Depicting individual responses to physical therapist led chronic pain self-management support with pain science education and exercise in primary health care: multiple case studies.
Jordan Miller, Joy C MacDermid, Julie Richardson and 2 others
PMID 29340199WHAT IT FOUND
In six people with chronic pain, function responses to a physiotherapist-led program combining pain science education, cognitive-behavioural principles and individualized exercise varied.
Some improved function, some did not change, some declined. The contribution of any component is unknown. These cases cannot show it works.
Key findings
01Function responses varied: two high-attendance participants had no clinically meaningful change, two low-attendance participants had clinically meaningful decline, and two high-attendance participants had clinically meaningful improvement.
02The study cannot establish effectiveness because the case series design does not allow comment on effectiveness or efficacy.
03Missed or discontinued visits were due to illness, specialist appointments, forgotten appointments, anxiety, depression, or work changes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only six cases were described, and they were selected from 18 participants to show different responses and attendance. The case series design cannot comment on effectiveness or efficacy, and there was no control group. Participants received several things together: pain science education, cognitive behavioural principles, self-management support, and individualized goal-oriented exercise. The contribution of any single component cannot be separated. Three participants booked appointments with their family doctor during the study, and two reported medication changes, so co-interventions may have affected outcomes. Attendance was uneven, with two participants stopping after 2 or fewer visits, so results may reflect dose, adherence, or context rather than treatment alone. Outcomes were self-reported, and some minimal important differences were based on half a standard deviation rather than an established threshold. The participants had multiple pain sites, comorbidities, and mental health concerns, so responses may not apply to simpler chronic pain cases.
The easy way to misread this
Do not conclude that COMMENCE improves chronic pain function. The study had no control group, only six cases, and it cannot separate the effects of pain science education, cognitive behavioural principles, individualized exercise, attendance, or co-interventions. It is a description, not a tested intervention.