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Adding the short, digital PainSMART-educational strategy whilst patients with musculoskeletal pain wait for primary
Richard Thompson1, Maria Fors2, Ann-Sofi Kammerlind3
1Department of Health, Medicine, and Caring Sciences, Unit of Physiotherapy, Linköping University, Linköping, SE-581 83, Sweden; Clinical Department of Rehabilitation in Finspång, Region Östergötland, Finspång, SE-581 85, Sweden.
Objectives:
Does adding the PainSMART-strategy to usual physiotherapy management of musculoskeletal pain (MSKP) improve pain intensity, pain self-efficacy and selected secondary outcomes?
Design:
A multi-centre randomised, control group-blinded, superiority trial. Adults seeking primary care physiotherapy with MSKP were randomly allocated to usual physiotherapy management alone (n = 250), or usual physiotherapy management plus the PainSMART-strategy (n = 254); a 7-min pain science education (PSE) film and short physiotherapist-initiated reflection on the film. Data were collected at baseline, follow-ups 1 (24-72hrs pre-physiotherapy consultation), 2 (24hrs post-consultation) and 3 (three months post-baseline).
Primary Outcomes:
Average pain intensity and pain self-efficacy.
Secondary Outcomes:
Best/worst pain intensity, MSKP-perceptions, MSKP-coping strategies, psychological flexibility, physical activity levels, sitting time, global rating of change.
Results:
Average pain intensity: No between-group difference in change from baseline to any follow-up (MD -0.06, 95% CI -0.36 to 0.25, 0-10 scale; 0.05, 95% CI -0.34 to 0.43; -0.08, 95% CI -0.54 to 0.37). Pain self-efficacy: Between-group difference in change from baseline favoured the PainSMART-group at follow-up 1 (MD 1.6, 95% CI 0.10 to 3.0, 0-60 scale; exploratory analysis), but not follow-ups 2 and 3 (MD -0.07, 95% CI -1.8 to 1.6; 1.3, 95% CI -1.0 to 3.6; primary analysis time points). Fewer patients in the PainSMART-group reported worsening.
Conclusion:
Combining the PainSMART-strategy with usual physiotherapy management did not result in additional clinically meaningful benefits once physiotherapy had commenced. During waiting times, the strategy may facilitate earlier improvements in MSKP-perceptions, self-efficacy and physical activity for some. This type of educational intervention is scalable within primary care.
Clinical Trials Registration:
The study protocol (2023-12-15) and statistical analysis plan (2024-09-25) were prospectively registered at ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT06187428) and the study protocol published (https://doi.org/10.1371/journal.pone.0316806).