Stefan Elbers

17 General introduction Self-Management Interventions One cannot not manage…The only question is how one manages. (Lorig & Holman, 2003) . Self-management has been defined as the everyday management of chronic conditions during the course of a disease (Allegrante et al., 2019). It generally involves behavioural or medical tasks to deal with the condition, but also coping with emotions and managing valued social roles (Lorig & Holman, 2003). Generic self-management interventions are a less comprehensive alternative compared to IMPT programmes. They do not target disease- specific mechanisms, such as the extinction of pain-related fear. Instead, they solely focus on training generic coping strategies that help patients minimize the burden of the disease. Strategies include goal-setting, learning to communicate effectively with health care providers, and adopting a structured approach towards making important decisions. The interventions often include peer support activities and can even be provided by lay teachers (e.g. expert patients) with no background in health care. For patients with chronic pain, this approach can be important for at least two reasons. First, patients often report difficulties in self-management skills such as planning ahead and finding resources (Corcoran et al., 2010; Lennox Thompson et al., 2020). Second, self-management programmes completely focus on supporting patients in how to self-regulate their condition throughout their lives. This approach may therefore incorporate important principles on how to deal with relapse, which could be used to improve IMPT programmes. AIMS AND OUTLINE The first aim of this dissertation is to provide an overview of the current state of literature on the longitudinal outcomes and treatment characteristics of IMPT programmes. Although the effectiveness of IMPT programmes compared to control treatments at specific time points has been investigated in systematic reviews (e.g. Kamper et al., 2015), it is unclear to what extent any treatment gains are maintained over time. Chapter two contains the results of a systematic review that describes the patterns of change over time in patient cohorts participating in IMPT programmes. The study also includes a detailed overview of heterogeneity regarding study, patient, and intervention characteristics, using the Template for Intervention Description and Replication (TIDieR) checklist. In Chapter three , we propose a ‘living workflow’, an iterative yearly updating cycle, that is intended to keep the outcomes of the review in Chapter 2 up-to-date. The second aim of this research project is to develop an intervention that facilitates the maintenance of treatment gains over time. Chapter four describes the results of a systematic review and meta-analysis on generic self-management interventions for