Marcus Beasley | University of Aberdeen (original) (raw)

Papers by Marcus Beasley

Research paper thumbnail of Lessons from experiences of accessing healthcare during the pandemic for remobilising rheumatology services: a national mixed methods study

Rheumatology Advances in Practice, 2022

Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for... more Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory MSK conditions. Methods Three established cohorts which included individuals with axial spondyloarthritis, psoriatic arthritis, and musculoskeletal pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semi-structured interviews. Results 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. 57% respondents had tried to access care since the start of UK national lockdown. Over a quarter reported being unable to book any type of healthcare appointment. GP appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinical...

Research paper thumbnail of Additional file 3: of Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Acceptability Study Theoretical Framework. (PDF 404 kb)

Research paper thumbnail of Additional file 2: of Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Interview Schedule. (PDF 139 kb)

Research paper thumbnail of Kingdom. Corresponding Author

Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptom... more Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptoms are associated with socio-demographic, dental, adverse psychological factors and pain elsewhere in the body. Material and Methods: Cross-sectional population data were obtained from UK Biobank (www.ukbiobank.ac.uk/) study which was conducted in 2006- 2010 and recruited over 500,000 people. Results: The overall prevalence of facial pain (FP) was 1.9 % (women 2.4%, men 1.2%) of which 48 % was chronic. The highest prevalence was found in the 51- 55 age group (2.2%) and the lowest in the 66- 73 age group (1.4%). There was a difference in prevalence by ethnicity (0.8 % and 2.7 % in persons reporting themselves as Chinese and Mixed respectively). Prevalence of FP significantly associated with all measures of social class with the most deprived and on lowest income showing the highest prevalence (2.5 % and 2.4 % respectively). FP was more common in individuals who rated themselves as extremel...

Research paper thumbnail of Maternal and perinatal risk factors and childhood cancer

Research paper thumbnail of Cognitive Behaviour Therapy, Exercise or Both for Chronic Widespread Pain

Research paper thumbnail of Erratum to: Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study

Rheumatology Advances in Practice, 2021

Research paper thumbnail of Comparing people who have and have not received a diagnosis of fibromyalgia: a cross‐sectional survey within the PACFiND study

Arthritis Care & Research, 2021

Research paper thumbnail of Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study)

Annals of the Rheumatic Diseases, 2021

ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of ... more ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR ...

Research paper thumbnail of Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

BMC Musculoskeletal Disorders, 2019

Background: Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatme... more Background: Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatment for patients with chronic widespread pain (CWP). Preventing the onset of CWP offers considerable benefits to the individual and society and the MAmMOTH study is the first aimed at CWP prevention. The study is a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. This nested qualitative study explores patients' treatment experiences, with a view to understanding their potential influences on acceptability of the intervention. Methods: The MAmMOTH Study recruited 1002 participants, half of whom were randomised to receive tCBT. Participants were eligible for invitation to the trial if they had pain for which they had consulted their GP, or had pain and visited a doctor frequently, and had 2 of 3 risk factors for development of CWP. Participants randomised to tCBT who had completed treatment were eligible for invitation to qualitative interviews for this study. Individual qualitative interviews were conducted with a sub-sample (n = 33) of patients at high risk of developing CWP who had been allocated to the intervention arm. Semi-structured telephone interviews explored treatment experiences and intervention acceptability. Data was analysed using Framework analysis. Results: Participants presented with a range of musculoskeletal and auto-immune conditions and almost half described their pain as 'chronic' on study entry. Many participants perceived the trial intervention to be aimed at treatment of pain rather than prevention of pain. Initial expectations prior to treatment varied, with scepticism more likely for those who had little prior knowledge of CBT approaches. All participants provided positive feedback post intervention particularly in relation to the modality, therapist experience and skills and the intervention. The majority of participants described positive changes in either their subjective level of pain or pain-management post-intervention and some attributed the positive change directly to the intervention as a result of empowerment, increased self-management and cognitive restructuring. Conclusions: This study extends our understanding of the acceptability and suitability of preventative interventions for chronic widespread pain and provides further evidence for the acceptability of tCBT. Trial registration: Clinical Trials.gov NCT02668003 (registered 29th January, 2016).

Research paper thumbnail of Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study

Rheumatology Advances in Practice, 2018

Objectives The aim was to develop and validate a simple clinical prediction model, based on easil... more Objectives The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months...

