Stefan Elbers

99 Self-management for patients with chronic pain plots (see Supplement 3) did not indicate any publication bias. This resulted in the following evidence statements: For physical function and pain intensity, there is moderate quality evidence for a small but clinically insignificant effect favouring self-management. For physical activity, there is low quality evidence for no effect of self-management compared to a control group. Although we did not calculate standardized mean differences for self- efficacy, based on the range of effects, we conclude that there is low quality evidence for a trend favouring the self-management intervention. The studies that were not included in the meta-analysis showed similar results and support these conclusions. Follow-up results Limitations in Physical Function. Twelve out of 15 studies with follow-up data were eligible for pooling (see Figure 6). The median follow-up time of all 15 studies was 12 months. As the statistical heterogeneity was low ( I 2 = 0%), we performed a meta-analysis. The pooled effect of 11 studies with endpoint data was not statistically significant, SMD = −0.07 [−0.16, 0.02], z = 1.60, p = 0.11, and this was also the case for Manning et al. (2014), SMD = −0.06 [−0.47, 0.36], z = 0.27, p = 0.78. In addition, Hutting et al. (2015) and Taal et al. (1993) also reported no effects at follow-up. The only study that reported a long-term positive effect on physical function was Dworkin et al. (2002); at 12 months follow-up, the self-management group showed less limitation in physical function compared to control, p = 0.01. Figure 6. Follow-up Comparison of Self-Management Intervention Versus Control on Physical Function.