Stefan Elbers

206 Chapter 8 show in detail the variation between intervention characteristics in different studies. The overview also gave rise to several suggestions for improvements in descriptions of IMPT programmes in future studies, such as the extent by which a treatment could be tailored to individual needs (reported in 47% of the cohorts), or the average duration of chronic pain of the study sample (reported in 46%). Inspired by the work of Boutron and colleagues (2020) and Elliot and colleagues (2014, 2017) – which included suggestions for methodology and dissemination – we decided to transform this study into a living systematic review. In Chapter 3 , we proposed a workflow and discussed how a living systematic review could reduce the investment of effort and time needed to update the study. Importantly, the increased speed of inclusion of primary studies intometa-analyses is expected to contribute to faster dissemination and implementation of research findings in clinical practice. Our second aimwas to develop an intervention that facilitates themaintenance of treatment gains and insights, using a co-design approach. The first step was to collect and evaluate RCTs that included generic self-management interventions for patients with chronic musculoskeletal pain ( Chapter 4 ). Although some comparisons indicated statistically significant results favouring the self-management condition over control, clinical relevance was low. Furthermore, GRADE outcome assessments indicated low-to-moderate quality of evidence across the outcome domains. The descriptive analysis of the behaviour change techniques reported in this thesis showed a large variation between studies, indicating differences in beliefs and underlying ideas of how best to facilitate health behaviour change. This absence of clear guidance towards maintenance was in line with our preliminary literature searches on relapse in chronic pain treatment and further justified our co-design approach to intervention development. This 18-month co-design project is described in Chapter 5 . To compensate for the paucity of studies on preventing relapse after IMPT programmes, we combined the different perspectives of patients, health care providers, scientists, and designers to find solutions to the problem of improving maintenance after treatment. Compared with traditional intervention development approaches, we expected that this structured collaboration with end-users would promote the acceptability of the intervention, and improve integration into existing treatment practices. Through various design iterations,we developed an evidence base, tested ideas, and developed two prototype interventions that were combined in one paper workbook. By reflecting on the whole process, we concluded that generative techniques helped to provoke detailed accounts of respondents’ experiences and beliefs. Moreover, the co-design activities stimulated active engagement and equality between patients, health care providers, designers, students and researchers. However, the limited involvement of patients and health care providers in the ‘develop’ phase, compared with previous phases, may have affected the acceptability of the final prototype. This workbook intervention was tested during a qualitative study – described in Chapter 6 – where patients and health care providers who had used the