Research paper thumbnail of Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

Canadian Journal of Pain, 2017

Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In ... more Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In unblinded trials this can affect outcomes. Aims: The aim of this analysis was to examine the association between treatment preference and expectation and outcome in a trial of pain treatments. Methods: In a randomized trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time points after treatment were compared between those matched or unmatched with their preference and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation. Results: Four hundred forty-two participants were recruited to the trial (69.5% female). The proportion reporting positive outcomes among participants matched to their preference compared to those unmatched was 33.3% vs. 34.4% at the end of treatment (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI], 0.44-1.46), 34.4% vs. 29.0% at 3 months (aOR = 1.23, 95% CI, 0.67-2.26), and 34.8% vs. 30.3% at 2 years (aOR = 1.31, 95% CI, 0.70-2.46). The proportion of participants reporting positive outcomes among those expecting improvement compared to those not expecting improvement was 36.6% vs. 15.0% at the end of treatment (aOR = 2.03, 95% CI, 1.07-3.85), 34.1% vs. 13.2% at 3 months (aOR = 2.31, 95% CI, 1.22-4.38), and 32.8% vs. 19.1% at 2 years (aOR = 1.16, 95% CI, 0.67-2.36). Conclusions: Treatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, and researchers assessing treatments should take into account this expectation effect. RÉSUMÉ Contexte: Les croyances et les attitudes des patients à l'égard d'un traitement peuvent influencer la réponse à ce traitement. Dans des essais sans insu, il peut y avoir un effet sur les résultats. Buts: Le but de cette analyse était d'étudier le lien entre les préférences et les attentes à l'égard du traitement, et le résultat obtenu dans un essai portant sur les traitements de la douleur. Méthodes: Dans un essai randomisé (ISRCTN67013851) portant sur quatre traitements pour la douleur chronique généralisée, on a demandé aux participants quelle était leur préférence quant au traitement, ainsi que l'amélioration qu'ils attendaient de chacun de ces traitements. Une comparaison de la proportion de participants ayant rapporté des résultats positifs sur leur santé à trois moments différents après le traitement a été effectuée entre ceux qui ont reçu le traitement qu'ils préféraient et ceux qui ont reçu un traitement autre que celui qu'ils préféraient, ainsi qu'entre ceux qui s'attendaient à une amélioration et ceux qui n'avaient pas de telles attentes. Les rapports de cotes ont été calculés et ajustés selon les caractéristiques de départ en ce qui concerne la préférence et les attentes. Résultats: Le nombre de participants recrutés pour cet essai était de 442 (69,5 % de femmes). La proportion de participants ayant rapporté un résultat positif parmi ceux qui ont reçu le traitement qu'ils préféraient comparativement à ceux qui ont reçu un traitement autre que celui qu'ils préféraient était de 33,3 % comparativement à 34,4 % à la fin du traitement (RC ajusté 0,80, 95 % IC 0,44-1,46); de 34,4 % comparativement à 29,0 % après trois mois (RCa 1,23, 0,67-2,26) et de 34,8 % comparativement à 30,3 % après deux ans (RCa 1,31, 0,70-2,46). La proportion de participants ayant rapporté des résultats positifs parmi ceux qui s'attendaient à une amélioration comparativement à ARTICLE HISTORY

Research paper thumbnail of What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian randomisation study using UK Biobank

PAIN, 2018

What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian ran... more What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian randomisation study using UK Biobank. Pain.

Research paper thumbnail of Is alcohol consumption related to likelihood of reporting chronic widespread pain in people with stable consumption? Results from UK biobank

PAIN, 2016

Studies have suggested alcohol consumption is strongly related to reduced reporting of chronic wi... more Studies have suggested alcohol consumption is strongly related to reduced reporting of chronic widespread pain (CWP) and level of disability in people with CWP or fibromyalgia. Direction of causality has not been established, that is whether the association is due to people's health influencing their alcohol consumption or vice versa. UK Biobank recruited over 500,000 people aged 40-69 years registered at medical practices nationwide. Participants provided detailed information on health and lifestyle factors including pain and alcohol consumption. Total units consumed per week was calculated for current drinkers. Information was also collected on changes in alcohol consumption and reasons for such changes. Analysis was by logistic regression expressed as odds ratios (ORs) with 95% confidence intervals (CIs), then adjusted for a large number of potential confounding factors (adjORs). In males who reported drinking the same as 10 years previously, there was a U-shaped relationship between amount drunk and odds of reporting CWP (non-drinkers CWP prevalence 2.4%, 19.1-32.1 units/wk 0.4%, >53.6 units/wk 1.0%; adjORs 2.53 95% CI [1.78-3.60] vs 1 vs 1.52 [1.05-2.20]). In females there was a decrease in proportion reporting CWP up to the modal category of alcohol consumption with no further change in those drinking more (non-drinkers CWP prevalence 3.4%, 6.4-11.2 units/wk 0.7%, >32.1 units/wk 0.7%; adjORs 2.11 [1.67-2.66] vs 1 vs 0.86 [0.54-1.39]). This large study has shown a clear relationship between alcohol consumption and reporting of pain even in people who had not reported changing consumption due to health concerns, after adjustment for potential confounding factors.

