Table 5.
Summary of Findings (Intervention vs Control)
| Author year | Clinically significant* improvement in pain intensity or pain-related function | QOL | Depression | Anxiety | Sleep | Opioid use | Unintended consequences/treatment satisfaction |
|---|---|---|---|---|---|---|---|
| Decision support coupled with case management | |||||||
| Ahles 200123 | NR | SF-36 mean: Pain component: 59.7 vs 46.9, P < 0.005 Role physical: 54.8 vs 37.5, P < .03 Role emotional: 81.9 vs 62.0, P < 0.001 Role social: 79.5 vs 64.5, P < 0.001 |
NR | NR | NR | NR | NR |
| Ahles 200624 | NR | SF-36 mean change: Role emotional: 13.9 vs 3.8, P = 0.046 Vitality: 7.4 vs 3.7, P = 0.048 |
NR | NR | NR | NR | NR |
| Bair 20152 (ESCAPE) | RMDQ: RR = 1.52 (95% CI 1.22 to 1.99) NNT = 8 (95% CI, 4 to 294) |
NR | NR | NR | NR | NR | NR |
| Dobscha 200927 (SEACAP) |
RMDQ: 21.9 vs 14.0%, P = 0.04 NNT = 13 (95% CI 7 to 271) |
Mean change EQ-5D: − 0.02 vs − 0.04, P = 0.17 | Mean change PHQ-9: − 3.7 vs − 1.2, P = 0.003 | NR | NR | Any opioid prescribed: 65 vs 61%, P = 0.56 | Mean change global treatment satisfaction: − 0.27 vs − 0.36, P = 0.44 |
| Hay 200628 | OMERACT-OARSI (high improvement): 27 vs 28%; P = 0.8 | NR | HADS depression:† 0.01 (95% CI − 0.7 to 0.7) |
HADS anxiety:† − 0.23 (95% CI − 1.1 to 0.6) |
NR | NR | Satisfaction with treatment:† − 19% (95% CI −32 to −4) |
| Kroenke 200930 (SCAMP) | BPI: 41.5 vs 17.3%; RR = 2.4 (95% CI 1.6 to 3.2) NNT = 4.1 (95% CI 3.0 to 6.5) |
SF-36:** General health: 11.1 (95% CI 4.2 to 18.0) Social functioning: 6.1 (95% CI −1.3 to 13.5) Vitality: 8.8 (95% CI 3.6 to 14.0) |
≥ 50% decrease in HSCL-20 from baseline: RR = 2.3 (95% CI 1.5 to 3.2) |
GAD-7:** − 2.2 (95% CI − 3.5 to − 0.9) |
NR | Any opioid prescribed: 54 vs 53%, P = 0.35 | NR |
| Kroenke 201431 (SCOPE) | BPI: 51.7 vs 27.1%; RR = 1.9 (95% CI 1.4 to 2.7) NNT = 4.1 (95% CI 3.0 to 6.4) |
SF-12:** Physical: 2.5 (95% CI 0.0 to 5.0) Mental: 0.2 (95% CI − 2.9 to 3.3) SF-36:** Social functioning: 5.3 (95% CI − 1.6 to 12.2) Vitality: 2.2 (95% CI − 3.9 to 8.2) |
PHQ-9:** − 1.8 (95% CI − 3.4 to − 0.2) |
GAD-7:** − 0.7 (95% CI − 1.9 to 0.5 |
PROMIS sleep:** − 1.0 (95% CI − 2.0 to 0.0) |
Mean # of months taking opioids: 2.0 vs 1.6, P = 0.27 | NR |
| Risk/complexity-matched treatment pathways | |||||||
| Burnham 201026 (CAPRI) | NR | NR | NR | NR | NR | NR | NR |
| Hill 201129 | RMDQ: 65 vs 57%; OR = 1.48 (95% CI 1.02 to 2.15) NNT = 10.8 (95% CI 5.8 to 206) |
SF-12:** Physical: − 2.93 (95% CI − 4.31 to − 1.56) Mental: − 0.69 (95% CI − 2.39 to 1.01) |
HADS depression:** 0.62 (95% CI 0.07 to 1.17) |
HADS anxiety**: 0.45 (95% CI − 0.10 to 1.01) |
NR | NR | Satisfaction with care (not satisfied): 27 vs 36% |
| Increasing access via group multidisciplinary intervention sessions | |||||||
| Angeles 201325 | NR | SF-36 mean change: Physical: − 15.3 vs 3.4, P = 0.01 Emotional: 2.6 vs 3.7, P = .92 Social: 3.2 vs 2.7, P = 0.95 Mental: 3.6 vs 3.6, P > 0.99 |
NR | NR | NR | NR | NR |
Abbreviations: QOL quality of life, RMDQ Roland-Morris Disability Questionnaire, SF-36 Medical Outcomes Study Short form-36, SF-12 Short form-12, EQ-5D EuroQol health-related quality of life, PHQ-9 Patient Health Questionnaire-9, OMERACT-OARSI Outcome measures in rheumatology-Osteoarthritis Research Society International, HADS hospital anxiety and depression, BPI brief pain inventory, HSCL-20 Hopkins symptom checklist, GAD-7 generalized anxiety disorder, PROMIS patient-reported outcomes measurement information system, ESCAPE Evaluation of Stepped Care for Chronic Pain, SEACAP Study of the Effectiveness of a Collaborative Approach to Pain, SCAMP Stepped Care for Affective Disorders and Musculoskeletal Pain, SCOPE Stepped Care to Optimize Pain Care Effectiveness, CAPRI Central Alberta Pain and Rehabilitation Institute
*≥ 30% decrease from baseline
**Between-group mean difference (intervention-control)
†Between-group mean difference (control-intervention)