Fifty-three RCTs (11,170 participants) were identified with 46 RCTs (8,539 participants; range 50 to 855) that provided final value data were included in the review. Thirty-six RCTs met three or less quality criteria and were considered lower quality. Ten RCTs met four or five criteria and were considered high quality.
The authors appeared to report results on outcomes for a selected number of comparisons based on intervention characteristics and components. Online supplementary data report outcomes for other comparisons, but no further details on the characteristics of these comparisons were provided. Most of these comparisons showed no statistically significant or only minor detectable significant differences between intervention and control groups, and many comparisons were not estimable because there were no data.
Treatment duration: treatment duration of less than eight weeks (34 RCTs) showed greater benefit compared to durations lasting more than eight weeks (12 RCTs). Duration less than eight weeks showed statistically significant benefit or minor differences between self-management and control in the short, medium, and long-term for pain intensity, physical function and self-efficacy.
Psychological component
Thirty-eight RCTs compared a self-management intervention that included a psychological component versus a control. Eight RCTs compared a self-management intervention that did not include a psychological component versus a control. Interventions including a psychological component showed evidence of benefit in the short and medium-term for pain intensity, physical function and self-efficacy when compared to controls; all reported small effect sizes.
Lifestyle component
Statistically significant benefits were shown for interventions with (39 RCTs) and without lifestyle components (seven RCTs) in the short and medium term for all outcomes except depression. Effect sizes were minor or small in RCTs including a lifestyle component. For RCTs without a lifestyle component, effects sizes were small for six outcome comparisons and medium for two outcome comparisons.
Pain Education component
For most outcomes, similar findings were reported in the short term whether the intervention included a pain education component (35 RCTs) or not (11 RCTs). In the medium term there was evidence in favour of RCTs including a pain education component; one minor effect (physical function), three small effects (pain intensity, self-efficacy and depression) and one medium effect (global health).
Physical Activity component
Forty RCTs included a physical activity component, four RCTs did not. There was evidence of greater benefit in RCTs with a physical activity component compared to RCTs without this component. Trials with this component showed small effect sizes in the short term for all outcomes except depression, in the medium and long term effects were minor or small. Trials without the component showed one small and medium effect in the short term.
Mind Body Therapy component
Most benefit was seen for interventions without a mind body component (20 RCTs); one minor effect (physical function; medium term), eight small effect sizes (all short term outcomes except depression; pain intensity and self efficacy in both medium and long term) and one medium effect size (self efficacy; medium term).
Sensitivity analyses showed some evidence of reduced effect size in high quality trials compared to low quality trials, but did not significantly differ from the overall results. Removal of studies with more than one intervention arm did not significantly alter the results.
Results from other subgroup analyses were reported in the review. There was no evidence of publication bias.