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Only to a limited extent has been compared the effectiveness of physical exercise and psychological interventions in subjects with chronic pain. Knowledge about this is necessary in order to compose optimal multimodal rehabilitation programs at different health care levels. Moreover, assuming that both types of interventions have effects, these effects may necessarily not concern the same outcome variables. Therefore it may be important to understand to what extent the effects overlap and the extent to which the effects are isolated to an intervention.
The overall strategic purpose of the present study is to develop effective multimodal rehabilitation programs. In this study the effectiveness of following three interventions are compared.
The overall hypothesis is that the former intervention means better long-term results because it clearly helps the individual to process the psychological aspects of itself likely to have long lasting effects.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| ACT | Experimental | Acceptance and Commitment Therapy is a version of Cognitive behavioral Therapy that focuses on acceptance and mindfulness. The aim is to prevent avoidance and control of negative private events such as anxiety or pain. The treatment consists of 7 weekly group sessions, 2 hours a week. The participants are given homework between sessions. |
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| Physical activity | Experimental | Participants are going to participate in a training programme including aerobic exercise as well as endurance and strength training for the neck, shoulders, low back, core and leg muscles. The training is group-based and supervised by a physiotherapist two times a week, one hour a time for eight weeks. Home exercises twice a week are also a part of the intervention. It is possible to individually adjust movements and intensity to the participants' capacity if needed. |
|
| Experience based discussion group | No Intervention | Participants are going to discuss their experiences of long term pain. The discussions is supervised by a heath care professional and is based on beforehand defined subjects, i.e. relations, spare time, economics, occupation. The meetings are hold for 7 weeks, 2 hours a week. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ACT | Behavioral | ACT is a type of Cognitive behavioral Therapy (CBT) that focuses on acceptance and mindfulness. The aim is to prevent avoidance and control of negative private events such as anxiety or pain. The treatment consists of 7 weekly group sessions, 2 hours a week. The participants are given homework between sessions. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Pain intensity | Pain intensity recent 7 days using a numeric rating scale | Change from baseline pain intensity at 12 months |
| Change in Depression | Depression scale of Hospital Anxiety and Depression Scale (HADS) | Change from baseline depression at 12 months |
| Change in Catastrophizing | The Pain Catastrophizing Scale (PCS) | Change from baseline catastrophizing at 12 months |
| Change in Acceptance | The Chronic Pain Acceptance Questionnaire (CPAQ) | Change from baseline acceptance at 12 months |
| Change in Disability | Pain Disability Index (PDI) | Change from baseline disability at 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Flexibility | The Psychological Inflexibility in Pain Scale (PIPS) | Change from baseline flexibility at 12 months |
| Change in Insomnia | The Insomnia Severity Index (ISI) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Björn Gerdle, MD, PhD | Linkoeping University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rehabilitation medicine, IMH, Linköping University | Linköping | Östergötland County | SE 581 85 | Sweden |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 29631567 | Derived | Wiklund T, Linton SJ, Alfoldi P, Gerdle B. Is sleep disturbance in patients with chronic pain affected by physical exercise or ACT-based stress management? - A randomized controlled study. BMC Musculoskelet Disord. 2018 Apr 10;19(1):111. doi: 10.1186/s12891-018-2020-z. |
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| ID | Term |
|---|---|
| D059350 | Chronic Pain |
| D010146 | Pain |
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001519 | Behavior |
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| ID | Term |
|---|---|
| D015444 | Exercise |
| ID | Term |
|---|---|
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |
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| Physical activity | Other | Participants are going to perform a training programme including aerobic exercise as well as endurance and strength training for the neck, shoulders, low back, core and leg muscles. The training is group-based and supervised by a physiotherapist two times a week, one hour a time for eight weeks. Home exercises twice a week are also a part of the intervention. It is possible to individually adjust movements and intensity to the participants' capacity if needed. |
|
| Change from baseline insomnia at 12 months |
| Change in Fear-avoidance beliefs | Fear-Avoidance Beliefs Questionnaire (FABQ) | Change from baseline fear-avoidance at 12 months |
| Change in Disability2 | Oswestry Disability Index (ODI) | Change from baseline disability2 at 12 months |
| Change in Health | The EuroQol instrument | Change from baseline health at 12 months |
| Change in Life satisfaction | The Life Satisfaction Questionnaire. | Change from baseline life satisfaction at 12 months |