Physical Therapist–Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial

Abstract

Objective. To investigate whether a 12-week physical therapist-delivered combined pain coping skills training (PCST) and exercise (PCST/exercise) is more efficacious and cost effective than either treatment alone for knee osteoarthritis (OA). Methods. This was an assessor-blinded, 3-arm randomized controlled trial in 222 people (73 PCST/exercise, 75 exercise, and 74 PCST) ages ‡50 years with knee OA. All participants received 10 treatments over 12 weeks plus a home program. PCST covered pain education and training in cognitive and behavioral pain coping skills, exercise comprised strengthening exercises, and PCST/exercise integrated both. Primary outcomes were self-reported average knee pain (visual analog scale, range 0-100 mm) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0-68) at week 12. Secondary outcomes included other pain measures, global change, physical performance, psychological health, physical activity, quality of life, and cost effectiveness. Analyses were by intent-totreat methodology with multiple imputation for missing data. Results. A total of 201 participants (91%), 181 participants (82%), and 186 participants (84%) completed week 12, 32, and 52 measurements, respectively. At week 12, there were no significant between-group differences for reductions in pain comparing PCST/exercise versus exercise (mean difference 5.8 mm [95% confidence interval (95% CI) 21.4, 13.0]) and PCST/exercise versus PCST (6.7 mm [95% CI 20.6, 14.1]). Significantly greater improvements in function were found for PCST/exercise versus exercise (3.7 units [95% CI 0.4, 7.0]) and PCST/exercise versus PCST (7.9 units [95% CI 4.7, 11.2]). These differences persisted at weeks 32 (both) and 52 (PCST). Benefits favoring PCST/exercise were seen on several secondary outcomes. Cost effectiveness of PCST/exercise was not demonstrated. Conclusion. This model of care could improve access to psychological treatment and augment patient outcomes from exercise in knee OA, although it did not appear to be cost effective.

Implementing a Pain Self‐Management Protocol in Home Care: A Cluster‐Randomized Pragmatic Trial

“…These results contrast with the findings of other recent reports . In a study targeting older adults with osteoarthritis of the knee, a combined cognitive and behavioral pain coping skills training and exercise protocol delivered by PTs over a 12‐week period resulted in better participant physical functioning at 12 weeks than in those who received exercise only or coping skills only training .…”

Fear of Reinjury in Athletes

“…These interventions have also been used in patients with general chronic musculoskeletal pain 48 and knee osteoarthritis. 7 Implementing psychologically informed practice in sports rehabilitation would require measurement of fear of reinjury as well as implementing the appropriate adjunctive interventions for athletes with high fear of reinjury.…”

Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial (Preprint)

“…In addition, as low self-efficacy, increased pain catastrophising and maladaptive pain coping strategies are common amongst people with OA [4][5][6], interventions that target these psychological factors may also provide benefits. Growing evidence supports the use of pain coping skills training (PCST) to improve pain and physical and psychological functioning in chronic pain conditions [7][8][9]. However, many people with OA may have difficulties accessing health professionals skilled in the prescription of exercise or psychological interventions.…”