Stefan Elbers

225 Summary Self-management interventions provide patients with skills and knowledge to support the everyday management of their chronic disease. This approach may therefore hold important information on how to deal with relapse, which could be used to improve IMPT programmes. Our primary aim was to determine the effectiveness of generic self- management programmes in improving physical functioning, self-efficacy, pain intensity and physical activity, compared to control. We identified 20 randomized controlled trials comparing a generic self-management intervention to a control group. For each outcome, we calculated standardized mean differences post-treatment and at follow-up, pooling the results if there was sufficient homogeneity between studies. Following a GRADE approach, we foundmoderate quality evidence for a statistically significant,but clinically unimportant, effect on physical functioning and pain intensity, favouring generic self-management interventions. At follow-up, we found moderate quality evidence of a small but clinically unimportant effect for self-efficacy, favouring generic self-management interventions. The other comparisons indicated no statistically significant effect. In line with our findings in Chapter 2 , we found substantial variation in intervention content, especially with respect to the described behaviour change techniques. This indicates different perspectives on how to change self-management behaviours. Overall, these results indicate that generic self- management interventions have a marginally favourable effect for patients with chronic pain on self-efficacy, physical functioning, and pain intensity. Chapter 5 contains the description and systematic evaluation of a co-design project to develop a relapse prevention intervention for patients with chronic pain who had participated in IMPT programmes. In contrast to many traditional health care intervention development approaches, co-design systematically includes the perspective of end-users in each phase of the development process. Consequently, this method has the potential to increase the uptake of health interventions. The first aim of this study was to provide an overview of all activities that were employed during the development of the prototype intervention. The second aim was to reflect at each development stage on how co-design influenced stakeholder involvement, the generation of insights, and the incorporation of stakeholder input into the design. In this embedded case study, we adopted a participatory action research approach, collaborating with patients, health care providers and designers throughout the project rather than treating them only as research subjects. During the project, all researchers contributed to a qualitative dataset through individual notes and reflective sessions. We also analysed all input from the co-design activities and the steering committee meeting minutes. We used the Double Diamond Model to organize the data across four design phases (i.e. 'discover', 'define', 'develop' and 'deliver') and adopted a deductive content approach to identify information concerning our second study aim. Over the course of 18 months, we organized multiple design activities, including interviews, co-creation sessions, data-analysis activities, and prototype-building sessions.