Positive psychosocial interventions improved symptom severity, quality of life, and mood in Veteran Administration patients with osteoarthritis (OA) of the hip and knee, according to a study reported in Pain Medicine.1 Despite affecting more than 20% of the population, OA has no cure.2 In veterans, the prevalence is 25%.3
In the study, 42 patients with OA of the hip or knee (mean age, 67.5±10.3; 16.7% women; pain scale rating, ≥4 on a 0 to 10 scale) were randomly assigned to participate in a positive skill building activity or a neutral control program for 6 weeks.
The primary outcome was measured by the Western Ontario and McMaster Osteoarthritis Index (WOMAC), which includes subdomains of pain, stiffness, and physical function. Secondary outcomes included psychosocial scores as measured by the Positive and Negative Affect Schedule.
Both outcomes were measured at baseline and months 1, 2, 3, and 6. Patients received weekly telephone calls to check their adherence to their respective program for 6 weeks.
The positive program activities asked patients to report 3 good events every day, write thank you letters, and perform 5 acts of kindness daily, in addition to encouraging them to increase the time they spent doing their favorite activities.
The neutral or control program instructed patients to record 3 events that affected them each day, identify slight changes to implement in the next week, record early memories, and account for everything they did on a weekly basis.
Both 6-week programs had a high retention rate; 78.6% of patients completed 5 of the 6 weekly calls and 64.3% completed 5 of the 6 weekly activities. From baseline to 6 months, patients in the positive intervention group, compared with patients in the control group, had significantly reduced their OA symptom severity (−12.6 vs −1.8; P =.02), negative affect (−2.1 vs 0; P =.03), and life satisfaction (1.2 vs −0.5; P =.02).
“Pain and functional difficulty showed large decreases lasting 6 months after the program, and overall life satisfaction increased,” noted lead study investigator Leslie R. M. Hausmann, PhD, assistant professor of medicine at the Center for Health Equity and Promotion, VA Pittsburgh Healthcare System, Pennsylvania, in an interview with Clinical Pain Advisor.
“The magnitude and persistence of these improvements were impressive for such a brief and simple program,” she explained. “While the program needs to be tested in other patient populations, the results of this initial study suggest that a positive psychological approach to pain management can provide great benefits to those suffering from arthritis pain.”
Summary and Clinical Applicability
The 6-week study in a diverse, albeit veteran-only, population demonstrated that positive psychological intervention can reduce OA symptoms.
Limitations and Disclosures
· The study recruited patients from a single VA hospital, which could limit the generalizability to other clinical settings and populations.
· Due to the small sample size, sub-analyses could not be conducted.
The study was supported by the Veterans Integrated Service Network 4 Center for Health Equity Research and Promotion Pilot Research Program. Said A. Ibrahim, MD, MPH, was supported partially by a K24 Mid-Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. C. Kent Kwoh, MD, received research funding from AbbVie, EMD Serono; Data Safety Monitoring Board, Astellas, Novartis; Advisory Board: Thuasne. Michael J. Hannon, MA, serves as a consultant for EMD Serono. Acacia Parks, PhD, is the chief research scientist for Happify, from which she also receives research funding and in which she owns shares.
- Hausmann LRM, Youk A, Kwoh CK, et al. Testing a positive psychological intervention for osteoarthritis. Pain Medicine. 2017;0:1-13. doi:10.1093/pm/pnx141
- Boring MA, Hootman JM, Liu Y, et al. Prevalence of arthritis and arthritis-attributable activity limitation by urban-rural county classification — United States, 2015. MMWR Morb Mortal Wkly Rep. 2017;66(20):527-532. doi:10.15585/mmwr.mm6620a2
- Murphy LB, Helmick CG, Allen KD, et al. Arthritis among veterans – United States, 2011-2013. MMWR Morb Mortal Wkly Rep. 2014;63(44):999-1003.