Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study

Abstract

This study tested the separate and combined effects of spouse-assisted pain coping skills training (SA-CST) and exercise training (ET) in a sample of patients having persistent osteoarthritic knee pain. Seventy-two married osteoarthritis (OA) patients with persistent knee pain and their spouses were randomly assigned to: SA-CST alone, SA-CST plus ET, ET alone, or standard care (SC). Patients in SA-CST alone, together with their spouses, attended 12 weekly, 2-h group sessions for training in pain coping and couples skills. Patients in SA-CST + ET received spouse-assisted coping skills training and attended 12-weeks supervised ET. Patients in the ET alone condition received just an exercise program. Data analyses revealed: (1) physical fitness and strength: the SA-CST + ET and ET alone groups had significant improvements in physical fitness compared to SA-CST alone and patients in SA-CST + ET and ET alone had significant improvements in leg flexion and extension compared to SA-CST alone and SC, (2) pain coping: patients in SA-CST + ET and SA-CST alone groups had significant improvements in coping attempts compared to ET alone or SC and spouses in SA-CST + ET rated their partners as showing significant improvements in coping attempts compared to ET alone or SC, and (3) self-efficacy: patients in SA-CST + ET reported significant improvements in self-efficacy and their spouses rated them as showing significant improvements in self-efficacy compared to ET alone or SC. Patients receiving SA-CST + ET who showed increased self-efficacy were more likely to have improvements in psychological disability. An intervention that combines spouse-assisted coping skills training and exercise training can improve physical fitness, strength, pain coping, and self-efficacy in patients suffering from pain due to osteoarthritis.

Exploring the effectiveness of couples interventions for adults living with a chronic physical illness: A systematic review

“…RC led to the greatest improvements in interpersonal outcomes for couples, and had some of the strongest effect sizes overall, which suggests that this may be an important area of need for couples living with chronic illness. Another key observation was that many couples interventions achieved greater effects than the same or similar patient-only intervention across emotional [42], interpersonal [37,43,44], cognitive [41,49], and somatic outcomes [46,48]. This suggests that partner-inclusion may provide benefits beyond that of the content of the intervention itself.…”

“…Six studies compared the couples intervention with a patient-only intervention [35,36,37,38,39,40], eight studies used a patient-only comparison group and a usual care control group [41,42,43,44,45,46,47,48], one study compared two types of couples interventions with a patient-alone comparison group [49], and the remaining twenty compared a couples intervention with usual care or waiting-list controls. Twenty-eight studies reported effect sizes, or provided information to calculate effect sizes.…”

“…When compared with a patient-only or control group, couples interventions based on CBST improved cognitive outcomes including self-efficacy [36,49,38,59] and illness appraisals [41,60,61,39,62].…”

“…Interventions using CBST improved somatic/ physical outcomes including symptom perception [41,42,63,61,48], fitness/ muscle strength [49], sexual limitation [64], physical Quality of Life (QOL) [61], Cholesterol [34], and fear of movement [48]. In comparison with a patient-only/ control group, CBST interventions enhanced behaviours such as dyadic coping [43], medication adherence [65], and increased dietary self-efficacy and spousal support [59].…”

“…An exception to this was a RC focused intervention which incorporated planning and decision-making skills, and homework tasks, which increased self-acceptance, reduced fatigue, and improved functional wellbeing [54]. Partners' also benefited from CBST across cognitive outcomes including partner-rated patient self-efficacy [49], self-efficacy for supporting patients to manage pain/ other symptoms, lower caregiver stress [66], less negative caregiver appraisals, uncertainty, and greater personal self-efficacy [61]. Interventions following this approach also increased physical QOL and active coping, and reduced general symptom distress in partners [61].…”