Research paper thumbnail of OP0122 Association between Alcohol Consumption and Chronic Widespread Pain: Results from A Population-Based Cross-Sectional Study

Annals of the Rheumatic Diseases, 2014

and their relatives simple tips and advices for an easier life with the disease. The basic assump... more and their relatives simple tips and advices for an easier life with the disease. The basic assumption was to use modern communication tools (YouTube) in order to increase the number of recipients. Methods: In order to achieve the objectives the Institute of Rheumatology has created a series of video-guides for people with rheumatic diseases and their relatives. Each film presented only one simple issue. According to the assumptions the message should be simple and short to make it easier to understand and remember. Short message is also useful for maintain the viewer's attention. The average duration of the film is between 100 and 150 seconds. Results: The first series consisted of five films: Kitchen of rheumatic person, Bathroom for rheumatic person, Rheumatic person on shopping, Rheumatic person on stairs and Rheumatic person in the car. There are plans to prepare next series-the first movie will be Rheumatic person in public transport. Video-Guides were put on YouTube and published in the World Arthritis Day 2013 on the website of Institute of Rheumatology and additional website: www.dzienreumatyzmu.pl under WAD slogan "Living better, ageing well". Conclusions: Video-guides published on YouTube is an easy and useful tool for health promotion. It is good way to communicate with people with rheumatic disease and help them cope with the problems of everyday lives. The main difficulty, except technical aspect, it's getting to the interested persons with information about the video-guides. Good collaboration with associations of people with rheumatic diseases is crucial to solve this problem.

Research paper thumbnail of 162 Receiving Preferred Treatment not Associated with Positive Outcome in a Randomized Trial

Rheumatology, 2016

Background: In a randomized trial of treatments for chronic widespread pain (CWP), participants w... more Background: In a randomized trial of treatments for chronic widespread pain (CWP), participants were asked their treatment preference just prior to randomisation (baseline). This analysis examined whether treatment preference was associated with baseline factors and whether receiving a preferred treatment affected outcomes. Methods: The MUSICIAN trial was a 2 Â 2 randomized trial of cognitive behavioural therapy (CBT) or exercise for people with CWP. Participants were randomly allocated to one of three active treatments [CBT (n ¼ 112), exercise (n ¼ 109), both exercise and CBT (n ¼ 112)] or usual care (n ¼ 109). Before allocation participants were asked, if they had a choice, which active treatment they would choose. A positive outcome was self-reported improvement in health of much or very much better 6, 9 and 30 months after entering the study. Associations between preference and baseline characteristics were examined, including age, gender, chronic pain grade (CPG), passive and active coping, fatigue, psychological distress, sleep problems and kinesiophobia. Differences in gender and CPG between preferences were tested by chi-square tests. For continuous variables, comparison was by analysis of variance and, where a difference was observed, Tukey's honest significant difference was used to identify which preferences differed and then the standardized mean difference (d) with 95% CIs were calculated. Among those allocated to active treatments, logistic regression was used to calculate odds ratios, adjusted for factors associated with preference, with 95% CIs of positive outcome in those receiving their preferred treatment and not receiving preferred treatment as the referent group. Results: Of 442 participants, 144 (33%) expressed preference for exercise, 20 (5%) for CBT, 199 (45%) for combined exercise and CBT and 79 (18%) expressed no preference. Compared with females, males were more likely to prefer exercise only (44 vs 28%) and less likely to prefer combined treatment (35 vs 50%). Those preferring CBT, compared with those preferring exercise, were higher in passive coping [d ¼ 0.9 (95% CI 0.41, 1.37)], fatigue [0.8 (0.34, 1.31)], psychological distress [0.7 (0.26, 1.21)], sleep problems [0.7 (0.18, 1.12)] and kinesiophobia [0.6 (0.17, 1.12)]. Those preferring CBT also had greater scores on passive coping than those preferring combined treatment [0.6 (95% CI 0.11, 1.03)] or no preference [0.5 (À0.01, 0.98)] and greater kinesiophobia than those with no preference [0.5 (À0.05, 0.95)]. Of participants allocated to CBT, exercise or combined treatment, 7, 39 and 50%, respectively, had a preference for their allocated treatment. There was no clear association between achieving a positive outcome and whether or not someone received their preferred treatment (see Table 1). Conclusion: Exercise and exercise combined with CBT were the most preferred treatments. Participants with specific preferences differed from each other with respect to factors which might influence outcome. However, receiving preferred treatment did not appear to influence treatment response. Disclosure statement: M.B. has received funding for the MUSICIAN Study from Arthritis Research UK. G.J.M. has received funding for the MUSICIAN Study from Arthritis Research UK. All other authors have declared no conflicts of interest.

