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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3093 — Racial differences in a randomized controlled trial of a telephone-based self-management intervention for osteoarthritis

Sperber NR (Durham VA Medical Center, Duke University Medical Center), Bosworth HB (Durham VA Medical Center, Duke University Medical Center), Coffman CJ (Durham VA Medical Center, Duke University), Lindquist JH (Durham VA Medical Center), Oddone EZ (Durham VA Medical Center, Duke University Medical Center), Weinberger M (Durham VA Medical Center, University of North Carolina Chapel Hill), Allen KD (Durham VA Medical Center, Duke University Medical Center)

Objectives:
Arthritis related disability and pain disproportionately affect racial minorities in the general population and Veterans Health Administration users. Previous studies suggest that cognitive and behavioral interventions may help attenuate racial differences in osteoarthritis outcomes. In a clinical trial of a 12-month telephone-based self-management intervention for veterans with hip and/or knee osteoarthritis, we examined whether the effect of the intervention on pain, physical function, self-efficacy, and affect differed between White and non-White participants.

Methods:
The sample consisted of 515 veterans with hip and/or knee osteoarthritis randomized to either osteoarthritis self-management intervention (n = 172), attention control (health education intervention) (n = 172), or usual care (n = 171). At baseline and 12-months, we collected the following: Arthritis Impact Measurement Scales-2 (AIMS2) pain, mobility, and affect subscales (0-10 scales) and Arthritis Self-Efficacy Scale (1-10 scale). We used linear mixed models to assess whether the osteoarthritis intervention had a differential effect on outcomes between White and non-White participants compared to the other two groups.

Results:
About half (54%) of the sample was White, with 93% of non-White being African American. Most were male (93%). The mean age was 60 years. Non-Whites in the osteoarthritis intervention group had significantly greater improvement on the AIMS2 mobility subscale than Whites compared to both usual care (difference = -0.6, 95% CI: -1.2,-0.1; p = 0.008) and health education (difference = -0.8, 95% CI: - 1.3, -0.2; p = 0.02). Non-White osteoarthritis intervention participants had slightly greater improvement than Whites in self-efficacy (difference with health education = 0.4, 95% CI: -0.4, 1.2; p = 0.29 and usual care = 0.5, 95% CI:-0.3, 1.2; p = 0.21) and AIMS2 affect (difference with health education = -0.3, 95% CI: -0.9,0.4; p = 0.40 and usual care = -0.3, 95% CI:-0.9,0.4; p = 0.44). There was no difference in pain improvement between non-Whites and Whites in the osteoarthritis intervention group compared to either usual care (p = 0.80) or health education (p = 0.84).

Implications:
Non-White osteoarthritis intervention participants had greater improvement in mobility, a key indicator of arthritis disability, compared to White participants. There was no differential effect on self-efficacy, affect or pain.

Impacts:
Osteoarthritis self-management interventions may be an important strategy for reducing racial disparities in disability. This telephone-based program could be disseminated widely within the VA health care system.


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