A 9-year follow-up of a self-management group intervention for persistent neck pain in primary health care: a randomized controlled trial

Figures & data

Figure 1 A flowchart illustrating participation in the study over the follow-ups.

Abbreviations: PASS, pain and stress self-management group intervention; IAPT, individually administered physiotherapy.

Table 1 Baseline characteristics for PASS group and IAPT group

	All participants originally included		Responders at 9-year follow-up
	PASS group	IAPT group	PASS group	IAPT group
	n = 77	n = 79	n = 48	n = 46
Female/male, n (%)/n (%)	69 (90)/8 (10)	70 (89)/9 (11)	45 (94)/3 (6)	43 (93)/3 (7)
Age, mean (SD), range	45.7 (11.5), 19–65	45.7 (11.6), 20–63	47 (10.6), 19–64	46.2 (11), 20–62
Pain intensity, mean (SD)
Present (0–10)	5.5 (2)	5.9 (2)	5.5 (1.9)	6 (2.1)
Average (0–10)	6 (1.8)	6.4 (2)	6.2 (1.8)	6.4 (2)
Worst/maximum (0–10)	8.4 (1.4)	8.5 (1.2)	8.4 (1.3)	8.6 (1.1)
Duration of neck pain, n (%)
3–6 months	7 (9)	11 (14)	3 (6.3)	6 (13)
7–12 months	4 (5)	9 (11)	4 (8.3)	7 (15.2)
1–2 years	12 (16)	12 (15)	6 (12.5)	8 (17.4)
>2 years	54 (70)	47 (60)	35 (72.9)	25 (54.3)
Use of analgesics due to neck pain, n (%)
Never	12 (16)	12 (15)	8 (16.7)	8 (17.4)
1 or 2 days per month	28 (36)	19 (24)	16 (33.3)	7 (15.2)
1 or 2 days per week	18 (23)	20 (25)	14 (29.2)	10 (21.7)
Every second day	9 (12)	11 (14)	4 (8.3)	9 (19.6)
Everyday	10 (13)	17 (22)	6 (12.5)	12 (26.1)
Current level of sick leave, n (%)
Not on sick leave	52 (67)	39 (49)	31 (64.6)	22 (47.8)
25% sick leave	3 (4)	6 (8)	2 (4.2)	4 (8.7)
50% sick leave	9 (12)	7 (9)	8 (16.7)	6 (13)
75% sick leave	3 (4)	2 (2)	2 (4.2)	1 (2.2)
Totally off work/sick leave	10 (13)	25 (32)	5 (10.4)	13 (28.3)
Days of sick leave during preceding 3 months (0–90), mean (SD)	22 (35.2)	32.9 (40.8)	23.9 (35.5)	38.6 (41.7)
Health care visits due to pain during preceding 3 months, mean (SD)	2.4 (3.2)	2.8 (3.5)	2.5 (2.8)	2.7 (3.2)
NDI score (0–100), mean (SD)	30.8 (10.7)	35.4 (14)	31.5 (11.7)	34.3 (14.6)
SES score (0–200), mean (SD)	136.7 (39.8)	128.3 (43.5)	136 (44)	136.8 (42.2)
CSQ pain control (0–6), mean (SD)	3.3 (1.1)	3.1 (1.2)	3.4 (1.2)	3.2 (1.1)
CSQ ability to reduce pain (0–6), mean (SD)	2.9 (1)	2.9 (0.9)	2.9 (1.2)	2.8 (0.8)
CSQ-CAT score (0–36), mean (SD)	11.3 (7.4)	11.8 (7.1)	11.9 (7.9)	12 (7.3)
HADS-D score (0–21), mean (SD)	4.3 (3.1)	4.9 (8.9)	4.6 (3.2)	4.9 (3)
HADS-A score (0–21), mean (SD)	8.2 (4.1)	8.1 (3.9)	8.3 (4.2)	7.6 (3.2)

Abbreviations: PASS, pain and stress self-management group intervention; IAPT, individually administered physiotherapy; NDI, Neck Disability Index; SES, Self-Efficacy Scale; CSQ, Coping Strategies Questionnaire; CSQ-CAT, Coping Strategies Questionnaire – catastrophizing subscale; HADS-D, depression subscale of the Hospital Anxiety and Depression Scale; HADS-A, anxiety subscale of the Hospital Anxiety and Depression Scale.

