The Effect of Occupational Engagement on Lifestyle in Adults Living with Chronic Pain: A Systematic Review and Meta-analysis

Table 1

Characteristics of the included trials.

Study reference^a	Participants (diagnoses, randomized/completed, age, gender, pain duration/intensity, and settings)	Intervention and comparators (duration/follow-up, included in the analyses, treatment contents, and providers)	Occupational engagement component explicated, mean (SD), and assessment tools	Lifestyle-related outcomes^b, mean (SD), and assessment tools
Soares and Grossi, 2002 (RCT), Sweden [25]	Fibromyalgia (100%) /46; yr, mean 45(9)yo 100% females; Pain duration (y) mean 3.6 (3.3); pain intensity (0-100 scale), mean 85.5(12.6); General practice	10 wk/FU1 (PI) 10 wk/FU2 6mo; IG1, /15 at FU2: educational intervention (EI) aimed self-management incl. education, information, and discussions on health-related topics; treatment contract on individual occupational goals; and consultations with experts/OT and PT; IG2, /14 at FU2: behavioral intervention (BI) incl. CBT, relaxation, and biofeedback/psychologist and physician; CG, : WL (no treatment)	Engaging in active behaviors, CSQ^c; IG1: intervention informed by individual treatment contract between the patients and the therapists incl. personal expectations, fears, goals, and needs; IG2: didactic information and practical training aimed acquisition and development of pain coping skills incl. homework and evaluation	Sleep quality, KSQ^d; BL, IG1: 3.94 (0.80); IG2: 3.69 (0.83); CG: 3.62 (0.81); FU1, IG1: 3.87 (0.83); IG2: 3.64 (0.91); CG: 3.74 (0.80); FU2, IG1: 4.08 (1.04); IG2: 3.21 (1.19); CG: NR
Cedraschi et al., 2004 (RCT), Switzerland [26]	Fibromyalgia; /129; mean 48.9 (9.7)yo; 93% females; Pain duration (y) mean 8.9 (5.9); pain intensity (0-105 scale), mean 65.4 (16.9); University clinic	6wk/FU1 (PI) 6wk/FU2 6mo; IG, : multidisciplinary self-management programme incl. swimming, relaxation, exercises, ADL impact, and didactic information and discussion/PT, OT, physician, and psychologist; CG, : WL (usual care allowed)	Fibromyalgia impact on daily activities, FIQ^e; Self-management incl. OT sessions aimed difficulties and solutions in ADL monitored through weekly diaries, individual activity planning, and adjusted activity pacing, to minimise fatigue and pain and increase the activity level	Sleep quality, Pott and Silverman questionnaire; BL, IG: 2.2 (1.4); CG: 2.1 (1.3); FU1: NR; FU2, IG: 2.6 (1.3); CG: 2.1 (1.5)
Jousset et al., 2004 (RCT), France [30]	Low back pain (100%); /83; mean 52.0 (16.7)yo; 32.6% females; Pain duration (y) mean NS; pain intensity (0-10 scale), mean 4.8(2.2); Regional rehabilitation centers	5wk/FU1 (PI) 5wk/FU2 6mo; IG, : multidisciplinary functional restoration program (FRP)/PT, OT, psychologist, and dietician; CG, : active individual therapy (AIT) incl. standard functional training and exercise prescription/PT	Pain interference with ADL, DPQ^f; Pain interference with work/leisure activity, DPQ^g; OT training for flexibility, endurance and coordination, weightlifting, and work simulation	PA-level (participation in sports/leisure activities), diary; BL: NR; FU1: NR; FU2, IG: 76.2% increase; CG: 51.2% increase
Fontaine and Haaz, 2007 (pilot RCT), USA [27]	Fibromyalgia (100%); /34; ≥18yr, mean 50.2 (9.1)yo; 95.8% females; Pain duration (y) mean 7.1 (4.3); pain intensity (0-10 scale), mean 5.7 (5.6); University clinic	12wk/FU (PI) 12 wk; IG, / 14: lifestyle physical activity program (LPA): a CBT-based physical activity promotion program based on Active Living Every Day^g incl. self-monitoring, goal setting, and problem-solving aimed integration of moderately intense PA in daily life/NS; CG, /20: fibromyalgia education (FME) incl. information on exercise and physical activity but no tailored recommendations/NS	Fibromyalgia impact on daily activities, FIQ^e; Practicing brisk walking, gardening, mowing the lawn, and using the stairs instead of the elevator of 10 to 30 min. bouts to match PA recommendations	PA-level, pedometer (walking steps); BL, IG: (±427); CG: NR; FU, IG: (±598), 69.8% increase, 71% improvers; CG: NR, 25% improvers
