Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 11, 2025
Date Accepted: Jun 9, 2026
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Combined physiotherapy and internet-based cognitive behavioural therapy in primary health care for chronic widespread pain: A randomised controlled trial.
ABSTRACT
Background:
Background:
Chronic widespread pain (CWP) is common in primary health care and it is challenging to find successful treatments. Recommended treatments include physical exercise and cognitive behavioural therapy (CBT). Interventions addressing both stress and chronic pain may yield synergistic effects. Internet-based CBT reduces stress-related pain responses, while person-centered physical activity enhances function and resilience. Combined, they may target core mechanisms underlying CWP.
Objective:
The aim was to evaluate the effectiveness of a therapist-guided internet-based cognitive behavioural therapy (I-CBT) program designed for stress management combined with a physiotherapist-guided physical activity plan , compared to the physiotherapist-guided physical activity plan as stand alone treatment, in individuals with CWP.
Methods:
In a randomized controlled trial, 129 individuals with CWP in Sweden were randomized to the intervention group comprising a therapist-guided 14 modules I-CBT program designed for stress combined with physiotherapist-guided physical activity plan, or a control group receiving only physiotherapy. The physiotherapy in both groups consisted of three physiotherapy visits where a person-centered physical activity plan was created and refined. Primary outcomes were pain intensity and number of pain locations. Secondary outcomes were symptoms of stress, overall health, fatigue and health related quality of life. All variables were assessed at baseline and after six months.
Results:
A total of 82 participants (64%) completed the six-month follow-up. There were no differences between the groups for change in any outcome. The effect size was 0.08 (P = 0.43) for pain intensity and 0.24 (P=0.42) for pain locations. Participants in the intervention group achieved their individual goals to a greater extent than those in the control group. Specifically, their main goals were fully attained by 37% of participants in the intervention group compared with 19% in the control group (P = 0.018), and their intermediate goals were achieved by 54% in the intervention group versus 36% in the control group (P = 0.014).
Conclusions:
I-CBT for stress, when combined with a physical activity plan, did not demonstrate superior improvements compared to the physical activity plan alone in individuals with CWP. However, participants receiving the combined intervention reached their individual goals to a higher extent, suggesting that the addition of I-CBT to physical activity may enhance personal goal attainment and engagement in rehabilitation. Given the high dropout rate, the results should be cautiously interpreted. Clinical Trial: ClinicalTrials.gov Identifier: NCT04624139
Citation
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