Research paper thumbnail of The impact of moving from a widespread to multi-site pain definition on other fibromyalgia symptoms

Arthritis care & research, Dec 9, 2017

The current study investigated whether associations between pain and the additional symptoms asso... more The current study investigated whether associations between pain and the additional symptoms associated with fibromyalgia are different in persons with chronic widespread (CWP) compared to multi-site pain (MSP), with or without joint areas. Six studies were utilized: 1958 British birth cohort, EpiFunD, Kid LBP, MUSICIAN, SHAMA and WHEST (females) studies. MSP was defined as the presence of pain in ≥8/≥10 body sites (adults/children) indicated on 4-view body manikins; conducted firstly to include joints (+joints) and secondly without (-joints). The relationship between pain and fatigue, sleep disturbance, somatic symptoms and mood impairment, were assessed using logistic regression. Results are presented as odds ratios (OR), with 95% confidence intervals (CI). There were 34,818 participants across the study populations (adults: mean age range 42-56yrs, % male 43-51 (excluding WHEST), CWP prevalence 12-17%). Amongst those reporting MSP, the proportion reporting CWP ranged between 62-7...

Research paper thumbnail of The Maintaining Musculoskeletal Health (MAmMOTH) Study: Protocol for a randomised trial of cognitive behavioural therapy versus usual care for the prevention of chronic widespread pain

BMC musculoskeletal disorders, Jan 26, 2016

Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromya... more Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromyalgia, and its cardinal feature chronic widespread pain (CWP). Prediction models have now been developed which identify groups who are at high-risk of developing CWP. It would be beneficial to be able to prevent the development of CWP in these people because of the high cost of symptoms and because once established they are difficult to manage. We will test the hypothesis that among patients who are identified as at high-risk, a short course of telephone-delivered CBT (tCBT) reduces the onset of CWP. We will further determine the cost-effectiveness of such a preventative intervention. The study will be a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. Eligible participants will be identified from a screening questionnaire sent to patients registered at general practices within three Scottish health boards. Those returning questionnaires indicati...

Research paper thumbnail of Can large surveys conducted on highly selected populations provide valid information on the epidemiology of common health conditions? An analysis of UK Biobank data on musculoskeletal pain

British journal of pain, 2015

Biobank-type studies are typically large but have very low participation rates. It has been sugge... more Biobank-type studies are typically large but have very low participation rates. It has been suggested that these studies may provide biased estimates of prevalence but are likely to provide valid estimates of association. We test these hypotheses using data collected on pain in a large Biobank study in the United Kingdom. UK Biobank recruited 503,325 persons aged 40-69 years (participation rate 5.5%). Participants completed questionnaires, including pain, lifestyle and environment factors. As a comparison, we used both a large population study of pain (MUSICIAN: n = 8847, aged: 40-69 years) conducted 2008-2009 and the National Child Development study (NCDS) which recruited all persons in Great Britain born during one week of 1958 and followed them up at age 44 years (n = 9377). 'Any pain' (UK Biobank 61.0%; MUSICIAN 63.9%), chronic pain (42.9%, 52.2%) and site-specific musculoskeletal pain (back 26.2%, 29.7%; shoulder/neck 23.3%, 25.3%) were generally similar in UK Biobank a...

Research paper thumbnail of The epidemiology of regional and widespread musculoskeletal pain in rural versus urban settings in those ≥55 years

British journal of pain, 2015

To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rural... more To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi(2) test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with ...

Research paper thumbnail of Lessons from experiences of accessing healthcare during the pandemic for remobilising rheumatology services: a national mixed methods study

Rheumatology Advances in Practice, 2022

Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for... more Objectives To understand the impact of the COVID-19 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory MSK conditions. Methods Three established cohorts which included individuals with axial spondyloarthritis, psoriatic arthritis, and musculoskeletal pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semi-structured interviews. Results 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. 57% respondents had tried to access care since the start of UK national lockdown. Over a quarter reported being unable to book any type of healthcare appointment. GP appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinical...

