A mixed methods evaluation of a third wave cognitive behavioural therapy and osteopathic treatment programme for chronic pain in primary care (OsteoMAP)

Introduction: The aim of this study was to evaluate the implementation of a 'third wave' cognitive behavioural therapy and osteopathic treatment programme (OsteoMAP) and explore its effect on patients with chronic musculoskeletal pain. Method: This evaluation included a non-randomised before-and-after patient reported outcomes study with an embedded fidelity evaluation. Patients were seen for 1 h per week for six weeks. They received a questionnaire prior to receiving treatment and six months later. A purposive sample of patients were interviewed and clinical sessions were observed to evaluate competence and adherence to the intervention manual. Results: 208 patients were enrolled and 86% attended 3 or more OsteoMAP sessions. 82 students were trained to deliver the intervention under supervision. They were >90% adherent to the manual in 8 of the 12 domains measured. At baseline (n = 147), 69% of patients were female, 64% white and 77% reported pain for more than one year. At 6 months (matched pairs n = 63), there were clinically important changes of 58% in a composite score for pain, function, mood and coping (Bournemouth Questionnaire) and significantly higher psychological flexibility scores (difference in means 6.98 (95% CI 4.2,9.8)) (Acceptance and Action Questionnaire). No statistically significant change was seen in mindfulness (Freiburg Mindfulness Inventory), 30% of patients reported temporary symptom increases during the course but 95% were satisfied or very satisfied with their overall experience and outcomes. Conclusions: OsteoMAP was feasible, well received with some beneficial effects. Integrating psychological and osteopathic care shows promise and further research is warranted to assess effectiveness. (C) 2017 Elsevier Ltd. All rights reserved.