Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4014 — A Randomized, Controlled Study of a Positive Psychological Intervention to Improve Pain, Functioning, and Wellbeing in Veterans with Osteoarthritis

Lead/Presenter: Leslie Hausmann, COIN - Pittsburgh/Philadelphia
All Authors: Hausmann LR (COIN-Pittsburgh/Philadelphia) Youk A (COIN-Pittsburgh/Philadelphia) Ibrahim SA (COIN-Pittsburgh/Philadelphia) Kwoh CK (University of Arizona) Hannon MJ (COIN-Pittsburgh/Philadelphia) Weiner DK (GRECC-Pittsburgh) Gallagher RM (COIN-Pittsburgh/Philadelphia) Parks A (Hiram College; Happify)

Objectives:
Osteoarthritis is a leading cause of disability for which there is no cure. More effective, safe, patient-centric treatments are needed. We developed and tested an intervention to build positive psychological skills (e.g., gratitude) to reduce pain, improve functioning, and increase psychosocial wellbeing in patients with knee or hip osteoarthritis.

Methods:
We conducted a randomized, controlled study with a 6-month follow up. We recruited patients from an academic VA Medical Center who were aged 50 years or older, had a diagnosis of knee or hip osteoarthritis, and rated their pain as 4 or greater on a 0-10 scale. Patients (N = 42) were randomized to either a 6-week intervention program containing positive skill-building activities (e.g. focusing on positive events, expressing thanks) or neutral control activities (e.g., getting organized, planning the future) tailored to the patient population. Adherence was assessed by telephone each week. We assessed pain and functioning using a validated measure of osteoarthritis symptom severity (WOMAC Osteoarthritis Index). We assessed wellbeing using measures of positive affect, negative affect, and life satisfaction. Measures were collected during an in-person baseline visit and by telephone 1, 3, and 6 months after the program ended. We used linear mixed models to examine changes over time.

Results:
The majority (64%) of patients completed more than 80% of their weekly activities. Patients in the positive intervention arm reported significantly more improvement over time in osteoarthritis symptom severity (p = 0.02, Cohen's d = 0.86), negative affect (p = 0.03, Cohen's d = 0.50), and life satisfaction (p = 0.02, Cohen's d = 0.36).

Implications:
This randomized controlled study successfully engaged VA patients with knee or hip osteoarthritis in a 6-week intervention to build positive psychological skills. The intervention yielded large improvements in osteoarthritis symptom severity and small to moderate improvements in measures of psychosocial wellbeing.

Impacts:
Patient-centric, psychosocial interventions that build resilience in the management of chronic and incurable pain conditions such as osteoarthritis offer a great potential to improve quality of life. Large trials are needed to identify mechanisms by which positive psychological skills reduce pain, to determine whether the benefits of such an intervention vary across clinical and demographic patient subgroups, and to explore implementation strategies.