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Maintaining musculoskeletal health using a behavioural therapy approach: a population based randomised controlled trial (The MAmMOTH study)

Maintaining musculoskeletal health using a behavioural therapy approach: a population based randomised controlled trial (The MAmMOTH study) Thumbnail


Abstract

Objective Cognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.

Methods A population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.

Results 996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0%?vs UC: 17.5%; OR 1.05; 95%?CI 0.75 to 1.48). Participants who received tCBT were more likely to report better quality of life (EQ-5D-5L utility score mean difference 0.024 (95% CI 0.009 to 0.040)); and had 0.023 (95% CI 0.007 to 0.039) more quality-adjusted life-years at an additional cost of £42.30 (95% CI -£451.19 to £597.90), yielding an incremental cost-effectiveness ratio of £1828. Most secondary outcomes showed significant benefit for the intervention.

Conclusions A short course of tCBT did not prevent onset of CWP in adults at high risk, but improved quality of life and was cost-effective. A low-cost, short-duration intervention benefits persons at risk of CWP.

Acceptance Date Nov 30, 2020
Publication Date Feb 1, 2021
Publicly Available Date Mar 29, 2024
Journal Annals of the Rheumatic Diseases
Print ISSN 0003-4967
Publisher BMJ Publishing Group
DOI https://doi.org/10.1136/annrheumdis-2020-219091
Publisher URL https://ard.bmj.com/content/early/2021/02/09/annrheumdis-2020-219091

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