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  • 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

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Pain
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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
  1. Marcus Beasley1,
  2. Gordon J Prescott2,
  3. Graham Scotland3,
  4. John McBeth4,
  5. Karina Lovell5,
  6. Phil Keeley5,
  7. Philip C Hannaford6,
  8. Deborah P M Symmons7,
  9. Ross I R MacDonald1,
  10. Steve Woby8 and
  11. Gary J Macfarlane1
  1. 1Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry, Aberdeen, UK
  2. 2Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry, Aberdeen, UK
  3. 3Health Economic Research Unit, Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry, Aberdeen, UK
  4. 4Arthritis Research UK Centre of Excellence in Primary Care, Keele University, Keele, Staffordshire, UK
  5. 5School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
  6. 6Centre for Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry, Aberdeen, UK
  7. 7Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK
  8. 8Research and Development Department, The Pennine Acute Hospitals NHS Trust, North Manchester General Hospital, Manchester, UK
  1. Correspondence to Professor Gary J Macfarlane; g.j.macfarlane{at}abdn.ac.uk

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.

  • Fibromyalgis/Pain Syndromes
  • Psychology
  • Economic Evaluations

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/rmdopen-2014-000026

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