Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management
Exercise and Movement TherapiesWork Group
Pre-Conference Assignment
Your pre-conference assignment is to review the assigned questions and readings for the Exercise and Movement Therapies Work Group. This worksheet is a tool for you to collect your thoughts and help generate work group discussion. Please feel free to compose additional discussion questions for the consideration of colleagues in your specific group. In addition, besides the readings for “All” work groups and the reading assignments specific to the Exercise and Movement Therapies work group, you are welcome to review background resources for any of the other work groups that are posted here:
Your work group facilitator(s) will lead the group through a discussion of the assigned questions toward the goal of reaching consensus on what is known (evidence-based) and what needs to be known (knowledge gaps), prioritizing, and making recommendations for research, policy, and practice. The last portion of the work group session on November 3rd will be dedicated to summarizing the discussion, agreed upon priorities, and recommendations into a slide deckfor presentation to the entire SOTA group on November 4th.
Please use the space below to identify areas in which there is sufficient evidence to inform VA policy and practice or areas in which significant evidence gaps remain. When considering evidence gaps, the work group will also be directed to prioritize which evidence gaps are most important to be addressed in future RFAs released by HSR&D.
To assist with the assignment, exercise and movement therapies include activities such as stretching and strengthening exercises, yoga, tai chi,Feldenkrais method, Alexander technique, or walking, which may also be more broadly characterized as: Strength/Resistance, Coordination/Stabilization, Cardiorespiratory, or Combined exercise and movement therapies.
KEY QUESTIONS for the Exercise and Movement Therapies Work Group:
- What exercise and movement therapies have strong evidence that they provide clinically-relevant benefits in pain intensity, pain-related function, quality of life, or other pain-related outcomes among patients with chronic musculoskeletal pain? What exercise and movement therapies have some promising evidence but need further study to fill evidence gaps? What exercise and movement therapies are lower priority for investment in research and implementation?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- What patient characteristics (e.g.,, age, gender, pain features, co-occurring conditions) predict a positive response to a certain type of exercise/movement therapy or to exercise/movement therapy relative to other types of therapies? If the evidence is weak, what are the priorities for better evidence?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- What is the evidence for effective frequency, duration, and intensity (i.e., dose) of exercise/movement therapies for improving outcomes during the initial course of therapy and for ensuring sustained benefit?What are effective strategies for engaging patients and ensuring an adequate dose is achieved and/or maintained?What is the evidence of the effectiveness of combining exercise and movement therapies with other treatments, particularly integrative therapies, or for a particular sequencing of therapies?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
- What are the barriers to delivering and engaging patients in exercise/movement therapy (patient/provider/facility/system) initially and over time (or in conjunction with other pain management therapies)? What are effective and efficient strategies for overcoming the barriers (e.g., education, tools, training/accreditation, outreach, technology/new modalities)?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above:
Cross Cutting Question for all groups:
- What primary and secondary outcome domains should be included in prospective research on benefits and harms of nonpharmacological therapies for chronic musculoskeletal pain?
- What is the evidence of validity, reliability, and responsivity to change for available measures in recommended outcome domains?
- What measures should be considered for outcomes assessment in a) clinical trials, b)prospective observational studies, and c) clinical program evaluations of nonpharmacological therapies for chronic musculoskeletal pain?
- What timing is recommended for assessment of outcomes of nonpharmacological therapies for chronic musculoskeletal pain?Do recommendations differ for different therapeutic approaches?
General Comments:
Areas with Sufficient Evidence:
Areas with Research Gaps:
Priorities for Future Research to Address Evidence Gaps identified above: