Background & Aims

Persistent musculoskeletal pain is the leading reason why people need rehabilitation globally. People with the condition often have disability and low quality of life. It is highly burdensome for individuals and health services. Many people with persistent musculoskeletal pain attend pain management programmes (PMPs) for self-management support. Physical activity (PA) is promoted on PMPs as it improves pain, function and quality of life. However, people with persistent musculoskeletal pain often do not maintain PA after PMPs. This project will develop an intervention to support PA maintenance after PMPs for people with persistent musculoskeletal pain. Phase 1 will explore the factors influencing PA maintenance in people with persistent musculoskeletal pain and identify potential intervention components. Phase 2 will assess the association of the factors identified in phase 1 with PA maintenance and further identify intervention components. Phase 3 will co-design the intervention.

Methods

Setting: UK NHS.
Phase 1: Qualitative study. Participants (n=35): people with persistent musculoskeletal pain 6-18 months post-PMP, their PA supporters, and PMP healthcare professionals. Semi-structured interviews will explore factors influencing PA maintenance after PMPs and identify potential intervention components. The Theoretical Domains Framework and Template for Intervention Description and Replication will inform the topic guides.
Phase 2: Prospective longitudinal study. Participants: people with persistent musculoskeletal pain (n=100-120). Assessments will be at PMP completion and six-months post. Measures will be the factors influencing PA maintenance identified in phase 1 and objective PA. The questionnaire will ask about intervention components.
Phase 3: Intervention co-design. Participants: people with persistent musculoskeletal pain 6-18 months post-PMP, their PA supporters, and healthcare professionals. Participants will attend workshops to co-design the intervention.

Results

Analysis plan
Phase 1: Data will be transcribed, anonymised and analysed inductively using reflexive thematic analysis and deductively using the Behaviour Change Wheel and Template for Intervention Description and Replication.
Phase 2: Descriptive statistics will summarise participant characteristics and measures at each assessment timepoint. Regression analyses will be used to assess the associations of each factor with PA maintenance. Qualitative data will be analysed using the Template for Intervention Description and Replication and Behaviour Change Wheel.
Phase 3: data analysis will be informed by the Behaviour Change Wheel framework and Template for Intervention Description and Replication.
Study outcomes:
Knowledge of the influences on PA maintenance gained from phases 1 and 2 will support selection of behaviour change techniques and intervention delivery methods in phase 3. Phase three will result in a PA maintenance intervention prototype.

Conclusions

This project will result in a new PA maintenance intervention for people with persistent musculoskeletal pain that have completed PMPs. The new intervention will be ready for full development and testing in a trial.

References

Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative research in sport, exercise and health, 11(4), 589-597.
British Pain Society (2013). Guidelines for Pain Management Programmes for adults. An evidence-based review prepared on behalf of the British Pain Society.
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Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation science, 7, 1-17.
Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006-2017.
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Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, (4).
Hoffmann, T. C., Glasziou, P. P., Boutron, I., Milne, R., Perera, R., Moher, D., … & Michie, S. (2014). Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Bmj, 348.
Hurley, M., Dickson, K., Hallett, R., Grant, R., Hauari, H., Walsh, N., … & Oliver, S. (2018). Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane database of systematic reviews, (4).
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Presenting Author

Gregory Booth

Poster Authors

Gregory Booth

PG Cert

St. George's, University of London

Lead Author

Lindsay Bearne PhD

Population Health Research Institute, St. George's, University of London

Lead Author

Danielle D'Lima PhD

Centre for Behaviour Change, University College London

Lead Author

Mohammed Hudda PhD

Dasman Diabetes Institute

Lead Author

Michael Ussher PhD

Population Health Research Institute, St. George's, University of London

Lead Author

Topics

  • Treatment/Management: Pharmacology: Psychological and Rehabilitative Therapies