Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness: A Cluster-randomized Trial

L.C.C. van der Maas, A. Köke, M. Pont, R.J. Bosscher, J.W.R. Twisk, T.W.J. Janssen, M.L. Peters

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background:Because of methodological flaws and a lack of theoretical foundation of body awareness (BA) in previous effect studies of interventions directed to stimulate BA, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluated short-term and long-term effects of a multidisciplinary pain rehabilitation program with and without psychomotor therapy (PMT), which focused on BA (measured by the scale of body connection) as a primary target of intervention.Methods:Ninety-four patients clustered in 20 treatment groups were cluster randomized, using a biased-coin design, to multidisciplinary treatment as usual with or without PMT. Outcome variables were health-related quality of life, disability, and depression. BA, catastrophizing, and self-efficacy were measured as potential process variables. Assessments were performed at baseline, directly after treatment, and at 3, 6, and 12 month follow-ups. The data were analyzed by linear mixed-model analysis according to the intention-to-treat principle.Results:Data of all 94 patients were used for analyses. After treatment, significant differences favoring PMT were found between conditions on depression (regression coefficient [RC]=-5.01; 95% confidence interval [CI], -8.81 to -1.21), BA (RC=0.23; 95% CI, 0.04 to 0.42) and catastrophizing (RC=-4.76; 95% CI, -8.03 to -1.48). These differences were no longer significant for depression at the 3-month follow-up and for catastrophizing at the 6-month follow-up.Conclusions:No clinical meaningful differences were found between treatment conditions in the primary outcome measures health-related quality of life and disability. However, this is the first long-term RCT that has shown that PMT improves BA in patients with chronic pain and shows good effect size and a significant decrease for catastrophizing.
Original languageEnglish
Pages (from-to)660-669
Number of pages10
JournalClinical Journal of Pain
Volume31
Issue number7
DOIs
Publication statusPublished - Jul 2015

Keywords

  • health-related quality of life
  • body awareness
  • psychomotor therapy
  • chronic pain
  • rehabilitation
  • CHRONIC MUSCULOSKELETAL PAIN
  • COGNITIVE-BEHAVIORAL TREATMENT
  • SELF-EFFICACY QUESTIONNAIRE
  • BECK DEPRESSION INVENTORY
  • GROUP LEARNING-PROGRAM
  • QUALITY-OF-LIFE
  • LOW-BACK-PAIN
  • PSYCHOSOMATIC SYMPTOMS
  • CATASTROPHIZING SCALE
  • DISABILITY INDEX

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