Barts and London School of Medicine and Dentistry, Centre for Health Sciences, Queen Mary University of London, UK.
Clin J Pain. 2012 May;28(4):344-54. doi: 10.1097/AJP.0b013e31822ed2f3.
The objective of the study was to report the evidence for effectiveness of different self-management course characteristics and components for chronic musculoskeletal pain.
We searched 9 relevant electronic databases for randomized, controlled trials (RCTs). Two reviewers selected studies against inclusion criteria and assessed their quality. We classified RCTs according to type of course delivery (group, individual, mixed or remote), tutor (healthcare professional, lay or mixed), setting (medical, community or occupational), duration (more or less than 8 weeks), and the number and type of components (psychological, lifestyle, pain education, mind body therapies, and physical activity). We extracted data on pain intensity, physical function, self-efficacy, global health, and depression and compared these outcomes for self-management and usual care or waiting list control. We used random effects standardized mean difference meta-analysis. We looked for patterns of clinically important and statistically significant beneficial effects for courses with different delivery characteristics and the presence or absence of components across outcomes over 3 follow-up intervals.
We included 46 RCTs (N=8539). Group-delivered courses that had healthcare professional input showed more beneficial effects. Longer courses did not necessarily give better outcomes. There was mixed evidence of effectiveness for components of courses, but data for courses with a psychological component showed slightly more consistent beneficial effects over each follow-up period.
Serious consideration should be given to the development of short (<8 weeks) group and healthcare professional-delivered interventions but more research is required to establish the most effective and cost-effective course components.
本研究旨在报告不同自我管理课程特征和组成部分对慢性肌肉骨骼疼痛的有效性证据。
我们在 9 个相关电子数据库中搜索了随机对照试验（RCT）。两名审查员根据纳入标准选择研究并评估其质量。我们根据课程提供方式（小组、个体、混合或远程）、导师（医疗保健专业人员、非专业人员或混合）、环境（医疗、社区或职业）、持续时间（超过或少于 8 周）以及组件的数量和类型（心理、生活方式、疼痛教育、身心疗法和体育活动）对 RCT 进行分类。我们提取了疼痛强度、身体功能、自我效能、总体健康和抑郁的数据，并将自我管理与常规护理或等待名单对照的这些结果进行了比较。我们使用随机效应标准化均数差荟萃分析。我们在 3 个随访间隔内，针对具有不同交付特征的课程以及是否存在各种结果的组件，寻找具有临床意义和统计学意义的有益效果模式。
我们纳入了 46 项 RCT（N=8539）。具有医疗保健专业人员参与的小组授课课程显示出更有益的效果。较长的课程不一定会产生更好的结果。课程组成部分的有效性存在混合证据，但具有心理成分的课程的数据在每个随访期间显示出更一致的有益效果。
应认真考虑开发短期（<8 周）小组和医疗保健专业人员授课的干预措施，但需要更多研究来确定最有效和最具成本效益的课程组成部分。
