A pain science education and walking program to increase physical activity in people with symptomatic knee osteoarthritis: A feasibility study
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(Published version)
Date
2020
Authors
Stanton, T.R.
Karran, E.L.
Butler, D.S.
Hull, M.J.
Schwetlik, S.N.
Braithwaite, F.A.
Jones, H.G.
Moseley, G.L.
Hill, C.L.
Tomkins-Lane, C.
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Journal article
Citation
PAIN Reports, 2020; 5(5):e830-1-e830-13
Statement of Responsibility
Tasha R. Stanton, Emma L. Karran, David S. Butler, Melissa J. Hull, Sarah N. Schwetlik, Felicity A. Braithwaite, Hannah G. Jones, G. Lorimer Moseley, Catherine L. Hill, Christy Tomkins-Lane, Carol Maher, Kim Bennell
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Abstract
Introduction: Nine of 10 people with knee osteoarthritis are inactive. Unhelpful pain beliefs may negatively influence physical activity levels. Targeting these unhelpful pain beliefs, through contemporary pain science education (PSE), may provide benefit. Objectives: To evaluate the feasibility of conducting a clinical trial to determine the effect of adding PSE (vs adding sham ultrasound) to an individualised, physiotherapist-led education and walking program in people with painful knee osteoarthritis. Methods: Twenty participants were randomised (1:1) into the PSE group or Control group, each receiving 4 in-person weekly treatments, then 4 weeks of at-home activities (weekly telephone check-in). Clinical outcomes and physical activity (7 days of wristworn accelerometry) were assessed at baseline, 4 (clinical outcomes only), 8, and 26 weeks. A priori feasibility criteria for recruitment, intervention adherence, viability of wrist-based accelerometry, and follow-up retention were set. Perceived intervention credibility, acceptability, and usefulness from participants and clinicians were assessed (ratings, written/verbal feedback). Results: Most feasibility criteria were met. On average, 7 adults/wk were eligible, with 70% recruited. Treatment compliance was high (in-person: 80% PSE; 100% Control; at-home: 78% PSE; 75% Control). Wrist-based accelerometry had .75% valid weartime. Sufficient follow-up rates were not achieved (26 weeks: 65%). Participant and clinician feedback highlighted that PSE was too complex and did not match patient expectations of “physiotherapy”, that sham ultrasound was problematic (clinician), but that both treatments had high credibility, acceptability, and usefulness. Conclusions: Progression to a full trial is warranted. Strategies to increase participant retention, refine the PSE content/delivery, and replace/remove the sham intervention are required.
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Data source: Supplemental digital content, http://links.lww.com/PR9/A67.
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© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.