age: 43 years % Male: 45% Race/Ethnicity:
Comorbidities: NR | NR |
A vs. B, Mean (SD) SF-36 Global health (0-100) Females only A vs. B (n=30 vs. 37) Baseline: 38.1 (14.5) vs. 35.1 (11.4) Postintervention: 47.6 (18.0) vs. 41.0 (15.1), difference 6.6 (95% CI −1.48 to 14.68) Intermediate term: 52.4 (21.6) vs. 43.6 (22.7), difference 8.8 (95% CI −2.10 to 19.70) Long term: 53.1 (24.5) vs. 47.2 (24.7), difference 5.9 (95% CI −6.18 to 17.98) Males only A vs. B (n=33 vs. 17) Baseline: 41.6 (14.6) vs. 42.6 (13.3) p=ns Postintervention: 48.5 (17.2) vs. 46.3 (14.4), difference 2.2 (95% CI −7.60 to 12.00) Intermediate term: 54.3 (18.3) vs. 50.3 (16.5), difference 4.0 (95% CI −6.64 to 14.64) Long term: 57.2 (21.8) vs. 52.4 (17.9), difference 4.8 (95% CI −7.56 to 17.16) |
A vs. B, Mean (SD) Harms: NR Perceived treatment appropriateness (0-10) Females only A vs. B (n=30 vs. 37) Postintervention: 6.4 (3.1) vs. 7.1 (3.4), difference −0.70 (95% CI −2.30 to 0.90) Males only A vs. B (n=33 vs. 17) Postintervention: 6.0 (3.6) vs. 6.3 (3.2), difference −0.30 (95% CI −2.38 to 1.78) Recommend treatment to relative with a similar pain (0-10) Females only A vs. B (n=30 vs. 37) Postintervention: 7.0 (3.7) vs. 7.9 (3.2), difference −0.90 (95% CI −2.58 to 0.78) Males only A vs. B (n=33 vs. 17) Postintervention: 6.1 (4.3) vs. 7.6 (3.8), difference −1.50 (95% CI −3.99 to 0.99) |
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Jousett, 2004 France Mean duration of pain: NR Fair |
A. CPMP (n=43) 5 weeks (6 hours per day, 30 hours total), group + individual, outpatient B. PA (n=41) 5 weeks (3 hours per week in clinic, 2 hours per week at home, 25 hours total), individual, outpatient |
Mean age: 41 years % Male: 67% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability:
|
A vs. B, Mean (SD) VAS pain (0-10) Baseline: 5.0 (2.2) vs. 4.6 (2.2) Intermediate term: 3.1 (2.5) vs. 4.0 (2.8), difference −0.90 (95% CI −2.04 to 0.24) Dallas Pain questionnaire ADLs subscale (0-100) Baseline: 53.7 (16.7) vs. 50.3 (16.7) Intermediate term: 36.7 (23.0) vs. 41.5 (24.4), difference −4.80 (95% CI −15.15 to 5.55) Quebec Back Pain Disability scale (0-100) Baseline: 34.6 (15.4) vs. 31.6 (15.9) Intermediate term: 22.0 (16.0) vs. 22.9 (17.7), difference −0.90 (95% CI −8.27 to 6.47) |
A vs. B, Mean (SD) HADS (0-21): Baseline: 17.0 (6.5) vs. 14.3 (6.2) Intermediate term: 12.7 (7.2) vs. 13.4 (6.4), difference −0.70 (95% CI −3.68 to 2.28) Dallas Pain Questionnaire anxiety/depression subscale (0-100): Baseline: 40.6 (25.3) vs. 31.8 (23.1) Intermediate term: 21.6 (22.9) vs. 27.8 (22.2), difference −6.20 (95% CI −16.05 to 3.65) |
A vs. B, % (n/N) or Mean (SD) Harms: NR Proportion seeking pain treatments Baseline: 85.7% (63/42) vs. 78.0% (32/41) Intermediate term: 64.3% (27/42) vs. 61.0% (25/41), RR 1.05 (95% CI 0.76 to 1.47) Treatment appreciation (1-5) Intermediate term: 1.9 (0.8) vs. 2.3 (0.9), difference −0.40 (95% CI −0.77 to −0.03) |
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Kaapa, 2006 Finland Mean duration of pain: 26 months Fair |
