Musculoskeletal Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
Medical Statistics Team , Institute of Applied Health Sciences, University of Aberdeen, School of Medicine and Dentistry , Aberdeen , UK.
RMD Open. 2015 Feb 18;1(1):e000026. doi: 10.1136/rmdopen-2014-000026. eCollection 2015.
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.
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.
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.
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.
ISRCTN67013851.
MUSICIAN 研究先前表明，对于慢性广泛性疼痛（CWP）的两种非药物干预措施，短期有益，但仅具有边际成本效益。我们希望确定它们的长期有效性和成本效益。
这是一项在英国初级保健中进行的 2×2 析因随机对照试验。符合条件的参与者为年龄≥25 岁，因 CWP 已咨询过全科医生。干预措施为为期 6 个月的电话认知行为疗法（tCBT）和/或量身定制的锻炼计划，与常规护理相比。主要结局是患者报告的健康状况变化。
884 人符合条件，442 人被随机分配，81.7%的人在治疗后 24 个月进行了随访。与常规护理（阳性结果 12.8%）相比，tCBT（35.4%；OR 3.7 95%CI（1.8 至 8.0））、运动（29.3%；OR 2.8 95%CI（1.3 至 6.0））和两种干预措施（31.2%；OR 3.1 95%CI（1.3 至 6.0））均显著更有效。对于个体和联合治疗，其有效性随时间的推移仅略有下降。那些疼痛强度更高/更具致残性、痛苦程度更高以及在基线时表现出被动应对方式的人，与没有这些特征的人相比，接受 tCBT 治疗更有可能获得阳性结果。tCBT 与生活质量的提高幅度最大和成本最低相关。每质量调整生命年的成本取决于分析方法，为 3957-5917 英镑。
对于患有 CWP 的人，短期的 tCBT 治疗是有效的，并且具有很高的成本效益。运动也有效，但成本更高，仅能使较少的患者获得阳性结果，而同时接受两种干预措施的患者没有优势。
ISRCTN67013851。
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