Research paper thumbnail of Additional file 3: of Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Acceptability Study Theoretical Framework. (PDF 404 kb)

Research paper thumbnail of Additional file 2: of Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

Interview Schedule. (PDF 139 kb)

Research paper thumbnail of Kingdom. Corresponding Author

Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptom... more Objectives: To determine the prevalence of facial pain and to examine the hypothesis that symptoms are associated with socio-demographic, dental, adverse psychological factors and pain elsewhere in the body. Material and Methods: Cross-sectional population data were obtained from UK Biobank (www.ukbiobank.ac.uk/) study which was conducted in 2006- 2010 and recruited over 500,000 people. Results: The overall prevalence of facial pain (FP) was 1.9 % (women 2.4%, men 1.2%) of which 48 % was chronic. The highest prevalence was found in the 51- 55 age group (2.2%) and the lowest in the 66- 73 age group (1.4%). There was a difference in prevalence by ethnicity (0.8 % and 2.7 % in persons reporting themselves as Chinese and Mixed respectively). Prevalence of FP significantly associated with all measures of social class with the most deprived and on lowest income showing the highest prevalence (2.5 % and 2.4 % respectively). FP was more common in individuals who rated themselves as extremel...

Research paper thumbnail of Maternal and perinatal risk factors and childhood cancer

Research paper thumbnail of Cognitive Behaviour Therapy, Exercise or Both for Chronic Widespread Pain

Research paper thumbnail of Erratum to: Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study

Rheumatology Advances in Practice, 2021

Research paper thumbnail of Comparing people who have and have not received a diagnosis of fibromyalgia: a cross‐sectional survey within the PACFiND study

Arthritis Care & Research, 2021

Research paper thumbnail of Maintaining musculoskeletal health using a behavioural therapy approach: a population-based randomised controlled trial (the MAmMOTH Study)

Annals of the Rheumatic Diseases, 2021

ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of ... more ObjectiveCognitive–behavioural therapy (CBT) has been shown to be effective in the management of chronic widespread pain (CWP); we now test whether it can prevent onset among adults at high risk.MethodsA population-based randomised controlled prevention trial, with recruitment through UK general practices. A mailed screening questionnaire identified adults at high risk of CWP. Participants received either usual care (UC) or a short course of telephone CBT (tCBT). The primary outcome was CWP onset at 12 months assessed by mailed questionnaire. There were seven secondary outcomes including quality of life (EuroQol Questionnaire-five dimensions-five levels/EQ-5D-5L) used as part of a health economic assessment.Results996 participants were randomised and included in the intention-to-treat analysis of which 825 provided primary outcome data. The median age of participants was 59 years; 59% were women. At 12 months there was no difference in the onset of CWP (tCBT: 18.0% vs UC: 17.5%; OR ...

Research paper thumbnail of Telephone cognitive behavioural therapy to prevent the development of chronic widespread pain: a qualitative study of patient perspectives and treatment acceptability

BMC Musculoskeletal Disorders, 2019

Background: Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatme... more Background: Telephone cognitive behavioural therapy (tCBT) is an acceptable and effective treatment for patients with chronic widespread pain (CWP). Preventing the onset of CWP offers considerable benefits to the individual and society and the MAmMOTH study is the first aimed at CWP prevention. The study is a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. This nested qualitative study explores patients' treatment experiences, with a view to understanding their potential influences on acceptability of the intervention. Methods: The MAmMOTH Study recruited 1002 participants, half of whom were randomised to receive tCBT. Participants were eligible for invitation to the trial if they had pain for which they had consulted their GP, or had pain and visited a doctor frequently, and had 2 of 3 risk factors for development of CWP. Participants randomised to tCBT who had completed treatment were eligible for invitation to qualitative interviews for this study. Individual qualitative interviews were conducted with a sub-sample (n = 33) of patients at high risk of developing CWP who had been allocated to the intervention arm. Semi-structured telephone interviews explored treatment experiences and intervention acceptability. Data was analysed using Framework analysis. Results: Participants presented with a range of musculoskeletal and auto-immune conditions and almost half described their pain as 'chronic' on study entry. Many participants perceived the trial intervention to be aimed at treatment of pain rather than prevention of pain. Initial expectations prior to treatment varied, with scepticism more likely for those who had little prior knowledge of CBT approaches. All participants provided positive feedback post intervention particularly in relation to the modality, therapist experience and skills and the intervention. The majority of participants described positive changes in either their subjective level of pain or pain-management post-intervention and some attributed the positive change directly to the intervention as a result of empowerment, increased self-management and cognitive restructuring. Conclusions: This study extends our understanding of the acceptability and suitability of preventative interventions for chronic widespread pain and provides further evidence for the acceptability of tCBT. Trial registration: Clinical Trials.gov NCT02668003 (registered 29th January, 2016).

Research paper thumbnail of Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study

Rheumatology Advances in Practice, 2018

Objectives The aim was to develop and validate a simple clinical prediction model, based on easil... more Objectives The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months...