Table 2 Between- and within-group comparisons for PASS and IAPT

Outcome measure treatment group	Baseline assessment (n = 129a)	9-year follow-up (n = 94b)	Mixed linear models comparisonsc,d			Simple main effects
			Baseline–9-year follow-up (n = 129a)			Between-group comparison at 9 years (n = 129a)
	Mean (SD)	Mean (SD)	Group	Time	Time × group	Estimate	95% CI	p-value
			p-value	p-value	p-value
NDI score (0–100)			0.0002	<0.0001	0.016	−8.4	−14.33 to −2.46	0.006
PASS group	30.5 (11.2)	19 (15.9)
IAPT group	35.6 (13.9)	26 (16.8)
SES score (0–200)			0.002	<0.0001	0.012	14.5	−0.58 to 29.58	0.059
PASS group	138.5 (40.6)	168.5(37.7)
IAPT group	129.4 (42.2)	157(43)
Pain at present (0–10)			0.003	<0.0001	0.383	−0.79	−1.83 to 0.24	0.132
PASS group	5.5 (2)	3.2 (2.5)
IAPT group	6.1 (2)	3.9 (2.9)
Pain average (0–10)			0.004	<0.0001	0.700	−1.0	−2.06 to 0.07	0.068
PASS group	6.1 (1.9)	3.4 (2.6)
IAPT group	6.6 (2)	4.2 (2.9)
Pain worst/maximum (0–10)			0.011	<0.0001	0.080	−1.4	−2.59 to −0.13	0.031
PASS group	8.4 (1.4)	5.4 (3.2)
IAPT group	8.6 (1.2)	6.6 (3.1)
CSQ-CAT score (0–36)			0.001	<0.0001	<0.0001	−1.3	−4.01 to −1.37	0.334
PASS group	11.4 (7.5)	6.6 (6.7)
IAPT group	12.3 (7.0)	7 (7.2)
Health care visits due to neck pain during preceding 3 months			0.018	0.0006	<0.0001	−0.2	−0.53 to 0.11	0.197
PASS group	2.3 (3.6)	1.6 (2.1)
IAPT group	2.6 (3.1)	2.9 (5.1)
	Md (IQR)	Md (IQR)	GEE models comparisonsd			OR	95% CI	p-value
			Group	Time	Time × group
			p-value	p-value	p-value
CSQ ability to control pain (0–6)			0.0006	<0.0001	<0.0001	0.93	0.42–2.06	0.865
PASS group	3 (3–4)	4 (3–5)
IAPT group	3 (3–4)	4 (3–5)
CSQ ability to reduce pain (0–6)			0.002	<0.0001	0.129	1.44	0.64–3.25	0.378
PASS group	3 (3–3)	4 (3–5)
IAPT group	3 (3–3)	3 (3–4)
Use of analgesics due to neck pain (0–4)			0.003	<0.0001	0.423	2.25	1.05–4.81	0.027
PASS group	1 (1–2.5)	1 (0–1)
IAPT group	2 (1–3)	1(0.5–2.5)

Notes: Comparisons based on all available data at 9-year follow-up, ie, baseline values for the participants available and approached for the 9-year follow-up (PASS group, n = 63; IAPT group, n = 66) and responders to the 9-year follow-up (PASS group, n = 48; IAPT group, n = 46).

a Including data from all participants available and approached for 9-year follow-up, ie, PASS, n = 63, and IAPT, n = 66.

b Including data from responders to the 9-year follow-up, ie, PASS, n = 48, and IAPT, n = 46.

c Covariance structure used for mixed model analyses: unstructured.

d Analyses based on five time points of assessment (ie, baseline, 20-week, 1-year, 2-year and 9-year follow-up). Differences with a significance level of p ≤ 0.05 are indicated in bold.

Abbreviations: PASS, pain and stress self-management group intervention; IAPT, individually administered physiotherapy; CI, confidence interval; NDI, Neck Disability Index; SES, Self-Efficacy Scale; CSQ-CAT, Coping Strategies Questionnaire – catastrophizing subscale; GEE, generalized estimating equation; Md, median; IQR, interquartile range; OR, odds ratio; CSQ, Coping Strategies Questionnaire.

Table 3 Comparisons between PASS and IAPT groups regarding satisfaction with care and use of coping skills acquired during the intervention at follow-ups based on all individuals with available data

Outcome measure, with response options n (%)	20-week follow-up			1-year follow-up			2-year follow-up			9-year follow-up
	PASS, n = 63	IAPT, n = 62	p-valuea	PASS, n = 58	IAPT, n = 57	p-valuea	PASS, n = 57	IAPT, n = 50	p-valuea	PASS, n = 48	IAPT, n = 46	p-valuea
Satisfaction with care/treatment			0.041			0.001			0.000			0.178
Very content/satisfied, n (%)	24 (38.1)	24 (38.7)		25 (43.1)	11 (19.3)		23 (40.4)	9 (18)		14 (29.2)	8 (17.4)
Rather content/satisfied, n (%)	27 (42.9)	16 (25.8)		23 (39.7)	18 (31.6)		27 (47.4)	16 (32)		17 (35.4)	12 (26.1)
Neither nor, n (%)	10 (15.9)	11 (17.7)		8 (13.8)	13 (22.8)		5 (8.8)	16 (32)		11 (22.9)	13 (28.3)
Rather discontent/dissatisfied, n (%)	2 (3.2)	6 (9.7)		2 (3.4)	8 (14)		2 (3.5)	2 (4)		1 (2.1)	6 (13)
Very discontent/dissatisfied, n (%)	0 (0)	5 (8.1)		0 (0)	7 (12.3)		0 (0)	7 (14)		2 (4.2)	1 (2.2)
Do not remember, n (%)										3 (6.3)	6 (13)
Use of coping skills acquired during the intervention in everyday life			0.006			0.003			0.010			0.061
Every day, n (%)	21 (33.3)	19 (30.6)		9 (15.5)	7 (12.3)		11 (19.3)	2 (4)		2 (4.2)	1 (2.2)
Often, n (%)	19 (30.2)	14 (22.6)		23 (39.7)	15 (26.3)		19 (33.3)	11 (22)		8 (16.7)	5 (10.9)
Occasionally, n (%)	17 (27)	12 (19.4)		18 (31)	12 (21.1)		16 (28.1)	19 (38)		18 (37.5)	11 (23.9)
Seldom, n (%)	4 (6.3)	1 (1.6)		6 (10.3)	5 (8.8)		7 (12.3)	5 (10)		13 (27.1)	10 (21.7)
Never, n (%)	2 (3.2)	16 (25.8)		2 (3.4)	18 (31.6)		4 (7)	13 (26)		2 (4.2)	11 (23.9)
Do not remember, n (%)	2 (3.2)	16 (25.8)		2 (3.4)	18 (31.6)		4 (7)	13 (26)		5 (10.4)	8 (17.4)

Notes:

a Fisher’s exact test. Differences with a significance level of p ≤ 0.05 are indicated in bold.

Abbreviations: PASS, pain and stress self-management group intervention; IAPT, individually administered physiotherapy.