Occupational Therapist–Delivered Cognitive–Behavioral Therapy for Knee Osteoarthritis: A Randomized Pilot Study

Murphy, Susan L.; Janevic, Mary R.; Lee, Pearl; Williams, David A.

doi:10.5014/ajot.2018.027870

Cited by 23 publications

(36 citation statements)

References 22 publications

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“…There were two primary aims to teaching general relaxation, rstly to initiate the process of postural deconstruction (see below) and secondly to raise consciousness of both emotional and muscular responses to pain. This focus is consistent with previous research supporting the use of relaxation interventions for arthritis pain [90] and the use of cognitive behavioural therapy interventions which incorporate relaxation for knee OA [20]. We speci cally targeted three easy-to-observe characteristics of relaxation.…”

Section: Component 2: General Relaxationmentioning

confidence: 69%

“…During this period, there have been continual re nements in the frequency, duration and nature of the exercises [11] along with the addition of self-management components which aim to provide reassurance about the value of exercise in OA [17]. While there has been some focus on adjunctive therapies [18], such as cognitive-behavioural therapy [19,20], there has been very little research investigating biopsychosocial interventions for knee OA [21], despite suggestions that this may improve clinical management [22,23]. This is particularly concerning given the evidence of strong links between psychosocial factors and clinical pain/disability in this disease.…”

Section: Discussionmentioning

confidence: 99%

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Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

Preece

Brookes

Williams

et al. 2021

Preprint

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Background: Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, the magnitude of clinical effect is considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While many exercise-based approaches incorporate an educational/coping component alongside muscle strengthening, there has been no previous attempt to integrate psychological techniques with muscle retraining. Building on these ideas, the aim of this study was to create a new integrated behavioural intervention for knee osteoarthritis, suitable for delivery by a physiotherapist.Methods: Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to knee muscle co-contraction. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with users.Results: The underlying framework incorporated ideas related to central sensitisation to pain, maladaptive motor responses to pain and also focused on the idea that increased knee muscle co-contraction could result from changes in postural tone. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to enable patients to visualise muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a full prototype version of the intervention. Conclusion: We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle patterns and beliefs associated with pain. Preliminary feedback and clinical indications are positive, and this motivates future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to a muscle strengthening programme. Trial Registration: ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered)

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Section: Component 2: General Relaxationmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

Preece

Brookes

Williams

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…However, the reason for the greater variance in ATQ-N, KDS, STAI-KYZ, and COPM shown by the experimental group is likely to be due to the effect of the CBT. Murphy et al [ 37 ] conducted a study on patients with osteoarthritis and found a notable beneficial effect of the CBT on pain and fatigue, thus providing a focused discussion on the high level of treatment satisfaction in the participants. In line with this, both the experimental and control groups in this study showed a significant improvement in the two items of COPM, while the variance was increased to a greater degree in the experimental group than in the control group with a particularly large improvement in the satisfaction, which may be attributed to the beneficial effect of CBT including the change towards positive thoughts and feelings and enhanced self-esteem and self-confidence, combined with the previously described positive effect of the occupation-based bilateral upper limb training.…”

Section: Discussionmentioning

confidence: 99%

Effects of Combining Cognitive Behavioral Therapy with Bilateral Upper Limb Training in Stroke Patients: A Randomized Controlled Trial

Choi

Kim

2022

Occupational Therapy International

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CBT has a beneficial effect on depression and anxiety; however, the number of cases where therapy was used in patients with stroke was rare. In addition, there is still a lack of research on the effects of occupation-based training and the effects of bilateral upper limb training that provides an intervention based on patients’ state of hemiplegic upper limb function. This study investigated the effects of combining CBT and occupation-based bilateral upper limb training on the depression, anxiety, upper limb function, and occupational performance. The experimental group was given 30-min cognitive behavioral therapy and occupation-based bilateral upper limb training, while the control group was given 30-min conventional occupational therapy and occupation-based bilateral upper limb training. For both groups, the intervention was given as a 30-min session once a day and five times a week for 4 weeks. Following intervention, the experimental group showed significant within-group variance for automatic thoughts, depression, anxiety, upper limb function, and occupational performance only ( p < 0.01 ). For between-group variance, a significant difference was found for automatic thoughts, depression, anxiety, and occupational performance ( p < 0.01 ), however, not for upper limb function ( p > 0.05 ). In this study, it is meaningful that this author provided good guidelines for therapists and caregivers by organizing and providing actual programs in a very rare situation where cognitive behavioral therapy was applied to stroke patients.

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“…Occupational therapy research in the United States has established credible evidence that effective interventions conducted in traditional service contexts (i.e., outpatient) have a positive impact on sequelae of chronic medical conditions, including low vision (Barstow et al, 2015) and arthritis (Murphy et al, 2018), and on medication adherence for patients with those conditions (Schwartz et al, 2017). In addition, international research has demonstrated that population health benefits can be achieved through occupational therapy's integration into models of primary care and can provide a platform to conduct ongoing research in the United States (Mackenzie et al, 2013;Richardson et al, 2010).…”

Section: Feasible Solutions To Integrate Occupational Therapymentioning

confidence: 99%

Primary Care Occupational Therapy: How Can We Get There? Remaining Challenges in Patient-Centered Medical Homes

Pape

Muir

2019

The American Journal of Occupational Therapy

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Passage of the Patient Protection and Affordable Care Act in 2010 mandated reform of the United States’ existing primary care system. As part of this reform, advanced practice models, including the Patient-Centered Medical Home model, expanded, with the goal of increasing the use of interprofessional teams. Integrating occupational therapy was promoted as an opportunity to enhance the value of care provided in these redesigned primary care practices. However, occupational therapy’s presence in primary care is still extremely limited.

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Occupational Therapist–Delivered Cognitive–Behavioral Therapy for Knee Osteoarthritis: A Randomized Pilot Study

Abstract: An online-supported cognitive-behavioral program for people with KOA delivered by occupational therapists is feasible and may contribute to improved physical function.

Cited by 23 publications

References 22 publications

Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

Tension Release Therapy: The Development of a New Integrated Behavioural Intervention for Knee Osteoarthritis

Effects of Combining Cognitive Behavioral Therapy with Bilateral Upper Limb Training in Stroke Patients: A Randomized Controlled Trial

Primary Care Occupational Therapy: How Can We Get There? Remaining Challenges in Patient-Centered Medical Homes

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