Evaluating the Effectiveness and Technique Composition of Combined Motor Learning and Behavior Change Strategies for Movement Behavior in Chronic Musculoskeletal Pain: A Systematic Review.

Objectives: This review assessed the effectiveness of combined motor learning (ML) and behavior change (BC) strategies on movement behavior in daily life for patients with chronic musculoskeletal pain (CMP) and analyzed the applied techniques. Data sources: Literature was searched in PubMed, CINAHL, and Embase databases. Study selection: The following eligibility criteria were formulated: randomized controlled trials and clinical controlled trials, adults with CMP, movement interventions consisting of ML and BC strategies, and movement behavior or activities in daily life as outcome measures. We used ASReview software for screening. Data extraction: Two reviewers extracted data and independently assessed the risk of bias of the studies included. A best evidence synthesis was conducted for effectiveness and technique analysis with frameworks for the applied techniques. Data synthesis: Nineteen papers were selected. Moderate evidence was found in favor of the combined strategies on the quality, and insufficient evidence on the quantity of movement behavior. For activities of daily life, inconsistent evidence was found. The ML techniques reflected a more explicit learning approach. A small portion of BC techniques were applied, such as goal setting and shaping knowledge. Conclusions: Evidence of the effectiveness of combined strategies is moderate for the quality of movement, insufficient for the quantity of movement, and inconsistent for activities of daily life. The studies used a limited set of ML and BC techniques. Interventions for CMP should apply a more diverse set of techniques and use movement behavior as an outcome measure.