Long-term follow-up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care

Eur J Pain. 2009 Nov;13(10):1080-8. doi: 10.1016/j.ejpain.2009.01.010. Epub 2009 Mar 5.


This study examined long-term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One-hundred and twenty-two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow-up assessments two-year post-treatment were completed by 65 participants. According to per-protocol analyses, short-term effects were maintained in both groups for the primary outcome, pain-related disability. The TBT-group reported lower disability levels compared with the EBT-group. Intention-to-treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self-efficacy were maintained over the 2-year post-treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT-group, and EBT participants reported higher fear of movement/(re)injury two years post-treatment compared to TBT. The study supports tailoring of treatments in concordance with patients' needs and preferences of activity goals and functional behavioural analyses including predictors of pain-related disability, for successful immediate outcomes and their maintenance in the long run. Exercise-based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2-year follow-up period.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics / administration & dosage
  • Analgesics / therapeutic use
  • Behavior Therapy*
  • Delivery of Health Care / statistics & numerical data
  • Disability Evaluation
  • Exercise Therapy*
  • Fear / psychology
  • Female
  • Follow-Up Studies
  • Humans
  • Long-Term Care
  • Male
  • Middle Aged
  • Motor Skills
  • Movement / physiology
  • Musculoskeletal Diseases / psychology*
  • Musculoskeletal Diseases / therapy*
  • Pain / psychology*
  • Pain Management*
  • Pain Measurement
  • Patient Compliance
  • Patient Dropouts
  • Patient Satisfaction
  • Primary Health Care
  • Self Efficacy
  • Sick Leave
  • Sweden


  • Analgesics