A. CPMP (n=59) 8 weeks (70 hours total), group + individual, outpatient B. PA (n=61) 6-8 weeks (10 hours total), individual, outpatient |
Mean age: 46 % Male: 0% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability: NR Comorbidities:
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A vs. B, Mean (SD) Low back pain NRS (0-10) Baseline: 4.6 (1.9) vs. 5.0 (2.6) Postintervention: 3.3 (2.5) vs. 3.4 (2.4), difference −0.10 (95% CI −0.98 to 0.78) Intermediate term: 3.3 (2.5) vs. 3.4 (2.5), difference −0.10 (95% CI −1.01 to 0.81) Long term (12 months): 3.6 (2.7) vs. 3.4 (2.5), difference −0.20 (95% CI −0.80 to 1.20) Long term (24 months): 3.5 (2.6) vs. 4.0 (2.9), difference −0.50 (95% CI −1.61 to 0.61) Sciatic pain NRS (0-10) Baseline: 2.7 (2.7) vs. 3.1 (3.1) Postintervention: 2.2 (2.7) vs. 2.0 (2.6), difference 0.20 (95% CI −0.76 to 1.16) Intermediate term: 2.3 (2.8) vs. 1.8 (2.3), difference 0.50 (95% CI −0.45 to 1.45) Long term (12 months): 2.5 (3.0) vs. 2.0 (2.5), difference 0.50 (95% CI −0.56 to 1.56) Long term (24 months): 2.1 (2.8) vs. 2.7 (2.9) ODI (0-100) Baseline: 25.4 (10.6) vs. 23.8 (11.7) Postintervention: 20.9 (10.1) vs. 21.6 (11.4), difference −0.70 (95% CI −4.60 to 3.20) Intermediate term: 20.4 (11.6) vs. 18.0 (11.5), difference 2.4 (95% CI −1.87 to 6.67) Long term (12 months): 18.9 (12.8) vs. 18.5 (12.4), difference 0.40 (95% CI −4.43 to 5.23) Long term (24 months): 19.7 (14.3) vs. 19.3 (13.1), difference 0.40 (95% CI −5.20 to 6.00) |
A vs. B, Mean (SD) Symptoms of depression (DEPS) (0–30) Baseline: 7.5 (5.2) vs. 6.7 (5.5) Postintervention: 5.5 (5.5) vs. 5.7 (5.2), difference −0.20 (95% CI −2.13 to 1.73) Intermediate term: 5.7 (4.6) vs. 5.8 (5.7), difference −0.10 (95% CI −2.01 to 1.81) Long term (12 months): 6.6 (5.8) vs. 5.0 (4.0), difference 1.60 (95% CI −0.31 to 3.51) Long term (24 months): 6.7 (5.3) vs. 5.7 (4.7), difference 1.00 (95% CI – 1.05 to 3.05) |
A vs. B, Mean (SD) Harms: NR Number contacts to any health-care professional Long term (12 months): 5.8 (9.9) vs. 5.4 (8.2), difference 0.40 (95% CI −3.08 to 3.88) Long term (24 months): 3.4 (7.0) vs. 5.3 (8.6), difference −1.90 (95% CI −5.09 to 1.29) |
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Mangels, 2009 Germany Mean duration of pain: NR Fair |
A. CPMP + booster sessions (n=119) ~4 weeks + 7, 20-minute booster sessions over 12 months, group + individual, inpatient B. CPMP (n=113) ~4 weeks, group + individual, inpatient C. PA (n=131) ~3.5 weeks, group + individual, inpatient |
Mean age: 49 years % Male: 22% Race/Ethnicity: NR Pain etiology/type Dorsalgia: 84% Other dorsopathies, 71% Arthrosis: 34% Disability: NR Comorbidities: NR |
A vs. B vs. C, Mean (SD) PPS - Affective pain perception (14-56) Baseline: 30.9 (9.4) vs. 30.9 (10.4) vs. 29.6 (9.0) Postintervention: 23.4 (9.4) vs. 23.7 (9.2) vs. 22.9 (8.2) A vs. C: difference 0.50 (95% CI −1.69 to 2.69) B vs. C: difference 0.80 (95% CI −1.39 to 2.99) 12 months: 24.1 (9.8) vs. 25.5 (9.9) vs. 25.1 (9.6) A vs. C: difference −0.10 (95% CI −3.50 to 1.50) B vs. C: difference 0.40 (95% CI −2.14 to 2.94) PPS - Sensory pain perception (10-40) Baseline: 18.9 (5.9) vs. 18.5 (5.6) vs. 18.8 (5.9) Postintervention: 15.9 (5.3) vs. 15.9 (5.2) vs. 16.4 (5.8) A vs. C: difference −0.50 (95% CI −1.89 to 0.89) B vs. C: difference −0.50 (95% CI −1.90 to 0.90) Long term: 16.3 (5.7) vs. 17.0 (6.1) vs. 17.3 (6.1) A vs. C: difference −1.0 (95% CI −2.53 to 0.53) B vs. C: difference −0.30 (95% CI −1.89 to 1.29) PDI (0-70) Baseline: 26.9 (13.9) vs. 26.1 (11.8) vs. 24.8 (12.5) Postintervention: 21.7 (13.3) vs. 20.3 (13.9) vs. 21.0 (13.1) A vs. C: difference 0.70 (95% CI −2.59 to 3.99) B vs. C: difference −0.70 (95% CI −4.12 to 2.71) Long term: 22.6 (16.0) vs. 22.0 (14.0) vs. 20.6 (13.5) A vs. C: difference 2.0 (95% CI −1.80 to 5.80) B vs. C: difference 1.4 (95% CI −2.19 to 4.99) |
A vs. B vs. C, Mean (SD) SF-12 PCS (0-100) Baseline: 33.5 (9.1) vs. 33.6 (7.4) vs. 33.9 (8.7) Postintervention: 38.9 (9.4) vs. 39.3 (9.9) vs. 38.6 (8.6) A vs. C: difference 0.30 (95% CI −1.94 to 2.54) B vs. C: difference 0.70 (95% CI −1.63 to 3.03) Long term: 38.4 (10.4) vs. 38.4 (9.7) vs. 38.4 (10.1) A vs. C: difference 0 (95% CI −2.64 to 2.64) B vs. C: difference 0 (95% CI −2.59 to 2.59) SF-12 MCS (0-100) Baseline: 43.9 (12.1) vs. 44.0 (11.1) vs. 44.5 (11.5) Postintervention: 48.9 (12.1) vs. 50.8 (10.5) vs. 50.9 (10.5) A vs. C: difference −2.0 (95% CI −4.82 to 0.82) B vs. C: difference −0.10 (95% CI −2.76 to 2.56) Long term: 45.6 (11.7) vs. 46.0 (11.2) vs. 45.0 (11.7) A vs. C: difference 0.60 (95% CI −2.42 to 3.62) B vs. C: difference 1.0 (95% CI – 2.00 to 4.00) BDI (0-63) Baseline: 11.4 (9.8) vs. 11.1 (10.1) vs. 10.1 (8.1) Postintervention: 7.2 (7.8) vs. 6.7 (6.0) vs. 7.8 (7.8) A vs. C: difference −0.60 (95% CI −4.08 to 2.88) B vs. C: difference −1.10 (95% CI −4.56 to 2.36) Long term: 10.7 (8.8) vs. 10.4 (7.8) vs.11.4 (8.2) A vs. C: difference −0.70 (95% CI −2.89 to 1.49) B vs. C: difference −1.0 (95% CI – 3.09 to 1.09) |
A vs. B vs. C, Mean (SD) Harms: One death during inpatient treatment (group A); no other details provided German Life Satisfaction (with health) Questionnaire (scale NR) Baseline: 28.4 (9.5) vs. 28.1 (9.0) vs. 28.9 (8.5) Postintervention: 33.1 (8.8) vs. 33.1 (9.2) vs. 32.5 (8.8) A vs. C: 0.60 (95% CI −1.60 to 2.80) B vs. C: 0.60 (95% CI −1.67 to 2.87) Long term: 33.3 (9.5) vs. 31.7 (9.8) vs. 31.2 (8.4) A vs. C: difference 2.1 (95% CI −0.21 to 4.41) B vs. C: difference 0.50 (95% CI −1.87 to 2.87) |
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Meyer, 2005 Switzerland Mean duration of pain: 36 months Fair |
A. CPMP (n=17) 8 weeks (17.5 hours/week, 140 hours total), session format NR for physical component, individual + group for psychological component, setting NR B. PA (n=16) 8 weeks 1.5 hours/week (12 hours total), session format NR, outpatient |
Median age: 43 years Male: 79% Race/Ethnicity: NR Pain etiology/type: Cervical, arm, and or head: 15% Knee: 3% Back and or leg: 69% Widespread areas: 9% Comorbidities: 1 or more, 39% Other characteristics: To be included, patients needed to have Sick-leave for at least 2 months or 50% work incapacity from a full-time job over 3 months |