Fontaine et al. 2010 (RCT), USA [23] and Fontaine et al. 2011 (RCT), USA [24]	Fibromyalgia (100%); /73; ≥18yr, mean 47.7 (10.7)yo; 95.7% females; Pain duration (y) mean 7.6 (6.2); pain intensity (0-100 scale), mean 56.5 (25.3); University clinic	12wk/FU1 (PI) 12wk/FU2 6mo/FU3 12mo; IG, /30 at FU2 and FU3: lifestyle physical activity program (LPA): a CBT-based physical activity promotion program based on Active Living Every Day^g incl. self-monitoring, goal setting, and problem-solving aimed integration of moderate-intensity PA in daily life/NS researchers; CG, /23 at FU2 and FU3: fibromyalgia education (FME) incl. information, question and answer, and social support, with no tailored recommendations (minimal intervention)/NS	Fibromyalgia impact on daily activities, FIQ^e; Practicing brisk walking, gardening, mowing the lawn, and using the stairs instead of the elevator of 10 to 30 min. bouts to match PA recommendations	BMI, weight (kg) divided by height (m^2); BL, IG: 31.4 (8.4); CG: 29.8 (6.2); FU1, IG: 31.0 (9.0); CG: 29.9 (6.2); FU2: NR; FU3: NR; PA-level, pedometer (walking steps); BL, IG: (±2135); CG: NR; FU1, IG: (±1770), 54.0% increased PA; CG: NR/NS; FU2, IG: (±3228); CG: (±2286); FU3, IG: (±3190); CG: (±2460)
Ruehlman et al., 2012 (RCT), USA [34]	Migraine/headaches, 65.5%; back injury/disease, 60.5%; tension headaches, 41%; OA, 31%; facial/jaw pain, 29%; premenstrual pain, 28%; cluster headache, 16%; pelvic injury/disease, 12%; RA, 7%; cancer, 1% (≤ 3 pain diagnoses per participant); /280; ≥18yr, mean 45yo; Pain duration (89,5%); pain intensity (0-5 scale), mean NS, min. 1.65 (1.58)-max. 3.94 (1.39); 64% females; Online	7 wk/FU1 (PI) 7wk/FU2 14wk; IG, : online self-management program incl. CBT, interpersonal, and self-management approaches/psychologists; CG, : WL, NS usual care (treatment regimens may vary)	Pain interference with daily life, e.g., recreation activity, chores, work, and self-care, PCP-EA^h; Off-line activities aimed practicing new skills, e.g., exercise and relaxation or/and implementation of personal goal-directed behavior	Stress, DASS^i; BL, IG: 8.84 (5.53); CG: 7.87 (5.44); FU1, IG: 7.30 (5.01); CG: 7.67 (6.46); FU2, IG: 7.36 (5.21); CG: 7.64 (5.63)
Cederbom et al., 2014 (RCT, feasibility trial), Sweden [32]	Musculoskeletal pain (100%); /16; ≥65yr, mean 84yo; 100% females; Pain duration (y) mean 27.5 (21.5); pain intensity (0-100 scale), mean 48.3 (25.7); Municipal primary health care service	12wk/FU1 (PI) 12wk/FU2 3mo; IG: BL/10 at FU1 and 9 at FU2: behavioral medicine intervention added physical therapy principles incl. analysis of individual physical and psychological characteristics, and social and physical environmental factors; environmental impact on the ability to perform everyday activities and difficulties in occupational performance; goal setting; practicing of goal behavior/PT; CG: BL/7 at FU1 and 7 at FU2: brief PA advice/PT	Pain-related disability, CPGQ^j; Monitoring (activity diary) and modification of duration and intensity of the everyday PA to match PA recommendations	PA-level, the Frändin-Grimby scale; BL, IG: 2.4 (0.51); CG: 2.4 (0.52); FU1, IG: 2.7 (0.48); CG: 2.6 (0.54); FU2, IG: 2.6 (0.53); CG: 2.6 (0.54)
Ismael Martins et al., 2014 (RCT), Brazil [28]	Fibromyalgia (100%); /27; yr, mean 42.5 (9.8)yo; 64% females; Pain duration (y) mean 4.2 (NS); pain intensity (0-10 scale), mean 6.6 (2.7); University clinic	12wk/FU1 (PI) 12wk; IG, : weekly Interdisciplinary Program (WIP) incl. educational activities, physical therapy, stretching, ergonomics, and postural orientations combined with CBT-based strategies and approaches to psychosocial and occupational features/physician, OT, PT, psychologist, and social worker; CG, : consultation in pain clinic with walking advice/NS	Fibromyalgia impact on daily activities, FIQ^e; Integration of a home exercise program, ADL ergonomics, and postural guidance	Sleep quality, PSP^k (overnight sleep quality item); BL, IG: 72.2 (8.6); CG: 91.2 (6.4); FU, IG: 92.3 (8.4); CG: 98.3 (7.4)
