Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial.
Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention.
Thurston Arthritis Research Center and Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA Duke University Medical Center, Durham, NC, USA Amgen, Inc, Thousand Oaks, CA, USA, Icahn School of Medicine at Mount Sinai, New York, NY, USA Harvard Medical School/Brigham and Women's Hospital, Boston, MA, USA Brown University, Pawtucket, RI, USA.
Christine
C
Rini
Laura S
LS
Porter
Tamara J
TJ
Somers
Daphne C
DC
McKee
Robert F
RF
DeVellis
Meredith
M
Smith
Gary
G
Winkel
David K
DK
Ahern
Roberta
R
Goldman
Jamie L
JL
Stiller
Cara
C
Mariani
Carol
C
Patterson
Joanne M
JM
Jordan
David S
DS
Caldwell
Francis J
FJ
Keefe
D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D001007:Anxiety / Q000523:psychology / Q000628:therapy; D018771:Arthralgia / Q000523:psychology / Q000628:therapy*; D058443:Catastrophization / Q000523:psychology; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D020377:Self Efficacy; D000069350:Telerehabilitation / Q000379:methods*; D016896:Treatment Outcome