Pain management training for people with persistent pain and their informal carers (JOINT SUPPORT): Multicentre randomised controlled feasibility trial with embedded qualitative study in English musculoskeletal services

Smith, Toby O., Khoury, Reema, Welsh, Allie, Hanson, Sarah, Grant, Kelly, Clark, Allan B., Ashford, Polly-Anna, Hammond, Matthew, Pond, Martin, Crowther, Coralie, Dures, Emma and Adams, Jo (2025) Pain management training for people with persistent pain and their informal carers (JOINT SUPPORT): Multicentre randomised controlled feasibility trial with embedded qualitative study in English musculoskeletal services. BMJ Open. ISSN 2044-6055 (In Press)

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Abstract

Objectives: To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of a pain management training intervention to support people with persistent musculoskeletal pain and their informal carers.   Design: Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study.   Setting: National Health Service (NHS) providers in four English hospitals.   Participants: Adults receiving NHS care for persistent musculoskeletal pain and their informal carers.   Intervention: Control: usual NHS care. Experimental: usual NHS care plus a carer–patient pain management training intervention (JOINT SUPPORT), comprising five, one-hour, group-based sessions for patients and carers, delivered by trained physiotherapists or occupational therapists. Content included: understanding pain, pacing, graded activity, fear avoidance, goal-setting, understanding the benefits of physical activity and medication management. This was re-enforced with a workbook. After the group-based sessions, patients and carers were supported through three telephone sessions.   Randomisation: Central randomisation was computer generated (2:1 Experimental: Control), stratified by hospital and patient-participant age (< and equal to 65 years). There was no blinding.   Main outcome measures: Data collected at baseline and three months post-randomisation included: screening logs, intervention logs, fidelity checklists and clinical outcomes on quality of life, physical and emotional outcomes, adverse events and resource use. Interviews with 14 patient-carer participants and six health professionals who delivered the intervention.   Results: 76 participants (38 patients; 38 carers) were enrolled. Sixty percent (312/480) of patients screened were eligible with 12% consenting to be randomised (38/312). Fifty-four percent (13/24) of the experimental group reached minimal compliance to the JOINT SUPPORT intervention. There was no evidence of treatment contamination. For patient-participant outcomes, within-group differences from baseline to three months favoured the control group when assessed by EQ-5D and GSE total score, but favoured the intervention group when assessed by numerical rating scale pain, fatigue and Centre for Epidemiologic Studies Depression Scale (CES-D) total score. Qualitative data demonstrated acceptability of the trial design and JOINT SUPPORT intervention with modifications to improve trial processes.   Conclusions: The JOINT SUPPORT intervention was acceptable to patient–carer dyads and health professionals. Modifications to trial design, particularly enhanced recruitment strategies, are required.

Item Type:	Article
Uncontrolled Keywords:	pain,chronic,self-management,carer,caregiver,feasibility rct
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Population Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Health Promotion Faculty of Medicine and Health Sciences > Research Groups > Nutrition and Preventive Medicine Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health Faculty of Medicine and Health Sciences > Research Groups > Health Services and Primary Care
Depositing User:	LivePure Connector
Date Deposited:	17 Feb 2025 10:30
Last Modified:	17 Feb 2025 12:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98510
DOI:

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