Bourgault et al., 2015 (RCT), Canada [29]	Fibromyalgia (100%); /56; ≥18yr, mean 48yo; 92.9% females; Pain duration (y) mean 13.8 (9.9); Pain intensity (0-10 scale), mean 6.5 (1.9); University clinic	12wk/FU1 (PI) 12wk/FU2 3mo (IG and CG)/FU3 6mo/FU4 12mo; IG, : multidisciplinary self-management program PASSAGE^m, incl. tailored exercise therapy and educational/psychological tools for self-management of fibromyalgia/NS; CG, : WL, NS usual care (nonpharmacological/pharmacological regimens may vary)	Fibromyalgia impact on daily activities, FIQ^e; Pain interference with daily activities, BPI^n; Client-entered approach incl. a patient contract with three personal outcome goals to be met, minimally acceptable changes expected, and an agreement on adherence to the program	Sleep quality, CPSI^l (the overall sleep quality score); BL, IG: 2.75 (1.82); CG: 2.89 (2.59); FU1, IG: 4.09 (2.04); CG: 3.72 (2.30); FU2, IG: 4.33 (2.18); CG: 3.57 (2.37); FU3, IG:; CG: NR; FU4, IG:; CG: NR
Cederbom et al., 2019 (RCT), Norway [33]	Chronic musculoskeletal pain—orthopedic diseases (88%); rheumatoid arthritis (21%); neurological diseases (20%); diabetes (14%); cancer (10%), mean 3.7 reported diagnoses per participant; /105; ≥75yr, mean 85yo; 87.6% females; Pain duration (y) mean 22.4 (22.5); Pain intensity (0-10 scale), mean 4.5 (1.9); Municipal primary health care service	12wk/FU1 (PI) 12wk/FU2 3mo; IG, : behavioral medicine intervention (BMPI) based on integrated behavioral medicine and physical therapy principles incl. tailored goal setting, tailored exercise, and progress monitoring/PT; CG, : PA recommendations and advice/PT	Pain interference with daily activities, BPI^n; Individual exercise doses adjusted to personal goals, e.g., walking indoors/outdoors, safe stairs climbing, or holding balance	PA-level, the Frändin-Grimby scale; BL, IG: 2.4 (0.7); CG: 2.4 (0.8); FU1, IG: 2.7 (0.8); CG: 2.5 (0.8); FU2, IG: 2.6 (0.7); CG: 2.5 (0.9)
Ariza-Mateos et al., 2020 (RCT), Spain [31]	Chronic pelvic pain (100%); /44; yr; mean 44 (9)yo; 100% females; Pain duration (y) mean 6.6 (4.9); Pain intensity (0-10 scale), mean 5.9 (1.9); University clinic	6wk/FU (PI) 6wk; IG, : client-centered approach to workload-capacity balance incl. didactic information, clarification of time consumption, energy expenditure, attention focus, personal goals, goal work, and evaluation/PT; CG, : an information leaflet about chronic pelvic pain, physical activity, fear of movement, false beliefs, active lifestyle, and behavioral advice/PT	Occupational performance and satisfaction, COPM^o; Client-centered approach incl. determination of painful activities in self-care, productivity, and leisure, and personally adjusted activity exposure plan	PA-level, IPAQ^p; PA: BL, IG: 1563.65 (918.15); CG: 1220.85 (1040.32); FU, IG: 2248.53 (1145.21); CG: 1150.55 (573.54)

BL: baseline; BMI: Body Mass Index; CBT: cognitive behavioral therapy; CG: control group; diff.: difference; FU: follow-up; HRQoL: Health-Related Quality of Life; IG: intervention group; incl.: inclusive; min.: minimal; MET: Metabolic Equivalent of Task; mo: month(-s); : number; OA: osteoarthritis; NR: not reported; NS: not specified; OT: occupational therapist; : value; PA: physical activity; PI: postintervention; PT: physical therapist; RA: rheumatoid arthritis; RCT: randomized controlled trial; wk: week(-s); WL: waiting list; y: year(-s); yo: years old. ; . ^aAuthor (-s), study design, and country of origin. ^bBody composition, PA-level, alcohol consumption, smoking, sleep quality, and stress. ^cCSQ: Coping Strategy Questionnaire; ^dKSQ: Karolinska Sleep Questionnaire; ^eFIQ: Fibromyalgia Impact Questionnaire; ^fDPQ: Dallas Pain Questionnaire. ^gDescribed in Blair SN, Active Living Every Day, Human Kinetics, Champaign, IL, 2001; ^hPCP-EA: Profile of Chronic Pain Extended Assessment; ⁱDASS: Depression Anxiety and Stress Scales; ^jCPGQ: Chronic Pain Grade Questionnaire; ^kPSP: Postsleep Protocol; ^lCPSI: Chronic Pain Sleep Inventory. ^mDescribed in Barcellos de Souza J, Charest J, Marchand S. École interactionnelle de fibromyalgie: description et évaluation. Douleur et analgésie. 2007; 20: 213–218; ⁿBPI: Brief Pain Inventory; ^oCOPM: the Canadian Occupational Performance Measure; ^pIPAQ: the International Physical Activity Questionnaire (Supplementary Materials, see Appendix 4).