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Chronic pain self-managementment support with pain science education and exercise (COMMENCE) for people with chronic pain and multiple comorbidities: a randomized controlled trial
Miller J, MacDermid JC, Walton DM, Richardson J
Archives of Physical Medicine and Rehabilitation 2020 May;101(5):750-761
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To investigate the effectiveness chronic pain self-management support with pain science education and exercise (COMMENCE) on improving function, pain interference, work status, pain intensity, fatigue, psychological factors associated with pain, health care visits, satisfaction, and perceived change compared to usual care. DESIGN: Parallel group randomized controlled trial with 1- and 12-week follow-ups. SETTING: Community health centre. PARTICIPANTS: Adults (n = 102) with chronic non-cancer pain referred for self-management support. Eighty of 102 participants completed 12-week follow-up assessments. No participants withdrew with adverse events. INTERVENTIONS: Participants were randomized to COMMENCE or usual care. MAIN OUTCOME MEASURES: Primary: Function measured using the Short Musculoskeletal Function Assessment (SMFA) - Dysfunction Index. Secondary: SMFA bother index, PROMIS pain interference, work status, numeric pain and fatigue rating scales, Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Pain Self-Efficacy Scale, Neurophysiology of Pain Questionnaire, number of healthcare visits, satisfaction, and global rating of change. RESULTS: COMMENCE resulted in greater improvements in function (mean difference at 12-week follow-up (MD) -8.0; 95%CI -14.7 to -1.3), bother with functional difficulties (MD -12.0; 95%CI -20.8 to -3.2), pain intensity (MD -1.0; 95%CI -2.1 to -0.1), catastrophizing (MD -8.2; 95%CI -14.5 to -2.0), self-efficacy (MD 7.0; 95%CI 0.8 to 13.2), knowledge (MD 2.8; 95%CI 1.6 to 3.9), satisfaction (MD 1.2; 95%CI 0.7 to 1.8) and perceived change (MD 1.4; 95%CI 0.8 to 2.1). There were no significant between group differences in pain interference, work, fatigue, depressive symptoms, or healthcare visits. CONCLUSION: COMMENCE is more effective than usual care at improving function, pain, catastrophic thinking, self-efficacy, pain knowledge, satisfaction, and perceived change, but not pain interference, work status, fatigue, depressive symptoms, or health care visits.

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