Treatment Expectation for Pain Coping Skills Training

Abstract

Objectives-This study examined predictors of treatment expectation among osteoarthritis (OA) patients in a multi-site clinical trial of pain coping strategies training (CST).Methods-Patients (N=171) completed a pre-treatment assessment battery that asked questions about treatment expectations, pain coping variables, pain, physical function, psychological distress, quality of life, and depression as well as background demographic and medical variables.Results-Regression analyses indicated that several variables accounted for 21% of the variance in treatment expectations (p < .0001). Patients who were classified as adaptive copers, reported higher self efficacy and social interaction, had higher quality of life, and who had lower levels of affective distress and depression had more positive expectations about engaging in pain coping skills training. Variables that were not associated with treatment expectation were level of pain and physical dysfunction, duration of disease, and disability status as well as demographic variables.Discussion-Thus, while many OA patients will approach pain coping skills training with positive expectations, others have lower expectations. This study suggests that a multidimensional assessment of OA patients with chronic pain can identify those who have higher expectations versus lower expectations. The results suggest that patients who are psychologically distressed are less optimistic about engaging in treatment and that these patients, in particular, may benefit from and need pre-treatment motivational interviewing to enhance their uptake of pain coping skills

Moderators of Effects of Internet-Delivered Exercise and Pain Coping Skills Training for People With Knee Osteoarthritis: Exploratory Analysis of the IMPACT Randomized Controlled Trial (Preprint)

“…In contrast to previous studies exploring moderators of PCST [13] and exercise [14], we found no evidence that age, BMI, expectation of treatment outcome, pain coping style, and education moderated the effect of the intervention relative to the control on changes in pain and function. Amongst the literature there appears to be some heterogeneity in moderators of treatment effects following exercise or PCST interventions for people with chronic pain conditions [32], which might be because of differences in intervention design or delivery across studies.…”

“…The exercise interventions of other studies also differed to ours, where they investigated moderators of aquatic exercise for people with OA [14] or a combined intervention of dietary weight loss and exercise (combining aerobic and resistance training) [33]. In addition, our sample comprised fewer females who were also, on average, younger than those of previous studies [13,14,33]. These differences in delivery mode and frequency/type of exercise/PCST, as well as heterogeneity in sample characteristics and measures of outcomes or moderator variables, might explain the differences between our findings and the limited existing literature.…”

“…Our intervention was unique in that it was remotely-delivered and combined both physical and psychological interventions. Other studies involved face-to-face, supervised exercise programs [14,33], or 10 sessions of PCST delivered face-to-face by nurse practitioners [13]. The exercise interventions of other studies also differed to ours, where they investigated moderators of aquatic exercise for people with OA [14] or a combined intervention of dietary weight loss and exercise (combining aerobic and resistance training) [33].…”

“…There is some evidence that pain coping style, expectation of treatment response, radiographic disease severity, age, and educational level may moderate the effects of a face-to-face PCST intervention on treatment outcomes amongst people with hip and knee OA [13]. Another study found that body mass index (BMI) moderated the effects of a supervised aquatic exercise intervention on changes in quality of life amongst people with OA [14].…”

“…Based on previous research [13][14][15][16][17] and/or theoretical plausibility, we investigated whether the effect of the internet-delivered treatment relative to the control treatment was moderated by each of the following baseline variables: gender, age, level of education (dichotomised as no tertiary training or some tertiary training), employment situation (dichotomised as employed or not employed), pain self-efficacy using the pain subscale of the Arthritis SelfEfficacy Scale [23] (scores ranging from one to ten, with higher scores indicating greater selfefficacy), pain catastrophising using the Pain Catastrophising Scale [24] (scores ranging from 0 to 52, with higher scores indicating greater catastrophising), expectation of treatment effects using a five-point Likert scale ranging from 'no effect' to 'complete recovery' (dichotomised into 'no effect to moderate improvement' or 'large improvement to complete recovery'), and BMI based on self-reported height and weight.…”