Individually Tailored Treatment in the Management of Musculoskeletal Pain : Development and Evaluation of a Behavioural Medicine Intervention in Primary Health Care

Abstract: This thesis deals with clinical pain intervention research from a behavioural medicine perspective. The general aim was to develop and evaluate an individually tailored treatment protocol focused on pain management in everyday life in people who experience persistent musculoskeletal pain. Another aim was to develop and incorporate an idiographic outcome measure for behavioural goal assessment in the formal evaluation of the clinical significance of treatment outcomes. The studies were conducted in a primary health care setting demonstrating a contribution from physical therapists in the field of behavioural medicine. Two separate samples of patients with musculoskeletal pain with a duration exceeding one month, n = 197 (Study I, descriptive and correlational design), and n = 97/82 (Study III/IV, randomized group-study) were included. In addition, four women were recruited for a series of experimental single-case studies (Study II).The treatment protocol that was individually tailored to each participant’s behavioural treatment goals and assumed determinants of pain-related disability was more effective in reducing pain-related disability, pain intensity, fear-avoidance, and in increasing pain control when compared to an intervention including physical exercises. The individually tailored treatment was generally more beneficial for resumption of everyday life activity, increasing satisfaction, fulfilling pre-treatment expectations, and in preparing individuals for self-management of pain. The Patient Goal Priority Questionnaire that was elaborated over the course of the project can be used to a) identify and assess behavioural treatment goals, b) elaborate individual functional behavioural analyses relevant for everyday life functioning, and c) determine the clinical significance of treatment outcomes – that is, whether interventions produce outcomes of relevance for each individual’s everyday life. The inclusion of idiographic outcome measures in clinical pain intervention research is necessary and improves the ecological validity of the evaluation of clinical significance.