Recent data indicate that pain coping and other psychological variables are key factors underlying racial disparities in osteoarthritis (OA) outcomes. Therefore interventions to enhance pain coping may be a key component in reducing racial disparities in pain and pain-related outcomes among veterans with OA. Coping Skills Training (CST) has been shown to improve outcomes among patients with OA, but the majority of participants in these studies have been Caucasians, and this intervention has also not been tested in veterans.
The objectives of this study were to: 1.) Assess the cultural sensitivity and appropriateness of a previously developed CST intervention for OA among African American veterans. 2.) Adapt the CST intervention accordingly, including modification into a telephone-based format. 3.) Perform a pilot trial of the adapted CST intervention in a sample of veterans with OA (of any racial / ethnic background).
We conducted two focus groups of 8 and 5 African American veterans with OA at the Durham VAMC, to obtain feedback on the CST intervention and its cultural appropriateness. We used this information to adapt the intervention. Next, we conducted a pilot trial of the adapted CST intervention, involving one in-person session and 9 weekly telephone calls. Intervention sessions involved teaching coping skills (e.g. cognitive restructuring, relaxation, imagery, and activity pacing) and providing guidance for home practice and use of coping skills during daily life situations. All participants were involved with the intervention. Outcomes were assessed at baseline and 12-week follow-up. The primary outcome was the Arthritis Impact Measurement Scales-2 (AIMS-2; measuring pain, affect, and physical function); secondary outcomes were the Coping Strategies Questionnaire and Arthritis Self-Efficacy Scale.
Adaptations to the CST intervention largely involved simplifying concepts and lowering literacy levels of patient materials. Veterans had no significant concerns regarding cultural appropriateness. Participants in the pilot trial were n=30 veterans with clinically documented OA (mean age = 58 years; 9 females; 14 Caucasians, 13 African Americans). The mean AIMS-2 total score decreased by 8% from baseline to follow-up (12.2 vs. 11.2), indicating improvement. There were similar decreases in AIMS-2 pain, affect, mood, tension, and walking / bending subscales. Arthritis self-efficacy increased by 19% (5.4 vs. 6.4). There were improvements in all subscales of the Coping Strategies Questionnaire, with particularly substantial improvements in Diverting Attention (10.5 vs. 21.1), Reinterpreting Symptoms (6.2 vs. 13.1), Increasing Behavioral Activity (12.7 vs. 19.0), and Total Coping Attempts (which includes all subscales except Catastrophizing; 84.9 vs. 117.6).
Participants in this telephone-based CST intervention substantially increased their positive coping behaviors, showing that this program has great potential for improving veterans' chronic pain coping skills and downstream outcomes. Given the extremely high prevalence of OA and other chronic pain conditions among veterans, this telephone-based CST intervention could have an important clinical impact if results of this pilot study are confirmed in a larger clinical trial.
- Golightly YM, Allen KD, Stechuchak KM, Coffman CJ, Keefe FJ. Associations of coping strategies with diary based pain variables among Caucasian and African American patients with osteoarthritis. International Journal of Behavioral Medicine. 2015 Feb 1; 22(1):101-8.
- Sperber N, Allen KD, Weinberger M, Bosworth HB. Racial differences in a randomized controlled trial of a telephone-based self-management intervention for osteoarthritis. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD.