Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs
Abstract Background There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients...
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Veröffentlicht in: | European journal of pain 2011-09, Vol.15 (8), p.775.e1-775.e11 |
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creator | Miles, Clare L Pincus, Tamar Carnes, Dawn Homer, Kate E Taylor, Stephanie J.C Bremner, Stephen A Rahman, Anisur Underwood, Martin |
description | Abstract Background There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients SM is optimally effective. Aims To systematically review randomized controlled trials of self-management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome. Method We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta-regression analyses for age and gender, as potential moderators. Results Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self-efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self-management. There was insufficient data on moderators of treatment. Conclusions The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power. |
doi_str_mv | 10.1016/j.ejpain.2011.01.016 |
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A systematic review of sub-group analysis within RCTs</title><source>MEDLINE</source><source>Wiley Online Library</source><creator>Miles, Clare L ; Pincus, Tamar ; Carnes, Dawn ; Homer, Kate E ; Taylor, Stephanie J.C ; Bremner, Stephen A ; Rahman, Anisur ; Underwood, Martin</creator><creatorcontrib>Miles, Clare L ; Pincus, Tamar ; Carnes, Dawn ; Homer, Kate E ; Taylor, Stephanie J.C ; Bremner, Stephen A ; Rahman, Anisur ; Underwood, Martin</creatorcontrib><description>Abstract Background There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients SM is optimally effective. Aims To systematically review randomized controlled trials of self-management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome. Method We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta-regression analyses for age and gender, as potential moderators. Results Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self-efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self-management. There was insufficient data on moderators of treatment. Conclusions The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power.</description><identifier>ISSN: 1090-3801</identifier><identifier>EISSN: 1532-2149</identifier><identifier>DOI: 10.1016/j.ejpain.2011.01.016</identifier><identifier>PMID: 21354838</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Anesthesia & Perioperative Care ; Chronic pain ; Humans ; Mediator ; Moderator ; Musculoskeletal pain ; Musculoskeletal Pain - prevention & control ; Musculoskeletal Pain - therapy ; Pain Management - methods ; Pain Management - trends ; Pain Measurement - methods ; Pain Measurement - trends ; Pain Medicine ; Predictive Value of Tests ; Predictor ; Randomized Controlled Trials as Topic - methods ; Randomized Controlled Trials as Topic - trends ; RCT ; Self Care - methods ; Self Care - trends ; Self-management ; Sub-groups ; Systematic review</subject><ispartof>European journal of pain, 2011-09, Vol.15 (8), p.775.e1-775.e11</ispartof><rights>European Federation of International Association for the Study of Pain Chapters</rights><rights>2011 European Federation of International Association for the Study of Pain Chapters</rights><rights>Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21354838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miles, Clare L</creatorcontrib><creatorcontrib>Pincus, Tamar</creatorcontrib><creatorcontrib>Carnes, Dawn</creatorcontrib><creatorcontrib>Homer, Kate E</creatorcontrib><creatorcontrib>Taylor, Stephanie J.C</creatorcontrib><creatorcontrib>Bremner, Stephen A</creatorcontrib><creatorcontrib>Rahman, Anisur</creatorcontrib><creatorcontrib>Underwood, Martin</creatorcontrib><title>Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs</title><title>European journal of pain</title><addtitle>Eur J Pain</addtitle><description>Abstract Background There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients SM is optimally effective. Aims To systematically review randomized controlled trials of self-management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome. Method We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta-regression analyses for age and gender, as potential moderators. Results Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self-efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self-management. There was insufficient data on moderators of treatment. Conclusions The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power.</description><subject>Anesthesia & Perioperative Care</subject><subject>Chronic pain</subject><subject>Humans</subject><subject>Mediator</subject><subject>Moderator</subject><subject>Musculoskeletal pain</subject><subject>Musculoskeletal Pain - prevention & control</subject><subject>Musculoskeletal Pain - therapy</subject><subject>Pain Management - methods</subject><subject>Pain Management - trends</subject><subject>Pain Measurement - methods</subject><subject>Pain Measurement - trends</subject><subject>Pain Medicine</subject><subject>Predictive Value of Tests</subject><subject>Predictor</subject><subject>Randomized Controlled Trials as Topic - methods</subject><subject>Randomized Controlled Trials as Topic - trends</subject><subject>RCT</subject><subject>Self Care - methods</subject><subject>Self Care - trends</subject><subject>Self-management</subject><subject>Sub-groups</subject><subject>Systematic review</subject><issn>1090-3801</issn><issn>1532-2149</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkd-q1DAQxosonj_6BiK586pr0jRtc6McFj0KBwQ9XodpO91Nt03WTmrpC_mcpuzxThhIGL5vmPl-SfJG8J3gonjf77A_g3W7jAux41sVz5JroWSWZiLXz-Ofa57Kiour5Iao55znJZcvk6tMSJVXsrpO_uzBsQWZbdEF263s6Bd2nvxhgnFEYmBHbBmErTf6YN2BEQ5dOoKDA47RxKxj40zNPHg64YABBrbtxRY_nRi4li1Hz2p02NlAH9kdo5UCjhBswyb8bXFhvmM01-lh8vM5WmBYyRJbbDjGOd_3j_QqedHBQPj66b1Nfn7-9Lj_kj58u_-6v3tIUWY8pFlbVU2WaVFAlZei5aBzXXKtilyrrqhLXdeKV2ULqpUKhJY1lKCUFLKLDi1vk3eXufHcXzNSMKOlBocBHPqZTFWVpSorvSnfPinnOkZkzpMdYVrNv2ij4MNFgHHfeOVkqLHoGmzthE0wrbdGcLOxNL25sDQbS8O3Kv4zoBmssw0MJ1yRej9PMSkywlBmuPmx0d5gCxFBS5nLvwYWqX0</recordid><startdate>20110901</startdate><enddate>20110901</enddate><creator>Miles, Clare L</creator><creator>Pincus, Tamar</creator><creator>Carnes, Dawn</creator><creator>Homer, Kate E</creator><creator>Taylor, Stephanie J.C</creator><creator>Bremner, Stephen A</creator><creator>Rahman, Anisur</creator><creator>Underwood, Martin</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>20110901</creationdate><title>Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs</title><author>Miles, Clare L ; Pincus, Tamar ; Carnes, Dawn ; Homer, Kate E ; Taylor, Stephanie J.C ; Bremner, Stephen A ; Rahman, Anisur ; Underwood, Martin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e320t-2d88c22916a8471d0a94970956495f6b79bb5087da5d35a193ba7a55313fa8493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Anesthesia & Perioperative Care</topic><topic>Chronic pain</topic><topic>Humans</topic><topic>Mediator</topic><topic>Moderator</topic><topic>Musculoskeletal pain</topic><topic>Musculoskeletal Pain - prevention & control</topic><topic>Musculoskeletal Pain - therapy</topic><topic>Pain Management - methods</topic><topic>Pain Management - trends</topic><topic>Pain Measurement - methods</topic><topic>Pain Measurement - trends</topic><topic>Pain Medicine</topic><topic>Predictive Value of Tests</topic><topic>Predictor</topic><topic>Randomized Controlled Trials as Topic - methods</topic><topic>Randomized Controlled Trials as Topic - trends</topic><topic>RCT</topic><topic>Self Care - methods</topic><topic>Self Care - trends</topic><topic>Self-management</topic><topic>Sub-groups</topic><topic>Systematic review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miles, Clare L</creatorcontrib><creatorcontrib>Pincus, Tamar</creatorcontrib><creatorcontrib>Carnes, Dawn</creatorcontrib><creatorcontrib>Homer, Kate E</creatorcontrib><creatorcontrib>Taylor, Stephanie J.C</creatorcontrib><creatorcontrib>Bremner, Stephen A</creatorcontrib><creatorcontrib>Rahman, Anisur</creatorcontrib><creatorcontrib>Underwood, Martin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miles, Clare L</au><au>Pincus, Tamar</au><au>Carnes, Dawn</au><au>Homer, Kate E</au><au>Taylor, Stephanie J.C</au><au>Bremner, Stephen A</au><au>Rahman, Anisur</au><au>Underwood, Martin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs</atitle><jtitle>European journal of pain</jtitle><addtitle>Eur J Pain</addtitle><date>2011-09-01</date><risdate>2011</risdate><volume>15</volume><issue>8</issue><spage>775.e1</spage><epage>775.e11</epage><pages>775.e1-775.e11</pages><issn>1090-3801</issn><eissn>1532-2149</eissn><abstract>Abstract Background There are now several systematic reviews of RCTs testing self-management for those with chronic musculoskeletal pain. Evidence for the effectiveness of self-management interventions in chronic musculoskeletal pain is equivocal and it is not clear for which sub-groups of patients SM is optimally effective. Aims To systematically review randomized controlled trials of self-management for chronic musculoskeletal pain that reported predictors, i.e., ‘baseline factors that predict outcome independent of any treatment effect’; moderators, i.e., ‘baseline factors which predict benefit from a particular treatment’; or mediators i.e., ‘factors measured during treatment that impact on outcome’ of outcome. Method We searched relevant electronic databases. We assessed the evidence according to the methodological strengths of the studies. We did meta-regression analyses for age and gender, as potential moderators. Results Although the methodological quality of primary trials was good, there were few relevant studies; most were compromised by lack of power for moderator and mediator analyses. We found strong evidence that self-efficacy and depression at baseline predict outcome and strong evidence that pain catastrophizing and physical activity can mediate outcome from self-management. There was insufficient data on moderators of treatment. Conclusions The current evidence suggests four factors that relate to outcome as predictors/mediators, but there is no evidence for effect moderators. Future studies of mediation and moderation should be designed with ‘a priori’ hypotheses and adequate statistical power.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>21354838</pmid><doi>10.1016/j.ejpain.2011.01.016</doi></addata></record> |
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subjects | Anesthesia & Perioperative Care Chronic pain Humans Mediator Moderator Musculoskeletal pain Musculoskeletal Pain - prevention & control Musculoskeletal Pain - therapy Pain Management - methods Pain Management - trends Pain Measurement - methods Pain Measurement - trends Pain Medicine Predictive Value of Tests Predictor Randomized Controlled Trials as Topic - methods Randomized Controlled Trials as Topic - trends RCT Self Care - methods Self Care - trends Self-management Sub-groups Systematic review |
title | Can we identify how programmes aimed at promoting self-management in musculoskeletal pain work and who benefits? A systematic review of sub-group analysis within RCTs |
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