Discussion
SECONDARY
This is the first multicenter cluster randomized clinical trial of a proactive, blended and integrated intervention with a physical therapist and mental health nurse for primary care patients with moderate MUPS aiming at prevention of chronicity. The results showed more patients with short-term adequate relief after treatment with the PARASOL intervention compared to the usual care group. Unfortunately, this between group difference in favour of the PARASOL intervention did not sustain in long-term. Although quality of life improved within the PARASOL group after the intervention, this improvement did not differ from the usual care group. No additional beneficial effects of the PARASOL intervention on the secondary outcomes were found, neither in short-term nor in long-term follow-up.Subjective symptom impact was one of the primary outcome measures because this subjective outcome adequately reflects the perception of symptoms. Better adequate short-term relief was not accompanied by significant improvements on severity of symptom scores. The explanation for this finding might be that the intervention focused on patients’ insight, perception of symptoms and modifiable prognostic risk factors. Thus the main effect of the PARASOL intervention might be diminishing the impact of symptoms on patients by improving coping strategies and perception of symptoms, without having an effect on symptom severity.The PARASOL intervention is the first blended care intervention in patients with moderate MUPS. It is hypothesized that blended care can help to stimulate self-management. Although self-management skills improved after the intervention, this improvement did not differ from the usual care group. A possible explanation might be that patients had a lack of intrinsic motivation due to the proactive approach of the GP since the presence of motivation is an important aspect for patients’ self-management [Although not statistically significant, a positive trend in the between group differences on quality of life in favour of the PARASOL intervention was found. Not achieving the preset sample size might be an important reason why we were not able to demonstrate the effectiveness of the PARASOL intervention. The size of the effect on quality of life at the end of treatment was similar to earlier research, but differ with a more recent primary care intervention in patients with MUPS [