A vs. B, Median (IQR) Pain, NRS (0-10) Baseline: 6.0 (3.5 to 7.0) vs. 5.5 (5.0 to 6.0) Postintervention change score: 1.0 (−1.0 to 2.0) vs. 1.0 (0.0 to 2.0), p=0.34 Baseline: 82.0 (58.5 to 124.5) vs. 136.5 (74.8 to 160.8) Postintervention change score: 10.0 (−9.0 to 37.0) vs. 3.0 (−10.0 to 36.0), p=0.60 |
A vs. B, Median (IQR) Baseline: 32.0 (26.7 to 44.0) vs. 29.6 (25.2 to 37.4) Postintervention change score: 6.0 (−5.4 to 12.9) vs. 2.5 (−3.6 to 11.9), p=0.90 Baseline: 30.0 (25.5 to 34.5) vs. 32.8 (28.4 to 37.4) Postintervention change score: −0.4 (−3.8 to 2.6) vs. −4.4 (−9.0 to 0.4), p=0.17 |
A vs. B, % (n/N) Harms
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Roche, 2007, Roche-LeBoucher 2011 France Mean duration of pain: NR (≥3 months) Fair |
A. CPMP (n=68) 5 weeks (6 hours/day, 150 hours total), group, outpatient B. PA (n=64) 5 weeks (5 hours/week, ~25 hours total), individual, outpatient + home setting |
Mean age: 40 years % Male: 65% Race/ethnicity: NR Pain etiology/type: Chronic LBP Disability:
|
A vs. B, Mean (SD) VAS pain (0-10) Baseline: 4.7 (2.1) vs. 4.5 (2.1) Postintervention change score: −1.9 (NR) vs. −1.5 (NR) Long term change score: −1.7 (2.6) vs. −1.0 (2.3), difference in change scores −0.70 (95% CI −1.64 to 0.24) DPQ, daily activities (0%-100%) Baseline: 51.8% (NR) vs. 51.0% (NR) Postintervention change score: −21.5% (NR) vs. −17.2% (NR) Long term change score: −20.3% (18.1%) vs. −10.4% (23.3%), difference in change scores −9.9 (95% CI −17.62 to −2.19) |
A vs. B DPQ, anxiety and depression (0%-100%) Baseline: 36.9% (NR) vs. 30.9% (NR) Postintervention change score: −17.6% (NR) vs. −7.4% (NR) Long term change score: −15.6% (21.4%) vs. −4.8% (23.5%), difference in change scores −10.8 (95% CI −19.20 to −2.40) | Harms: one right tibial fracture in Group A which occurred at home; no other details provided |
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Ronzi, 2017 France Mean duration of pain: NR (≥3 months) Poor |
A. CPMP (n=49) 5 weeks (30 hours/week; 150 hours total), group + individual, inpatient B. CPMP (n=56) 5 weeks (11 hours/week; 55 hours total), group + individual, outpatient C. PA (n=54) Duration: 5 weeks (~5 hours/week, ~25 hours total), individual, outpatient + home setting |
Mean age: 42 years % Male: 59% Race/ethnicity: NR Pain etiology/type: Chronic LBP Disability: NR Other characteristics: NR |
A vs. B vs. C, Median (IQR) VAS pain (0-100) Baseline: 54 (45 to 65) vs. 55 (36 to 68) vs. 45 (24 to 65) Long term: 45 (25 to 59) vs. 37 (15 to 61) vs. 33 (19 to 48) DPQ, daily activities (0%-100%) Baseline: 63.0% (51.0% to 72.0%) vs. 57.0% (48.0% to 66.0%) vs. 54.0% (48.0% to 69.0%) Long term: 51.0% (12.0% to 64.5%) vs. 39.0% (24.0% to 57.0%) vs. 54.0% (36.0% to 63.0%) |
A vs. B vs. C, Median (IQR) HADS (0-100) Baseline: 17.0 (12.0 to 21.0) vs. 14.0 (11.0 to 18.0) vs. 16.0 (12.0 to 21.0) Long term 11.5 (7.5 to 18.0) vs. 12.0 (7.0 to 15.0) vs. 13.0 (8.0 to 19.0) A vs. C and B vs. C, p=ns DPQ, anxiety and depression (0%-100%) Baseline: 45.0% (20.0% to 60.0%) vs. 35.0% (25.0% to 45.0%) vs. 40.0% (15.0% to 55.0%) Long term: 30.0% (5.0% to 45.0%) vs. 25.0% (5.0% to 45.0%) vs. 30.0% (5.0% to 45.0%) Baseline: 35.7 (29.4 to 39.5) vs. 34.5 (30.7 to 39.2) vs. 35.6 (31.9 to 37.2) Long term: 39.1 (33.8 to 50.4) vs. 41.6 (34.2 to 49.9) vs. 37.5 (33.0 46.8) A vs. C and B vs. C, p=ns Baseline: 43.3 (32.1 to 49.8) vs. 43.4 (35.9 to 51.1) vs. 41.2 (36.1 to 50.8) Long term: 48.3 (42.1 to 53.4) vs. 46.6 (38.7 to 56.6) vs. 48.9 (41.4 to 54.8) A vs. C and B vs. C, p=ns | Harms: No adverse effect related to the interventions was reported |
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Schweikert, 2006 Germany Mean duration of pain: NR (≥6 months) Fair |
A. CPMP (n=200) 3 weeks hours total NR), group, inpatient B. PA (n=209) 3 weeks hours total NR), group + individual, inpatient |
Mean age: 47 years Male: 83% Race/Ethnicity: NR Pain etiology/type: Chronic LBP Disability:
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A vs. B, Mean (SD) Back pain (scale 1-6) Baseline: 4.3 (1.3) vs. 4.5 (1.2) Postintervention change score: −1.2 (1.2) vs. −1.2 (1.2), difference in change scores 0 (95% CI −0.25 to 0.25) Hannover functional questionnaire (FFbH) (0-100) Baseline: 76.0 (19.2) vs. 72.2 (18.3) Postintervention change score: 2.8 (12.3) vs. 3.5 (13.4), difference in change scores −0.70 (95% CI −3.37 to 1.97) |
A vs. B, Mean (SD) Depression (0-48) Baseline: 8.3 (7.3) vs. 7.4 (6.3) Postintervention change score: −2.3 (4.7) vs. −1.6 (4.2), difference in change scores −0.70 (95% CI −1.62 to 0.22) STAI (20-80) Baseline: 39.2 (10.4) vs. 38.8 (9.9) Postintervention change score: −2.7 (6.9) vs. −2.3 (6.3), difference in change scores −0.40 (95% CI −1.78 to 0.98) EQ-5D HRQOL (0-100) Baseline: 60.8 (17.6) vs. 59.3 (16.6) Postintervention: 70.3 (19.3) vs. 68.6 (19.5), difference 1.7 (95% CI −2.21 to 5.61) Intermediate term: 70.0 (17.7) vs. 63.8 (19.9), difference 6.2 (95% CI 2.39 to 10.01) | NR |
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Smeets, 2006a, 2008 Netherlands Mean duration of pain: 56.7 months Cluster RCT Fair |
A. CPMP (n=61) 10 weeks (~75 hours total), group + individual, outpatient B. PA (n=53) 10 weeks (~75 hours total), group + individual, outpatient |
Mean age 42 years Male: 53% Race/ethnicity: NR Mean duration of functional limitations: 35.1 months Pain etiology/type: Chronic LBP
Disability pension:
Trauma preceding LBP: 18% |
A vs. B adjusted mean change score (SD) from baseline VAS, current pain (0-10) Baseline: 4.60 (2.40) vs. 5.12 (2.66) Postintervention: adjusted difference in change scores: −0.018 (95% CI −0.934 to 0.899) Intermediate term: adjusted difference in change scores: 0.498 (95% CI −0.429 to 1.425) Long term: adjusted difference in change scores: 0.804 (95% CI −0.123 to 1.731) Pain Rating Index Total (MPQ) (scale NR) Baseline: 18.08 (9.04) vs. 18.34 (11.32) Postintervention: adjusted difference in change scores: −0.95 (95% CI −4.59 to 2.98) Intermediate term: adjusted difference in change scores: 1.97 (95% CI −1.71 to 5.65) Long term: adjusted difference in change scores: 2.64 (95% CI −1.04 to 6.32) RMDQ (0-23) Baseline (mean, SD): 13.51 (3.92) vs. 14.15 (3.70)) Postintervention: adjusted difference in change scores: −0.05 (95% CI −1.71 to 1.62) Intermediate term: adjusted difference in change scores: 0.62 (95% CI −1.06 to 2.30) Long term: adjusted difference in change scores: 1.16 (–0.52 to 2.84) VAS, main (activity) complaints (0-10) Baseline: 7.24 (1.70) vs. 7.45 Postintervention: adjusted difference in change scores: −0.64 (95% CI −1.60 to 0.33) Intermediate term: adjusted difference in change scores: −0.23 (95% CI −1.19 to 0.74) Long term: adjusted difference in change scores: 0.03 (95% CI −0.94 to 1.00) |
A vs. B adjusted mean change score (SD) from baseline BDI (0-63) Baseline: 9.75 (6.68) vs. 10.38 (7.62) Postintervention: adjusted difference in change scores: 2.17 (95% CI 0.18 to 4.17) Intermediate term: adjusted difference in change scores for group: 0.49 (95% CI −1.54 to 2.51) Long term: adjusted difference in change scores: 1.05 (95% CI −0.97 to 3.07) Global Improvement (1-7) Postintervention: adjusted difference in change scores: 0.20 (95% CI – 0.35 to 0.75) Intermediate term: adjusted difference in change scores: −0.38 (95% CI −0.94 to 0.18) Long term: adjusted difference in change scores: −0.61 (95% CI −1.16 to −0.05) |
A vs. B, % (n/N) or mean (SD) Harms:
(effect modification by RMDQ) p=NS between groups except for in the 90th percentile strata of RMDQ. Postintervention: adjusted difference: −21.58 (95% CI −39.56 to −3.59) |
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Turner, 1990 USA Mean duration of pain: 12.9 years Poor |
A. CPMP (n=18) 8 weeks (4 hours/week, 32 hours total), group and individual, outpatient B. PA (n=21) 8 weeks (2 hours/week, 16 hours total). group + individual, outpatient |
Mean age: 44 years Male: 52.1% Race/ethnicity: White: 100% Pain etiology/type: Chronic LBP Disability: N/A |
A vs. B, Mean (SD) MPQ Pain Rating Index (0-78) Baseline: 25.5 (12.41) vs. 19.4 (10.6) Postintervention: 14.78 (11.44) vs. 17.51 (10.2), difference −2.73 (95% CI −9.75 to 4.29) Intermediate term: 13.29 (9.15) vs.15.65 (9.15), difference −2.36 (95% CI −8.32 to 3.60) Long term: 18.21 (13.31) vs. 14.94 (7.86), difference 3.27 (95% CI −3.70 to 10.24) SIP (0-100) Baseline: 8.50 (4.59) vs. 8.42 (8.21) Postintervention: 3.63 (2.98) vs. 5.49 (6.79), difference −1.86 (95% CI −5.36 to 1.64) Intermediate term: 4.51 (4.68) vs. 6.25 (10.08), difference −1.74 (95% CI −6.99 to 3.51) Long term: 4.75 (3.40) vs. 4.73 (7.85) difference 0.02 (95% CI −4.02 to 4.06) |
A vs. B, Mean (SD) CES-D (0-60) Baseline: 12.38 (7.31) vs. 11.95 (7.68) Postintervention: 7.36 (5.89) vs. 7.38 (4.57), difference −0.02 (95% CI −3.42 to 3.38) Intermediate term: 8.29 (7.94) vs. 9.29 (8.30), difference −1.0 (95% CI −6.30 to 4.30) Long term: 10.00 (7.57) vs. 9.31 (7.73), difference 0.69 (95% CI – 4.29 to 5.67) |
A vs. B, Mean (SD) Harms: NR Patient satisfaction (1-7): Postintervention: 5.50 (NR) vs. 4.48 (NR), p=NS |
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van Eijk-Hustings, 2013, 2016 Netherlands Mean duration of pain: 6.8 years Fair |
