Table 1

Key findings and subsequent recommendations for course design

Key finding from phases I and IIHow 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 learningInclusion 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 problemCourse run over 3 days in a single week
Expert professional input may be useful or appealing to participantsExpert professional input delivered by DVD for economy
Reproducibility and fidelity of the interventionDevelopment 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.