Health coaching improves physical activity, disability and pain in adults with chronic non-cancer pain: a systematic review.

QUESTION: What is the effect of health coaching on physical activity, disability, pain and quality of life compared with a non-active control in adults with chronic non-cancer pain?

DESIGN: Systematic review and meta-analysis of randomised controlled trials. Evidence was synthesised as standardised mean differences with 95% confidence intervals using random-effects models. Risk of bias was assessed using the revised Cochrane risk of bias tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine evidence certainty.

DATA SOURCES: MEDLINE, Embase, CENTRAL, CINAHL, Scopus and PEDro were searched from inception to November 2023.

PARTICIPANTS: Adults with chronic non-cancer pain.

INTERVENTION: Health coaching to increase physical activity.

OUTCOME MEASURES: Measures of physical activity, disability, pain and quality of life.

RESULTS: Twenty-six randomised trials (n = 4,403) were included. Trials had moderate to high risk of bias. Health coaching had a trivial to small effect on improving physical activity compared with control (15 trials; SMD 0.21, 95% CI 0.07 to 0.35; low certainty evidence). Health coaching had a small effect on improving disability (19 trials; SMD 0.25, 95% CI 0.17 to 0.32; moderate certainty evidence) and pain (19 trials; SMD 0.31, 95% CI 0.18 to 0.43; very low certainty evidence) compared with control. The effect of health coaching on quality of life was unclear due to significant imprecision in the effect estimate (five trials; SMD 0.19, 95% CI -0.14 to 0.53; moderate certainty evidence).

CONCLUSION: Health coaching promotes a trivial to small improvement in physical activity and small improvements in disability and pain in adults with chronic non-cancer pain. The effect of health coaching on quality of life remains unclear.

REGISTRATION: PROSPERO CRD42020182740.