{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T19:47:35Z","timestamp":1782762455537,"version":"3.54.5"},"reference-count":51,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Finding successful treatments for chronic widespread pain (CWP) in primary care is challenging. Interventions addressing both stress and pain may yield synergistic effects. Internet-based cognitive behavioral therapy (iCBT) reduces stress-related pain responses, while physical activity enhances function and resilience. Combined, they may target core CWP mechanisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the effectiveness of therapist-guided iCBT for stress management combined with physiotherapist-guided physical activity, compared to stand-alone physical activity, on pain and associated symptoms in individuals with CWP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants with CWP, aged 18-70 years, were recruited in this parallel, multicenter randomized controlled trial via social media in Sweden. The intervention group received a 14-module iCBT program plus a physical activity plan; the control group received the physical activity plan only. Primary outcomes were pain intensity and pain locations. Secondary outcomes included stress, fatigue, depression, and quality of life. Variables were self-assessed using paper questionnaires at baseline and 6 months. Allocation was concealed; participants and researchers were not blinded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 129 participants (64 intervention, 65 control), 82 (64%) completed the 6-month follow-up. In the intervention group, 37% (16\/43) completed all 14 iCBT modules. No between-group differences were observed for change in any outcome: pain intensity (mean 1.7, 95% CI \u20137.5 to 11.0), pain locations (mean \u20130.8, 95% CI \u20132.2 to 0.6), Stress and Crisis Inventory (mean 2.0, 95% CI \u20133.3 to 7.4), Fibromyalgia Impact Questionnaire (mean 2.7, 95% CI \u20133.7 to 9.2), global fatigue (mean 3.0, 95% CI \u20137.2 to 13.3), Multidimensional Fatigue Inventory (general fatigue: mean 0.1, 95% CI \u20131.1 to 1.3; physical: mean 0.4, 95% CI \u20131.1 to 1.9; mental: mean 0.4, 95% CI \u20131.1 to 2.0; reduced activity: mean \u20132.8, 95% CI \u20130.5 to 2.1; reduced motivation mean \u20130.5, 95% CI \u20132.2 to 1.2), Hospital Anxiety and Depression Scale (anxiety: mean \u20130.8, 95% CI \u20132.3 to 0.7; depression: mean \u20130.2, 95% CI \u20131.7 to 1.3), and Short-Form 36 subscales (physical function: mean 2.9, 95% CI \u20133.7 to 9.5; role physical: mean \u201313.1, 95% CI \u201328.3 to 2.0; role emotional: mean \u20134.0, 95% CI \u201322.8 to 14.8; energy\/fatigue: mean 3.4, 95% CI \u20134.0 to 10.8; emotional well-being: mean \u20130.5, 95% CI \u20138.2 to 7.3; social functioning: mean \u20134.6, 95% CI \u201315.0 to 5.8; pain: mean \u20133.1, 95% CI \u20139.8 to 3.6; general health: mean \u20132.2, 95% CI \u20139.2 to 4.9). Both groups improved across several outcomes. Main goals were attained by 37% (17\/46) in the intervention group vs 19% (8\/42) in controls (P=.02), and intermediate goals by 54% (25\/46) vs 36% (15\/42; P=.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study novelly examines stress-targeting interventions for pain. Clinicians could focus on tailored physical activity plans while considering optional stress management to support behavioral change and goal attainment. Due to high loss to follow-up, results should be interpreted cautiously.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT04624139; https:\/\/clinicaltrials.gov\/study\/NCT04624139<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/86792","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T13:05:09Z","timestamp":1781010309000},"page":"e86792","source":"Crossref","is-referenced-by-count":0,"title":["Combined Internet-Based Cognitive Behavioral Therapy and Face-to-Face Physiotherapy in Primary Health Care for Chronic Widespread Pain: Randomized Controlled 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