Aims
Goal setting is a core component of many interventions for chronic musculoskeletal pain (CMP), and its delivery style may influence outcomes. This systematic review and meta-analysis aimed to assess the effectiveness of multi-component behavioural interventions with goal setting on pain, disability, and physical activity in people with CMP, and to explore whether delivery style (participant-led/person-centred vs source-led) or pain type influenced outcomes.
Methods
We searched electronic databases and clinical trial registries for randomised controlled trials (RCTs) of adults ≥18 years with CMP that compared multi-component behavioural interventions that included goal setting to control. Data extraction, risk of bias, and evidence certainty assessments were conducted in duplicate. We performed random effects meta-analyses to evaluate effects on pain intensity, disability, and physical activity post-intervention. We conducted subgroup analyses to explore differences in outcomes based on goal setting delivery style and pain type based on anatomical location or musculoskeletal conditions e.g., rheumatoid or osteoarthritis.
Results
Thirty-eight RCTs involving 7,328 participants (mean age 56.5 +/- 14.3 years; 61.2% female) were included. Post-intervention, there was a difference favouring goal setting interventions for reducing pain intensity [mean difference: -6.45, 95% confidence interval (CI): -9.47 to -3.43] and disability [standardised mean difference (SMD): -0.32, 95%CI: -0.43 to -0.21] but not for physical activity [SMD: 0.09, 95%CI: 0.0 to 0.18]. Subgroup analyses showed a significant difference favouring participant-led/person-centred delivery over source-led delivery for reducing disability [p = 0.01]. Effects were not moderated by pain type.
Conclusion
Multi-component behavioural interventions with goal setting provide small improvements in pain and disability, but not physical activity, in adults with CMP. Involving participants in the goal setting process may further improve disability.