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

Table 2

Summary of findings.

Occupational engagement component included in chronic pain treatment of adults compared with other or no treatment
Patient or population:	Adults with primary chronic pain
Intervention:	Using occupational engagement
Comparison:	No occupational engagement component
Outcomes	Comparator	Anticipated absolute effect (95% CI)	Number of participants (studies)	Quality of the evidence (GRADE) a
(A) Physical activity level, SD units: two different instruments used - (a) 6-point ordinal scale; (b) pedometer-driven walking step count; and c) activity diary. Low scores mean lower physical activity level.	Other treatment (brief advice/ information leaflet/ standard physiotherapy/ fibromyalgia education).	At 6-12-weeks from baseline: SMD 0.69 higher (0.29 to 1.09 higher) g; (b) Observed significant increase in physical activity participation (walking steps) in the intervention group compared to controls.	298 (5)	⊕⊕○○ c d e f (Low)
		At 3-12-months after intervention: (a) SMD 0.26 higher (0.0 to 0.52 higher) g; (b) Observed significant increase in physical activity participation (n registered activities) in the intervention group compared to controls.	257 (4)	⊕⊕○○ c e f (Low)
(B) Sleep quality, SD units: four different instruments used - (a) 9-point ordinal scale, high scores mean low quality of sleep; (b) 10-point ordinal scale, high scores mean high quality of sleep; (c) 0-5-item Likert scale, high scores mean high quality of sleep; and (d) 30-390-point interval scale, high scores mean high satisfaction with sleep quality/good quality of sleep.	Other treatment (consultation with walking advise) or no treatment (waiting list, usual care allowed).	At 10-12-weeks from baseline: SMD 0.09 lower (0.45 lower to 0.27 higher) g.	300 (4)	⊕⊕○○ c e f (Low)
		At 3-6-months after intervention: (a) SMD 0.35 higher (0.08 lower to 0.61 higher) g; (b) Observed significant increase in sleep quality after a behavioral intervention compared to an educational intervention and controls.	266 (3)	⊕⊕○○ c e f (Low)
(C) Stress level, 4-point ordinal scale used. Lower scores mean stress decrease.	Other treatment (waiting list with non-specified usual care, treatment regimens may vary).	At 14-weeks from baseline: mean 0.93 lower (standard error 0.30), p<0.00.	305 (1)	⊕○○○ c e (Very low)
(D) BMI, calculated from weight (kg) divided by height (m2).	Other treatment (Fibromyalgia education).	At 12-weeks after intervention: mean 1.1 higher (5.3 lower to 2.9 higher).	84 (1)	⊕○○○ b e (Very low)

CI: confidence interval; d: day; MD: mean difference; n: number; SD: standard deviation; SMD: standardized mean difference. Notes: in Soares (2002), adjusted for direction; a: quality rated from 1 (very low quality) to 4 (high quality); b: evidence limited by inconsistency; c; evidence limited by imprecision; d: evidence limited by heterogeneity; e: evidence limited by small sample size; f: evidence limited by risk of bias (suspicion of selective reporting bias); g: based on Hedges’ g interpretation of effect sizes. GRADE Working Group grades of evidence: high: we are very confident that the true effect lies close to that of the estimate of the effect; moderate: we are moderately confident in the effect estimate/the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different; low: our confidence in the effect estimate is limited/the true effect may be substantially different from the estimate of the effect; very low: we have very little confidence in the effect estimate/the true effect is likely to be substantially different from the estimate of effect.