A phase III randomized three-arm trial of physical therapist delivered pain coping skills training for patients with total knee arthroplasty: the KASTPain protocol.
BACKGROUND
Approximately 20% of patients report persistent and disabling pain following total knee arthroplasty (TKA) despite an apparently normally functioning prosthesis. One potential risk factor for unexplained persistent pain is high levels of pain catastrophizing. We designed a three-arm trial to determine if a pain coping skills training program, delivered prior to TKA, effectively reduces function-limiting pain following the procedure in patients with high levels of pain catastrophizing.


METHODS
The trial will be conducted at four University-based sites in the US. A sample of 402 patients with high levels of pain catastrophizing will be randomly assigned to either a pain coping skills training arm, an arthritis education control arm or usual care. Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts. Arthritis education will be delivered by nurses trained in the delivery of arthritis-related content. The primary outcome will be change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale score 12 months following surgery. A variety of secondary clinical and economic outcomes also will be evaluated.


CONCLUSIONS
The trial will be conducted at four University-based sites in the US. A sample of 402 patients with high levels of pain catastrophizing will be randomly assigned to either a pain coping skills training arm, an arthritis education control arm or usual care. Pain coping skills will be delivered by physical therapists trained and supervised by clinical psychologist experts. Arthritis education will be delivered by nurses trained in the delivery of arthritis-related content. The primary outcome will be change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scale score 12 months following surgery. A variety of secondary clinical and economic outcomes also will be evaluated.
Departments of Physical Therapy and Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, USA. dlriddle@vcu.edu
Daniel L
DL
Riddle
Francis J
FJ
Keefe
Dennis
D
Ang
Khaled
K
J
Levent
L
Dumenci
Mark P
MP
Jensen
Matthew J
MJ
Bair
Shelby D
SD
Reed
Kurt
K
Kroenke
D000223:Adaptation, Psychological; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000523:psychology; D006801:Humans; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D059408:Pain Management / Q000379:methods* / Q000523:psychology; D010147:Pain Measurement / Q000379:methods* / Q000523:psychology; D026741:Physical Therapy Modalities / Q000523:psychology; D016896:Treatment Outcome