Stefan Elbers

103 Self-management for patients with chronic pain management intervention groups are not more effective than control groups. For physical activity, there is low quality evidence that self-management interventions are not more effective than control groups. The studies that could not be included in the GRADE analysis showed similar trends and corroborated these conclusions. DISCUSSION Summary of Main Results The primary aim of this study was to investigate the effectiveness of self-management interventions on physical function, self-efficacy, pain intensity and physical activity for patients with chronic musculoskeletal pain. We identified 20 randomized controlled trials that compared a self-management intervention to a control group. For post- intervention results, we found moderate quality evidence for a statistically significant, but clinically unimportant effect on physical function and pain intensity, both favouring the self-management group. We also found low quality evidence for a trend favouring self- management interventions on self-efficacy and for no effect on physical activity. There was moderate quality evidence for a small, clinically insignificant, effect on self-efficacy at follow-up. We found moderate quality evidence for no between-group differences at follow-up for the remaining outcome measures. The results from the meta-analyses were corroborated by the studies that could not be included in the pooling. These findings indicate that self-management interventions have an only marginal benefit for patients with chronic musculoskeletal pain both in the short and long-term. Furthermore, we found a large variety in BCTs used, indicating substantial differences between interventions in how to teach self-management skills. Similarities to and Differences With Other Systematic Reviews We identified four related systematic reviews that show similar trends in effectiveness. Jordan et al. (2010) identified one subgroup of self-management interventions that specifically targetedpatientswithosteoarthritis.For both short-and long-termcomparisons with control groups, the effects on clinical outcomes were inconclusive: Three studies of seven showed improvement on pain intensity; and for functional disability and quality of life, one out of five studies reported better results for the self-management group than the control group. In addition, Nolte and Osborne (2013) evaluated the outcomes of 18 self-management interventions that adopted the Stanford criteria and concluded that these interventions were only marginally effective for pain, disability and depression. Only the median effect sizes for self-efficacy, d = 0.30 (Range: 0.05–0.72), and for knowledge, d = 0.78 (range: −0.05 to 1.11), were medium to large at post-intervention. Warsi et al.