Effectiveness and Cost-effectiveness of an Internet-Based Self-management Program for People With Chronic Pain: A Randomized Controlled Trial With Economic Evaluation (the ReabilitaDOR Trial)
Bibliographic record
Abstract
OBJECTIVE: To investigate the effectiveness and cost-effectiveness of an Internet-based self-management program compared with an online booklet for people with chronic musculoskeletal pain. DESIGN: Parallel-group, randomized controlled superiority trial with economic evaluation conducted in Brazil. METHODS: Patients with chronic musculoskeletal pain were randomly allocated to receive an Internet-based self-management program (ReabilitaDOR) or an online booklet. Participants were recruited from university- and community-based physical therapy clinics and through social media. The primary outcome was pain intensity at 8 weeks. The secondary outcomes were function; quality of life; kinesiophobia; global perceived effect; anxiety and depression; pain catastrophizing; pain-related attitudes and beliefs; self-efficacy; and adverse effects at 8 weeks, 6 months, and 12 months after randomization. The economic evaluation from the societal perspective was conducted for pain intensity and quality-adjusted life years (QALYs). RESULTS: We included 162 participants (ReabilitaDOR, n = 83; online booklet, n = 79). There was no statistically significant difference in pain intensity between groups at 8 weeks (mean difference: −0.74; 95% confidence interval: −1.5, 0.04), and no significant differences in the secondary outcomes. From a societal perspective, the intervention had a 0.98 probability of being cost-effective at a willingness-to-pay threshold of $200 per point of improvement in pain intensity and 0.63 at a willingness-to-pay threshold of $50 000 per QALY gained compared to the control group. CONCLUSION: An Internet-based self-management program was not superior to an online booklet for chronic musculoskeletal pain. The Internet-based self-management program seemed to be a cost-effective intervention for pain intensity, but not for QALYs. These findings should be interpreted with caution due to high dropout rates and the trial running during the COVID-19 pandemic. J Orthop Sports Phys Ther 2026;56(1):38-49. Epub 30 October 2025. doi:10.2519/jospt.2025.13418
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".