Health improvement in chronic widespread pain. Outcomes and experiences

Abstract

Aim: The purpose of this thesis was to investigate changes in health outcomes and experiences of improvement over time and the effect of person-centred physical activity delivered with digital e-health support on health outcomes in participants with chronic widespread pain (CWP), as well as predictors of improvements.

Methods: The thesis includes four studies. Study I is a long-term follow-up study investigating health changes in women with CWP (n=126) after ten to twelve years. Study II is an interview study exploring experiences of improvement among women with CWP (n=17) that had improved over time. Study III is a randomised controlled trial investigating the health effects of a person-centred health plan co-created with a physiotherapist and supported by a digital e-health platform compared to support by one telephone call in participants with CWP (n=139). Study IV investigates the effect of person-centred health plans, including physical activity, after twelve months in participants with CWP (n=102).

Results: The results showed significant improvements in pain, fatigue, depression, overall health, health-related quality of life and stress after ten to twelve years among the participants in Study I. Also, participants who reported less stress symptoms ten to twelve years earlier had a higher chance of substantial improvement in pain intensity at follow-up. The analysis in Study II yielded three categories describing participants’ thoughts of their improvement: experiences of improvement, developed strategies for better health and the meaning of contextual factors for improvement. Study III found no significant benefits when the person-centred health plan was supported with the digital e-health platform compared to support by the telephone call. There was a significant difference in global fatigue in favour of the group receiving support by telephone. The results in Study IV showed no significant change in level of physical activity twelve months after the participants had co-created the health plan. A positive experience of physical activity at baseline was associated with a higher likelihood of reaching a level of physical activity sufficient to receive health-enhancing effects.

Conclusion: Many people with CWP seem to experience a reduction in several symptoms over time. Experienced life stressors and clinical manifestations of stress impact the potential for improvement over time. The results of this thesis also support multifactorial reasons for improvement, highlighting the importance of individual factors. This underscores the value of stress-reducing interventions and rehabilitation based on a person-centred approach. Additionally, the results emphasise the importance of considering patients' own experiences and perceptions of physical activity before planning rehabilitation to enhance their level of physical activity.