Research paper thumbnail of Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

Canadian Journal of Pain, 2017

Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In ... more Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In unblinded trials this can affect outcomes. Aims: The aim of this analysis was to examine the association between treatment preference and expectation and outcome in a trial of pain treatments. Methods: In a randomized trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time points after treatment were compared between those matched or unmatched with their preference and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation. Results: Four hundred forty-two participants were recruited to the trial (69.5% female). The proportion reporting positive outcomes among participants matched to their preference compared to those unmatched was 33.3% vs. 34.4% at the end of treatment (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI], 0.44-1.46), 34.4% vs. 29.0% at 3 months (aOR = 1.23, 95% CI, 0.67-2.26), and 34.8% vs. 30.3% at 2 years (aOR = 1.31, 95% CI, 0.70-2.46). The proportion of participants reporting positive outcomes among those expecting improvement compared to those not expecting improvement was 36.6% vs. 15.0% at the end of treatment (aOR = 2.03, 95% CI, 1.07-3.85), 34.1% vs. 13.2% at 3 months (aOR = 2.31, 95% CI, 1.22-4.38), and 32.8% vs. 19.1% at 2 years (aOR = 1.16, 95% CI, 0.67-2.36). Conclusions: Treatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, and researchers assessing treatments should take into account this expectation effect. RÉSUMÉ Contexte: Les croyances et les attitudes des patients à l'égard d'un traitement peuvent influencer la réponse à ce traitement. Dans des essais sans insu, il peut y avoir un effet sur les résultats. Buts: Le but de cette analyse était d'étudier le lien entre les préférences et les attentes à l'égard du traitement, et le résultat obtenu dans un essai portant sur les traitements de la douleur. Méthodes: Dans un essai randomisé (ISRCTN67013851) portant sur quatre traitements pour la douleur chronique généralisée, on a demandé aux participants quelle était leur préférence quant au traitement, ainsi que l'amélioration qu'ils attendaient de chacun de ces traitements. Une comparaison de la proportion de participants ayant rapporté des résultats positifs sur leur santé à trois moments différents après le traitement a été effectuée entre ceux qui ont reçu le traitement qu'ils préféraient et ceux qui ont reçu un traitement autre que celui qu'ils préféraient, ainsi qu'entre ceux qui s'attendaient à une amélioration et ceux qui n'avaient pas de telles attentes. Les rapports de cotes ont été calculés et ajustés selon les caractéristiques de départ en ce qui concerne la préférence et les attentes. Résultats: Le nombre de participants recrutés pour cet essai était de 442 (69,5 % de femmes). La proportion de participants ayant rapporté un résultat positif parmi ceux qui ont reçu le traitement qu'ils préféraient comparativement à ceux qui ont reçu un traitement autre que celui qu'ils préféraient était de 33,3 % comparativement à 34,4 % à la fin du traitement (RC ajusté 0,80, 95 % IC 0,44-1,46); de 34,4 % comparativement à 29,0 % après trois mois (RCa 1,23, 0,67-2,26) et de 34,8 % comparativement à 30,3 % après deux ans (RCa 1,31, 0,70-2,46). La proportion de participants ayant rapporté des résultats positifs parmi ceux qui s'attendaient à une amélioration comparativement à ARTICLE HISTORY

Research paper thumbnail of What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian randomisation study using UK Biobank

PAIN, 2018

What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian ran... more What is the effect of alcohol consumption on the risk of chronic widespread pain? A Mendelian randomisation study using UK Biobank. Pain.

Research paper thumbnail of Is alcohol consumption related to likelihood of reporting chronic widespread pain in people with stable consumption? Results from UK biobank

PAIN, 2016

Studies have suggested alcohol consumption is strongly related to reduced reporting of chronic wi... more Studies have suggested alcohol consumption is strongly related to reduced reporting of chronic widespread pain (CWP) and level of disability in people with CWP or fibromyalgia. Direction of causality has not been established, that is whether the association is due to people's health influencing their alcohol consumption or vice versa. UK Biobank recruited over 500,000 people aged 40-69 years registered at medical practices nationwide. Participants provided detailed information on health and lifestyle factors including pain and alcohol consumption. Total units consumed per week was calculated for current drinkers. Information was also collected on changes in alcohol consumption and reasons for such changes. Analysis was by logistic regression expressed as odds ratios (ORs) with 95% confidence intervals (CIs), then adjusted for a large number of potential confounding factors (adjORs). In males who reported drinking the same as 10 years previously, there was a U-shaped relationship between amount drunk and odds of reporting CWP (non-drinkers CWP prevalence 2.4%, 19.1-32.1 units/wk 0.4%, >53.6 units/wk 1.0%; adjORs 2.53 95% CI [1.78-3.60] vs 1 vs 1.52 [1.05-2.20]). In females there was a decrease in proportion reporting CWP up to the modal category of alcohol consumption with no further change in those drinking more (non-drinkers CWP prevalence 3.4%, 6.4-11.2 units/wk 0.7%, >32.1 units/wk 0.7%; adjORs 2.11 [1.67-2.66] vs 1 vs 0.86 [0.54-1.39]). This large study has shown a clear relationship between alcohol consumption and reporting of pain even in people who had not reported changing consumption due to health concerns, after adjustment for potential confounding factors.

