Group acceptance and commitment therapy for the rehabilitation of persistent pain in rheumatic and musculoskeletal disorders

Abstract

Introduction
Relieving human suffering is a challenging goal and it is particularly so in the context of chronic pain. Despite the well reported high prevalence rates and economic burden of chronic pain, and subsequent recent advances in medical treatments, many patients continue to suffer. Multidisciplinary pain management programmes (PMPs) based on the biopsychosocial model of healthcare have been used to address this suffering, and these have predominantly used Cognitive Behavioural Therapy (CBT) principles. More recently, new developments in the field include the adaptation of a third wave behaviour therapy, namely Acceptance and Commitment Therapy, for group format. Few studies have examined the effectiveness of group Acceptance and Commitment Therapy within the context of rheumatic disease in a hospital setting.

Aims
This thesis aimed to evaluate the effectiveness of two hospital based, biopsychosocial interventions which used Acceptance and Commitment Therapy (ACT), delivered in group format, for improving physical, social and emotional functioning in rheumatology patients suffering with chronic musculoskeletal pain and related distress. It also aimed to review any existing research which had previously examined the efficacy of ACT in group format for adult rheumatology patients. This would provide information and evidence on existing outcomes from similar programmes and place our two studies in context. Additionally, the review aimed to explore ACT outcome measures used in studies to date. No review of group ACT for Chronic Musculoskeletal Pain (CMP) had been carried out previously and therefore this review aimed to bring together and summarise the findings from research in this area.

Method
The effectiveness of two ACT based pain rehabilitation programmes in Ireland was evaluated for this thesis. These were multidisciplinary team led group programmes in two hospital settings. In study 1, data were collected over a 5-year period (2009-2013) with 128 participants within the Health Service Executive (HSE) in the Southeast. The second study, based on a newly developed pain rehabilitation programme in the HSE Midwest region, over a 2-year period (2015-2017), had data from 68 completers available for analyses. Outcomes included physical, social and emotional functioning, pain and ACT process measures. The programmes ran over an 8-week period, one day per week, with primary, secondary and process measures taken pre-treatment, posttreatment and at a 6-month follow up review. No review could be found where the evidence for ACT for CMP in rheumatic disease and specifically in groups had been reviewed, therefore a systematic review of published randomised controlled trails examining group ACT for adults with chronic musculoskeletal pain due to rheumatic disease was also carried out.

Results
Study 1 showed statistically significant improvements for emotional functioning, from pre to post intervention across all outcome measures. Additionally, further significant improvements continued to be made over the post intervention period of six months following completion of the programme. Study 2 results from the HSE Midwest region showed statistically significant improvements for physical, social and emotional functioning across all outcome measures from pre to post intervention, except for pain intensity. In this study improvements made during the programmes were maintained at follow up and further gains were made during the post intervention period for some outcome measures. Findings from the systematic review complimented the findings from the two empirical studies carried out. Specifically, the review facilitated an exploration of the ACT outcome measures which have been used to date.

Conclusion
Group ACT may be an effective treatment in improving physical, social and emotional 14 functioning in patients with chronic musculoskeletal pain due to rheumatic disease. In addition, support was found in both studies for some of the processes of ACT. Limitations are discussed along with the need for future research using mediational analyses and realist research to explore further how improvements are made.

Thesis is embargoed until 31 July 2026

Date of Award	Jul 2024
Original language	English
Sponsors	Vice Chancellor's Research Scholarship (VCRS)
Supervisor	Lynn Dunwoody (Supervisor)