Self-Management of Persistent Neck Pain Two-Year Follow-up of a Randomized Controlled Trial of a Multicomponent Group Intervention in Primary Health Care

Study Design. A 2-year follow-up of a randomized controlled trial. Objective. To compare long-term effects of (a) a multicomponent pain and stress self-management group intervention (PASS) and (b) individually administered physical therapy (IAPT) on patients with persistent tension-type neck pain in a primary health care (PHC) setting. Summary of Background Data. In a previously reported short-term follow-up, PASS had better effects on pain control, pain-related self-efficacy, disability, and catastrophizing than IAPT. Long-term effects of self-management interventions for persistent neck pain, for example, maintenance of improvement and adherence to coping skills are sparsely investigated. Methods. Persons with persistent tension-type neck pain seeking physical therapy treatment at nine PHC centers in Sweden were randomly assigned to either PASS or IAPT. Before intervention, at 10 and 20 weeks and at 1 and 2 years after the intervention, the participants completed a self-assessment questionnaire comprising: the Self-Efficacy Scale, the Neck Disability Index, the Coping Strategies Questionnaire, the Hospital Anxiety and Depression Scale, and questions regarding neck pain and analgesics. Analyses were performed using linear mixed models for repeated measures. Results. The study included 156 participants (PASS n = 77, IAPT n = 79). Between baseline, 10-week, 20-week, 1-year, and 2-year follow-up, significant time-by-group interaction effects were found in favor of PASS regarding the primary outcomes ability to control pain (P < 0.001) and self-efficacy for performing activities in spite of pain (P = 0.002), and the secondary outcome catastrophic thinking (P < 0.001) but not in neck pain-related disability. Conclusion. The initial treatment effects of a self-management group intervention were largely maintained over a 2-year follow-up period and with a tendency to have superior long-term effects as compared to individually-administered physical therapy, in the treatment of persistent tension-type neck pain with regard to coping with pain, in terms of pain control, self-efficacy, and catastrophizing.