Stefan Elbers

97 Self-management for patients with chronic pain Figure 4. Post treatment comparison of self-management intervention versus control on pain intensity. Physical Activity. Only three studies compared differences in changes of physical activity immediately post-treatment. Two studies provided sufficient information for a meta- analysis (Stuifbergen et al., 2010; Knittle et al., 2015). We pooled these study outcomes as the I 2 was 0% and there was substantial overlap in the two confidence intervals. There was no significant difference between the intervention group and the control group, SMD = 0.14 [0.38, −0.14], z = 1.18, p = 0.24 (see Figure 5). This is in line with Taal et al. (1993), who also did not find a difference between self-management and control groups on physical activity. Figure 5. Post treatment comparison of self-management intervention versus control on physical activity. Evaluationof theEvidence. TheGRADEevidenceplot (table4) shows thepost-intervention comparisons combined with the quality of evidence. For each outcome measure, fewer than 25% of the participants were from high risk of bias studies. The inconsistency was high for self-efficacy, due to high statistical heterogeneity compared with low overlap in confidence intervals. For the other outcome measures, the statistical heterogeneity was either limited or mainly contributable to one study. As a result of substantial variations in intervention content and outcomemeasures, all comparisons were downgraded for indirectness. Physical activity was the only comparison downgraded for imprecision, because the combined sample size was smaller than the optimal information size. Visual inspection of the funnel