Persistent musculoskeletal pain : A web-based activity programme for behaviour change, does it work? Expectations and experiences of the physiotherapy treatment process

Sammanfattning: This thesis concerned persons with persistent musculoskeletal pain in primary health care and had three aims. The first aim was to evaluate the effects of a web-based programme for behaviour change. The second aim was to create and evaluate a multimodal intervention. The third aim was to explore and describe expectations andexperiences of the physiotherapy treatment process.In Study I, we evaluated the effects of a web-based activity programme for behaviour change added to multidisciplinary rehabilitation (MDR) in primary health care. Ninety-nine participants were randomized to 1) MDR with an additional web-based programme, and 2) MDR. Outcome measures were work ability, pain intensity, pain-relate disability and health-related quality of life. There were no significant effects of the web-based programme for any outcome measure at 4 or 12 months. In conclusion, this study provides no support for adding a self-guided web-based programme to MDR in primary health care.In Study II, we evaluated first the web-based programme from Study I compared to the waiting list. Effect measures were workability, pain intensity, disability and self-efficacy. Thereafter, we evaluated the effects and process of a novel multimodal intervention consisting of the web-based programme with additional individual counselling, and individually tailored physiotherapy treatment. Ten participants were included in the study. Effects were evaluated using a Single Subject Experimental Design (SSED) and the process was evaluated by interviews with the participants and log data of usage of the modalities. There were no conclusive effects of the self-managed web-based programme as compared to the waiting list. The SSED analyses of the multimodal intervention showed promising short-term results regarding disability and pain intensity, but no conclusive results for work ability or self-efficacy. The multi-modal intervention process seemed successfully implemented, and the importance of physiotherapy and, to some extent counselling, was emphasized by the participants. In conclusion, the newly designed multimodal intervention in primary health care seemed feasible and showed some promising short-term effects, while the implementation of a self-managed web-based programme as a single intervention seemed without effect.In Study III, qualitative interviews were conducted with ten participants to explore their expectations of physiotherapy. Data were analysed with qualitative content analysis and the findings described a multi-faceted picture of the participants’ expectations, encompassing several aspects regarding the treatment process and outcome. Regarding the treatment process, participants expected a good dialogue, to be confirmed as individuals, and to get an explanation for their pain. The participants expected tailored training with frequent follow-ups and their expectations of outcome ranged from hope of the best possible results to being realistic or resigned.In Study IV, qualitative interviews were conducted with 11 participants to explore their experiences in physiotherapy treatment. Data were analysed with qualitative content analysis. The findings show how the participants described how they used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. There were experiences involving the importance of establishing an alliance with the physiotherapist, based on trust and with a continuous dialogue. When exercises, activities and other treatment modalities were individualized, participants were actively involved in the process. This was rewarding but was also considered an effort and a challenge. The physiotherapist’s initiatives and actions were considered important for incentive and support.In conclusion, we found no effects of the web-based activity programme on behaviour change for persons with persistent musculoskeletal pain. The newly designed multi-modal intervention in primary health care seemed feasible and showed some promising short-term effects. Expectations of physiotherapy treatment were multi-faceted, encompassing both process and outcome. After finishing physiotherapy, the participants described how they used knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies to manage pain and the process of acceptance. The importance of alliance and incentives for activities throughout the physiotherapy treatment process were also described.