A. CPMP (n=108) 12 weeks (36 days of sessions), group, outpatient B. PA (n=47) 12 weeks (24 sessions), group, outpatient |
Mean age 42 years Male: 4% Race/Ethnicity: NR Pain etiology/type: FM Disability: NR |
Estimated marginal means (SD), A vs. B FIQ, Pain Baseline: 6.3 (2.1) vs. 6.2 (1.8) Postintervention: 5.5 (2.1) vs. 5.3 (2.1), difference 0.20 (95% CI −0.53 to 0.93 Long term: 5.3 (2.1) vs. 5.2 (2.5) difference 0.10 (95% CI −0.67 to 0.87) FIQ Total Baseline: 64.5 (14.6) vs. 60.0 (14.4) Postintervention: 55.1 (15.6) vs. 53.2 (16.5), difference 1.90 (95% CI −3.58 to 7.38 Long term: 50.9 (20.8) vs. 52.0 (21.9), difference −1.1 (95% CI −8.40 to 6.20) |
Estimated marginal means (SD), A vs. B EQ-5D (scale −0.59 to 1) Baseline: 0.36 (0.3) vs. 0.41 (0.3) Postintervention): 0.49 (0.3) vs. 0.47 (0.3), difference 0.02 (95% CI −0.08 to 0.12 Long term: 0.55 (0.3) vs. 0.54 (0.3), difference 0.01 (95% CI −0.09 to 0.11 FIQ, Depression Baseline: 5.2 (3.1) vs. 4.8 (2.1) Postintervention: 4.1 (3.1) vs. 4.6 (2.7), difference −0.50 (95% CI −1.53 to 0.53 Long term: 3.9 (3.1) vs. 5.0 (3.4), difference −1.1 (95% CI −2.20 to 0.002) FIQ, Anxiety Baseline: 5.9 (3.1) vs. 4.9 (2.1) Postintervention: 5.0 (2.1) vs. 4.6 (2.7), difference 0.40 (95% CI −0.39 to 1.19 Long term: 4.7 (3.1) vs. 5.0 (3.4), difference −0.30 (95% CI −1.40 to 0.80 |
Estimated marginal means (SD), A vs. B Harms: NR A vs. B Contact with GPs a Baseline: 2.3 (3.1) vs. 3.3 (5.5) Long term: 0.9 (2.1) vs. 0.7 (2.1), difference 0.20 (95% CI −0.53 to 0.93 Contact with medical specialists a Baseline: 1.9 (1.0) vs. 1.9 (1.4) Long term: 0.3 (1.0) vs. 0.4 (0.7), difference – 0.10 (95% CI −0.42 to 0.22 Contact with physiotherapists a Baseline: 2.7 (5.2) vs. 1.9 (1.4) Long term: 2.6 (5.2) vs. 0.4 (0.7) difference 2.20 (95% CI 0.69 to 3.71) Contact with other paramedical professionals a Baseline: 1.1 (3.1) vs. 1.1 (2.7) Long term: 1.0 (3.1) vs. 2.1 (3.4), difference – 1.10 (95% CI −2.20 to 0.002) |
BDI = Beck Depression Inventory; CES-D = Center for Epidemiological Studies Depression; CI = confidence interval; CPMP = comprehensive pain management program; EQ-5D = EuroQol 5Dimensions; FIQ = Fibromyalgia Impact Questionnaire; FM = fibromyalgia; HADS = Hospital Anxiety and Depression Scale; HRQOL = health-related quality of life; IP = Inpatient; LBP = low back pain; MCS = Mental component summary score (of the SF-12 or SF-36); MVAS = Million visual analog scale; NR = not reported; NS = not statistically significant; ODI = Oswestry Disability Index; OP = outpatient; PA = physical activity; PACT = Performance Assessment of Capacity Testing; PCS = Physical component summary score (of the SF-12 or SF-36); PDI = Pain Disability Index; PPS = Pain Perception Scale; RCT = randomized controlled trial; SIP = Sickness Impact Profile; SD = standard deviation; SF-36 = Short-Form 36 questionnaire; STAI = State-Trait Anxiety Inventory; VAS = visual analog scale
Total number of consultations over a period of 2 months prior to measurement
From: Appendix B, Results Overview
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