Key findings and subsequent recommendations for course design
| Key finding from phases I and II | How this finding influenced course design (influences on main trial shown in brackets) |
|---|---|
| Group delivery appears to be effective (SR1) Networking with others popular feature of SM courses (QS) | Group intervention |
| Most evidence to support professional tutors (SR1) Mixed professional and lay tutor-led course also effective (SR1) | Groups to be led by a combination of a lay and a professional tutor |
| Medical and community settings associated with effective courses (SR1) Convenience of courses important to participants (QS) | Courses to be held in convenient community or health centre settings |
| Courses longer than 8 weeks were no more effective than courses under 8 weeks (SR1) | Shorter duration course |
| SM Interventions with psychological components were more effective than usual care (SR1) Increased number of components were not associated with bigger effect sizes (SR1) | Principal component of new intervention to be psychological |
| Little evidence to support mind body therapy components (SR1) | Relaxation to be control intervention in main trial. Relaxation was included because participants liked it and to match exposure with the control (QS) |
| Increasing self-efficacy may mediate intervention (SR2) | Course should aim to promote self-efficacy |
| Increasing physical activity may mediate intervention (SR2) Patient resistance to concept of exercise but not general activity (QS) | We decided against a large physical activity component in the course but include taster activities (possible hobbies) |
| Depression at baseline may be a predictor for poorer outcomes (SR2) | Course covers depression and encourages people who feel they may be depressed to discuss this with their doctor |
| Concerns of attendees about what happens after the course is completed (QS) | Follow-up session at 2 weeks |
| Reduction in activities common in chronic MSK pain patients (QS) | Inclusion of “taster” activity sessions in the course |
| Isolation common in chronic MSK pain patients (QS) | Have plenty of time for socialising |
| Other key considerations influencing course design | |
| Adult educationalists advised that to be interesting and effective the course should employ multiple media and modalities, be delivered in 20-min bites and encourage experiential learning | Inclusion of role play, filmed material, small group exercises, exercises for pairs, active listening exercises, brainstorming, etc |
| Attrition from self-management courses running over 6–8 weeks known to be a problem | Course run over 3 days in a single week |
| Expert professional input may be useful or appealing to participants | Expert professional input delivered by DVD for economy |
| Reproducibility and fidelity of the intervention | Development of a course manual and training package |
MSK, musculoskeletal; QS, qualitative study; SR1, systematic review about components and characteristics of courses; SR2, systematic review about predictors, mediators and moderators of patient outcomes on courses.