Background & Aims
Healthcare systems world-wide grapple with the escalating burden of chronic musculoskeletal (MSK) pain. Exploring complementary methods to promote uptake and engagement in self-management may alleviate the strain on healthcare systems and broaden access for individuals otherwise lacking healthcare provisions. People with lived experience of pain (i.e., peers) may be well-placed to offer support and guidance for others with chronic MSK pain to promote successful self-management. Peer support refers to “the giving of assistance and encouragement by an individual considered equal” as part of a created social network or intervention [1]. This systematic review and meta-analysis of randomised controlled trials aimed to evaluate the effectiveness of peer support interventions in reducing pain and improving health outcomes in community-dwelling adults with chronic musculoskeletal pain.
Methods
This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [2] and was prospectively registered on PROSPERO (CRD42022356850). A systematic search (inception – January 2023) of electronic databases (MEDLINE, Embase, Emcare, PsychINFO, CINAHL, The Cochrane Library, Scopus) and grey literature was undertaken to identify relevant randomised controlled trials. Peer support interventions that involved formal support provided and received by people with the same pain condition [1], and in which peers delivering the intervention had received training, were included. All stages of the review were conducted by two independent reviewers. Risk of bias and GRADE assessments were performed on included studies. Meta-analyses used a generic inverse-variance random effects model, calculating mean difference (MD; 95% CIs) or standardised mean difference (SMD; 95% CIs).
Results
Of 16,445 records identified, 29 records reporting on 24 studies (n=6202 participants) were included. All evidence had unclear-high risk of bias and low-very low certainty. Peer support interventions resulted in greater improvements in pain (medium-term: MD -3.48, 95%CI -6.61, -0.35; long-term: MD -1.97, 95%CI -3.53, -0.42), self-efficacy (medium-term: SMD 0.26, 95%CI 0.16, 0.36; long-term: SMD 0.21, 95%CI 0.07, 0.36), and function (long-term: SMD -0.10, 95%CI -0.19, -0.00) relative to usual care, and greater self-efficacy (medium-term: SMD 0.36, 95%CI 0.20, 0.51) relative to waitlist control. Peer support interventions resulted in similar clinical improvement as active (health professional-led) interventions, bar long-term self-efficacy (MD -0.41, 95%CI -0.77, -0.05), which favoured active interventions. Pooled health service utilisation outcomes showed unclear estimates. Self-management, quality of life, and social support outcomes had mixed evidence.
Conclusions
Overall, peer support interventions demonstrated small improvements over usual care and waitlist controls for some clinical outcomes although evidence certainty was low-very low. Comparable clinical improvements following professional- and peer-led self-management interventions highlight potential for peer support as an adjunct or alternative to traditional care. Future work exploring ways to sustain health behaviour change to improve longer-term clinical outcomes is warranted.
References
[1] Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud 2003;40:321–332.
[2] Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;10:1–11.
[3] Goff AJ, De Oliveira Silva D, Merolli M, Bell EC, Crossley KM, Barton CJ. Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review. J Physiother 2021;67:177–189.
[4] Siddall B, Ram A, Jones MD, Booth J, Perriman D, Summers SJ. Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: a systematic review and meta-analysis. PAIN 2022;163:e20.
Presenting Author
Monique Wilson
Poster Authors
Monique Wilson
OTHR
University of South Australia
Lead Author
Felicity Braithwaite
BPT (Hons)
University of South Australia
Lead Author
John Arnold
PhD
University of South Australia
Lead Author
Sophie Crouch
BPsychology (Advanced)(Hons)
University of Adelaide
Lead Author
Emily Moore
BPsychology (Hons); BPhysio (Hons)
University of South Australia
Lead Author
Alrun Heil
BScience (Physiotherapy)
Bern University of Applied Sciences
Lead Author
Kay Cooper
PhD
Robert Gordon University
Lead Author
Tasha Stanton
The University of South Australia
Lead Author
Topics
- Systematic Reviews/Meta-Analysis