Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses

Lia Clazina C van der Maas; Albère Köke; Ruud J Bosscher; Jos W R Twisk; Thomas W J Janssen; Madelon Peters

doi:10.1097/AJP.0000000000000320

Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses

Lia Clazina C van der Maas^*, Albère Köke, Ruud J Bosscher, Jos W R Twisk, Thomas W J Janssen, Madelon Peters

^*Corresponding author for this work

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Abstract

BACKGROUND: The results of a recently performed RCT (1) showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness, catastrophizing and depression was improved by adding psychomotor therapy (PMT), an intervention targeting body awareness (BA). No significant effects were found on quality of life and disability. The present follow-up study aims to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated.

METHODS: 94 patients with chronic pain participated in a RCT comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analysed by linear mixed model analysis.

RESULTS: Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy and/or catastrophizing. In the regression model with depression as the outcome variable the regression coefficient of treatment (i.e. PMT vs. TAU) decreased with 34% and became non-significant when BA was added as a potential mediator. Patients with low body awareness seemed to benefit more from PMT than patients with high body awareness, especially on depression, body awareness and catastrophizing.

CONCLUSIONS: BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that appears to provide its benefits through improving BA and may be especially beneficial for patients with low BA.

Original language	English
Pages (from-to)	763–772
Journal	Clinical Journal of Pain
Volume	32
Issue number	9
DOIs	https://doi.org/10.1097/AJP.0000000000000320
Publication status	Published - Sept 2016

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title = "Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses",

abstract = "BACKGROUND: The results of a recently performed RCT (1) showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness, catastrophizing and depression was improved by adding psychomotor therapy (PMT), an intervention targeting body awareness (BA). No significant effects were found on quality of life and disability. The present follow-up study aims to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated.METHODS: 94 patients with chronic pain participated in a RCT comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analysed by linear mixed model analysis.RESULTS: Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy and/or catastrophizing. In the regression model with depression as the outcome variable the regression coefficient of treatment (i.e. PMT vs. TAU) decreased with 34% and became non-significant when BA was added as a potential mediator. Patients with low body awareness seemed to benefit more from PMT than patients with high body awareness, especially on depression, body awareness and catastrophizing.CONCLUSIONS: BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that appears to provide its benefits through improving BA and may be especially beneficial for patients with low BA.",

author = "{van der Maas}, {Lia Clazina C} and Alb{\`e}re K{\"o}ke and Bosscher, {Ruud J} and Twisk, {Jos W R} and Janssen, {Thomas W J} and Madelon Peters",

year = "2016",

month = sep,

doi = "10.1097/AJP.0000000000000320",

language = "English",

volume = "32",

pages = "763–772",

journal = "Clinical Journal of Pain",

issn = "0749-8047",

publisher = "Lippincott Williams and Wilkins Ltd.",

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T2 - Mediation and Subgroup Analyses

AU - van der Maas, Lia Clazina C

AU - Köke, Albère

AU - Bosscher, Ruud J

AU - Twisk, Jos W R

AU - Janssen, Thomas W J

AU - Peters, Madelon

PY - 2016/9

Y1 - 2016/9

N2 - BACKGROUND: The results of a recently performed RCT (1) showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness, catastrophizing and depression was improved by adding psychomotor therapy (PMT), an intervention targeting body awareness (BA). No significant effects were found on quality of life and disability. The present follow-up study aims to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated.METHODS: 94 patients with chronic pain participated in a RCT comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analysed by linear mixed model analysis.RESULTS: Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy and/or catastrophizing. In the regression model with depression as the outcome variable the regression coefficient of treatment (i.e. PMT vs. TAU) decreased with 34% and became non-significant when BA was added as a potential mediator. Patients with low body awareness seemed to benefit more from PMT than patients with high body awareness, especially on depression, body awareness and catastrophizing.CONCLUSIONS: BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that appears to provide its benefits through improving BA and may be especially beneficial for patients with low BA.

AB - BACKGROUND: The results of a recently performed RCT (1) showed that the effect of a multidisciplinary treatment of chronic pain patients on body awareness, catastrophizing and depression was improved by adding psychomotor therapy (PMT), an intervention targeting body awareness (BA). No significant effects were found on quality of life and disability. The present follow-up study aims to explore the relationship between improvements in BA and multidisciplinary chronic pain rehabilitation treatment outcome across treatment conditions and the possible mediating effect of BA between treatment conditions. Furthermore, the hypothesis that patients with low BA benefit more from PMT was investigated.METHODS: 94 patients with chronic pain participated in a RCT comparing multidisciplinary treatment as usual (TAU) with TAU plus PMT. Outcome variables were health-related quality of life, disability and depression. Self-efficacy and catastrophizing were the process variables of treatment and the potential mediating factors in the relationship between BA and the outcome variables. The data were analysed by linear mixed model analysis.RESULTS: Improvements in BA were related to improvements in all outcome variables across treatment conditions. The relationships were partly mediated by self-efficacy and/or catastrophizing. In the regression model with depression as the outcome variable the regression coefficient of treatment (i.e. PMT vs. TAU) decreased with 34% and became non-significant when BA was added as a potential mediator. Patients with low body awareness seemed to benefit more from PMT than patients with high body awareness, especially on depression, body awareness and catastrophizing.CONCLUSIONS: BA might be an important target of treatment to improve the multidisciplinary treatment outcome in chronic pain patients. Furthermore, PMT is an intervention that appears to provide its benefits through improving BA and may be especially beneficial for patients with low BA.

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DO - 10.1097/AJP.0000000000000320

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SN - 0749-8047

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SP - 763

EP - 772

JO - Clinical Journal of Pain

JF - Clinical Journal of Pain

IS - 9

ER -

Body Awareness as an Important Target in Multidisciplinary Chronic Pain Treatment: Mediation and Subgroup Analyses

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