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A Positive Psychological Intervention Improves Outcomes for Veterans with Knee or Hip Osteoarthritis


BACKGROUND:
Osteoarthritis (OA), the most prevalent form of arthritis, causes substantial disability. The majority of existing OA treatments yield only small to moderate reductions in pain and disability and can have negative side effects. In the context of societal-wide efforts to reduce reliance on opioids and other potentially harmful pharmacological pain treatments, safe and effective non-pharmacological techniques for managing OA pain and symptoms are urgently needed. Naturally occurring positive affect – defined as the feelings experienced when one is pleasurably engaged with the environment – is associated with less pain in women with OA or fibromyalgia and better functioning following a hip fracture. This study sought to determine whether patients randomized to a program designed to boost positive affect and develop positive psychological skills (e.g., gratitude and kindness) would report greater improvements over time in OA symptom severity and measures of psychosocial well-being compared with patients randomized to a neutral control program. Forty-two Veterans (ages 50 and older) with knee or hip OA were randomized to a six-week program containing positive skill-building activities or structurally similar but affectively neutral control activities tailored to the patient population. Adherence was assessed by telephone each week. Outcomes included OA symptom severity and measures of well-being (i.e., positive affect, negative affect, and life satisfaction) measured at baseline and by telephone at one, three, and six months after the program ended.

FINDINGS:

  • The 6-week positive psychological intervention produced large reductions in OA symptom severity, decreased negative affect, and increased life satisfaction compared to a robust control program among Veterans with knee or hip osteoarthritis.
  • Retention through both 6-week programs was high, with 79% of participants completing at least 5 of 6 weekly calls and 64% reporting that they completed 80% or more of their weekly activities.
  • Participants rated the activities as highly beneficial, highly enjoyable, and low in difficulty.

IMPLICATIONS:

  • This positive psychological intervention yielded substantial, lasting benefits for pain-related and psychosocial outcomes. Results indicate the potential of a non-pharmacological therapy to improve symptom management in this population with moderate to severe pain and suggest that using positive activities as part of an overall treatment program for patients with OA could have a large impact.

LIMITATIONS:

  • Veterans were recruited from only one VAMC, and the small sample size did not allow for exploration of complex mediation models or subgroup comparisons.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D. Drs. Hausmann and Youk are part of HSR&D's Center for Health Equity Research & Promotion (CHERP) in Pittsburgh and Philadelphia PA.


Hausmann L, Youk A, Kwoh K, et al. Testing a Positive Psychological Intervention for Osteoarthritis. Pain Medicine. June 27, 2017; e-pub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.