Research paper thumbnail of OP0122 Association between Alcohol Consumption and Chronic Widespread Pain: Results from A Population-Based Cross-Sectional Study

Annals of the Rheumatic Diseases, 2014

and their relatives simple tips and advices for an easier life with the disease. The basic assump... more and their relatives simple tips and advices for an easier life with the disease. The basic assumption was to use modern communication tools (YouTube) in order to increase the number of recipients. Methods: In order to achieve the objectives the Institute of Rheumatology has created a series of video-guides for people with rheumatic diseases and their relatives. Each film presented only one simple issue. According to the assumptions the message should be simple and short to make it easier to understand and remember. Short message is also useful for maintain the viewer's attention. The average duration of the film is between 100 and 150 seconds. Results: The first series consisted of five films: Kitchen of rheumatic person, Bathroom for rheumatic person, Rheumatic person on shopping, Rheumatic person on stairs and Rheumatic person in the car. There are plans to prepare next series-the first movie will be Rheumatic person in public transport. Video-Guides were put on YouTube and published in the World Arthritis Day 2013 on the website of Institute of Rheumatology and additional website: www.dzienreumatyzmu.pl under WAD slogan "Living better, ageing well". Conclusions: Video-guides published on YouTube is an easy and useful tool for health promotion. It is good way to communicate with people with rheumatic disease and help them cope with the problems of everyday lives. The main difficulty, except technical aspect, it's getting to the interested persons with information about the video-guides. Good collaboration with associations of people with rheumatic diseases is crucial to solve this problem.

Research paper thumbnail of 162 Receiving Preferred Treatment not Associated with Positive Outcome in a Randomized Trial

Rheumatology, 2016

Background: In a randomized trial of treatments for chronic widespread pain (CWP), participants w... more Background: In a randomized trial of treatments for chronic widespread pain (CWP), participants were asked their treatment preference just prior to randomisation (baseline). This analysis examined whether treatment preference was associated with baseline factors and whether receiving a preferred treatment affected outcomes. Methods: The MUSICIAN trial was a 2 Â 2 randomized trial of cognitive behavioural therapy (CBT) or exercise for people with CWP. Participants were randomly allocated to one of three active treatments [CBT (n ¼ 112), exercise (n ¼ 109), both exercise and CBT (n ¼ 112)] or usual care (n ¼ 109). Before allocation participants were asked, if they had a choice, which active treatment they would choose. A positive outcome was self-reported improvement in health of much or very much better 6, 9 and 30 months after entering the study. Associations between preference and baseline characteristics were examined, including age, gender, chronic pain grade (CPG), passive and active coping, fatigue, psychological distress, sleep problems and kinesiophobia. Differences in gender and CPG between preferences were tested by chi-square tests. For continuous variables, comparison was by analysis of variance and, where a difference was observed, Tukey's honest significant difference was used to identify which preferences differed and then the standardized mean difference (d) with 95% CIs were calculated. Among those allocated to active treatments, logistic regression was used to calculate odds ratios, adjusted for factors associated with preference, with 95% CIs of positive outcome in those receiving their preferred treatment and not receiving preferred treatment as the referent group. Results: Of 442 participants, 144 (33%) expressed preference for exercise, 20 (5%) for CBT, 199 (45%) for combined exercise and CBT and 79 (18%) expressed no preference. Compared with females, males were more likely to prefer exercise only (44 vs 28%) and less likely to prefer combined treatment (35 vs 50%). Those preferring CBT, compared with those preferring exercise, were higher in passive coping [d ¼ 0.9 (95% CI 0.41, 1.37)], fatigue [0.8 (0.34, 1.31)], psychological distress [0.7 (0.26, 1.21)], sleep problems [0.7 (0.18, 1.12)] and kinesiophobia [0.6 (0.17, 1.12)]. Those preferring CBT also had greater scores on passive coping than those preferring combined treatment [0.6 (95% CI 0.11, 1.03)] or no preference [0.5 (À0.01, 0.98)] and greater kinesiophobia than those with no preference [0.5 (À0.05, 0.95)]. Of participants allocated to CBT, exercise or combined treatment, 7, 39 and 50%, respectively, had a preference for their allocated treatment. There was no clear association between achieving a positive outcome and whether or not someone received their preferred treatment (see Table 1). Conclusion: Exercise and exercise combined with CBT were the most preferred treatments. Participants with specific preferences differed from each other with respect to factors which might influence outcome. However, receiving preferred treatment did not appear to influence treatment response. Disclosure statement: M.B. has received funding for the MUSICIAN Study from Arthritis Research UK. G.J.M. has received funding for the MUSICIAN Study from Arthritis Research UK. All other authors have declared no conflicts of interest.

Research paper thumbnail of The impact of moving from a widespread to multi-site pain definition on other fibromyalgia symptoms

Arthritis care & research, Dec 9, 2017

The current study investigated whether associations between pain and the additional symptoms asso... more The current study investigated whether associations between pain and the additional symptoms associated with fibromyalgia are different in persons with chronic widespread (CWP) compared to multi-site pain (MSP), with or without joint areas. Six studies were utilized: 1958 British birth cohort, EpiFunD, Kid LBP, MUSICIAN, SHAMA and WHEST (females) studies. MSP was defined as the presence of pain in ≥8/≥10 body sites (adults/children) indicated on 4-view body manikins; conducted firstly to include joints (+joints) and secondly without (-joints). The relationship between pain and fatigue, sleep disturbance, somatic symptoms and mood impairment, were assessed using logistic regression. Results are presented as odds ratios (OR), with 95% confidence intervals (CI). There were 34,818 participants across the study populations (adults: mean age range 42-56yrs, % male 43-51 (excluding WHEST), CWP prevalence 12-17%). Amongst those reporting MSP, the proportion reporting CWP ranged between 62-7...

Research paper thumbnail of The Maintaining Musculoskeletal Health (MAmMOTH) Study: Protocol for a randomised trial of cognitive behavioural therapy versus usual care for the prevention of chronic widespread pain

BMC musculoskeletal disorders, Jan 26, 2016

Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromya... more Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromyalgia, and its cardinal feature chronic widespread pain (CWP). Prediction models have now been developed which identify groups who are at high-risk of developing CWP. It would be beneficial to be able to prevent the development of CWP in these people because of the high cost of symptoms and because once established they are difficult to manage. We will test the hypothesis that among patients who are identified as at high-risk, a short course of telephone-delivered CBT (tCBT) reduces the onset of CWP. We will further determine the cost-effectiveness of such a preventative intervention. The study will be a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. Eligible participants will be identified from a screening questionnaire sent to patients registered at general practices within three Scottish health boards. Those returning questionnaires indicati...

Research paper thumbnail of Can large surveys conducted on highly selected populations provide valid information on the epidemiology of common health conditions? An analysis of UK Biobank data on musculoskeletal pain

British journal of pain, 2015

Biobank-type studies are typically large but have very low participation rates. It has been sugge... more Biobank-type studies are typically large but have very low participation rates. It has been suggested that these studies may provide biased estimates of prevalence but are likely to provide valid estimates of association. We test these hypotheses using data collected on pain in a large Biobank study in the United Kingdom. UK Biobank recruited 503,325 persons aged 40-69 years (participation rate 5.5%). Participants completed questionnaires, including pain, lifestyle and environment factors. As a comparison, we used both a large population study of pain (MUSICIAN: n = 8847, aged: 40-69 years) conducted 2008-2009 and the National Child Development study (NCDS) which recruited all persons in Great Britain born during one week of 1958 and followed them up at age 44 years (n = 9377). 'Any pain' (UK Biobank 61.0%; MUSICIAN 63.9%), chronic pain (42.9%, 52.2%) and site-specific musculoskeletal pain (back 26.2%, 29.7%; shoulder/neck 23.3%, 25.3%) were generally similar in UK Biobank a...

Research paper thumbnail of The epidemiology of regional and widespread musculoskeletal pain in rural versus urban settings in those ≥55 years

British journal of pain, 2015

To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rural... more To examine whether the prevalence of regional and chronic widespread pain (CWP) varies with rurality and to determine the characteristics of persons in rural locations in whom pain is found to be in excess. Participants, aged ≥55 years, from participating general practices in seven different geographical locations in Scotland were sent a postal questionnaire. The 1-month prevalence of 10 regional pain conditions plus CWP was identified using body manikins. Differences in the prevalence of pain with differing rurality were examined using Chi(2) test for trend. Thereafter, among the rural population, the relationships between pain and putative risk factors were examined using Poisson regression. Thus, results are described as risk ratios. There was some evidence to suggest that the prevalence of CWP increased with increasing rurality, although the magnitude of this was slight. No large or significant differences were observed with any regional pain conditions. Factors associated with ...