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Improving the Multidisciplinary Treatment of Chronic Pain by Stimulating Body Awareness

A Cluster-randomized Trial

Van der Maas, Lia C.C. MSc*†‡§; Köke, Albère PhD; Pont, Menno MD; Bosscher, Ruud J. PhD; Twisk, Jos W.R. PhD#**; Janssen, Thomas W.J. PhD‡§; Peters, Madelon L. PhD††

The Clinical Journal of Pain: July 2015 - Volume 31 - Issue 7 - p 660–669
doi: 10.1097/AJP.0000000000000138
Original Articles

Background: Because of methodological flaws and a lack of theoretical foundation of body awareness (BA) in previous effect studies of interventions directed to stimulate BA, it is impossible to attribute treatment effects to this specific component of a multidisciplinary treatment. Therefore, this study evaluated short-term and long-term effects of a multidisciplinary pain rehabilitation program with and without psychomotor therapy (PMT), which focused on BA (measured by the scale of body connection) as a primary target of intervention.

Methods: Ninety-four patients clustered in 20 treatment groups were cluster randomized, using a biased-coin design, to multidisciplinary treatment as usual with or without PMT. Outcome variables were health-related quality of life, disability, and depression. BA, catastrophizing, and self-efficacy were measured as potential process variables. Assessments were performed at baseline, directly after treatment, and at 3, 6, and 12 month follow-ups. The data were analyzed by linear mixed-model analysis according to the intention-to-treat principle.

Results: Data of all 94 patients were used for analyses. After treatment, significant differences favoring PMT were found between conditions on depression (regression coefficient [RC]=−5.01; 95% confidence interval [CI], −8.81 to −1.21), BA (RC=0.23; 95% CI, 0.04 to 0.42) and catastrophizing (RC=−4.76; 95% CI, −8.03 to −1.48). These differences were no longer significant for depression at the 3-month follow-up and for catastrophizing at the 6-month follow-up.

Conclusions: No clinical meaningful differences were found between treatment conditions in the primary outcome measures health-related quality of life and disability. However, this is the first long-term RCT that has shown that PMT improves BA in patients with chronic pain and shows good effect size and a significant decrease for catastrophizing.

*Human Movement and Education Division

Health Care and Social Work Division, University of Applied Sciences Windesheim, Zwolle

Reade, Centre of Rehabilitation and Rheumatology

Amsterdam Rehabilitation Research Centre Reade

§MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences

**Department of Health Sciences, VU University

#Department of Epidemiology and Biostatistics, VU Medical Centre, Amsterdam

Adelante Expertise Centre Pain Rehabilitation, Hoensbroek

††Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands

Trial registry: CCMO NL17547.029.07 (

The authors declare no conflict of interest.

Reprints: Lia C.C. Van der Maas, MSc, Human Movement and Education Division, University of Applied Sciences Windesheim, Campus 2-6, Zwolle 8000 GB, The Netherlands (e-mail:

Received January 12, 2014

Received in revised form August 14, 2014

Accepted July 3, 2014

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