Linking Physical Activity to Personal Values: Feasibility and Acceptability Randomized Pilot of a Behavioral Intervention for Older Adults with Osteoarthritis Pain

Jennifer C Plumb Vilardaga, Sarah Kelleher, Allison Diachina, Jennie Riley, Tamara Somers, Jennifer C Plumb Vilardaga, Sarah Kelleher, Allison Diachina, Jennie Riley, Tamara Somers

Abstract

Background Osteoarthritis (OA) pain is common and leads to functional impairment for many older adults. Physical activity can improve OA outcomes for older adults, but few are appropriately active. Behavioral interventions can reduce barriers to physical activity. We developed and tested a brief, novel behavioral intervention for older adults combining values to enhance motivation and strategic activity pacing to improve arthritis-related pain and functioning and increase physical activity. Methods A randomized feasibility and acceptability pilot trial compared Engage-PA to treatment as usual plus fitness tracker (TAU+) in N=40 adults age 65+ with OA pain in the knee or hip. Engage-PA involved two 60-minute telephone sessions. All participants wore a fitness tracker to collect daily steps throughout the study and completed baseline and post-treatment assessments of secondary outcomes (arthritis-related pain and physical functioning, physical activity, psychological distress, psychological flexibility, and value-guided action). The impact of COVID-19 on general wellbeing and physical activity was also assessed. Descriptive statistics were conducted for feasibility and acceptability outcomes. Indicators of improvement in secondary outcomes were examined via change scores from baseline to post-treatment and performing independent samples t -tests to assess for between-group differences. Results Feasibility was high; 100% accrual, low (5%) attrition, and 100% completion of study sessions. Acceptability was high, with 89% finding the intervention "mostly" or "very" helpful. Engage-PA participants demonstrated improvements in arthritis pain severity ( M diff =1.68, p <.05), arthritis-related physical functioning ( M diff =.875, p =.056), and self-reported activity ( M diff =.875, p <.05) from baseline to post-treatment as compared to TAU+. Sixty-three percent of participants provided useable objective daily steps data. Other secondary outcome patterns were not interpretable in this small sample. COVID-19 added additional burden to participants, such that 50% were exercising less, 68% were more sedentary, and 72% lost access to spaces and social support to be active. Conclusions Engage-PA is a promising brief, novel behavioral intervention that has potential to support older adults in improving arthritis-related pain and functioning and increasing physical activity. The feasibility and acceptability of the intervention is particularly notable as most participants reported COVID-19 added more barriers to physical activity, and Engage-PA may be appealing in future studies. Trial Registration: clinicaltrials.gov, NCT04490395, registered 7/29/2020, https://ichgcp.net/clinical-trials-registry/NCT04490395.

Conflict of interest statement

Competing interests: Jennifer Plumb Vilardaga receives royalties from New Harbinger publications. The remaining authors certify that there are no competing interests to disclose.

Figures

Figure 1
Figure 1
CONSORT flow diagram

References

    1. WHO | Information sheet: global recommendations on physical activity for health 65 years and above [Internet]. WHO. [cited 2020 Jan 28]. Available from:
    1. Felson DT. The course of osteoarthritis and factors that affect it. Rheum Dis Clin North Am. 1993. Aug;19(3):607–15.
    1. Fang M, Noiseux N, Linson E, Cram P. The Effect of Advancing Age on Total Joint Replacement Outcomes. Geriatr Orthop Surg Rehabil. 2015. Sep;6(3):173–9.
    1. Marshall K, Hale D. Older Adults and the Opioid Crisis. Home Healthcare Now. 2019. Apr;37(2):117.
    1. Physical Activity Helps Arthritis Pain | CDC; [Internet]. 2019. [cited 2020 Sep 16]. Available from:
    1. Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA. 2014. Jun 18;311(23):2387–96.
    1. Uthman OA, Windt DA van der, Jordan JL, Dziedzic KS, Healey EL, Peat GM, et al. Exercise for lower limb osteoarthritis: systematic review incorporating trial sequential analysis and network meta-analysis. BMJ [Internet]. 2013. Sep 20 [cited 2020 Sep 16];347. Available from:
    1. Singh MAF. Exercise Comes of Age: Rationale and Recommendations for a Geriatric Exercise Prescription. J Gerontol A Biol Sci Med Sci. 2002. May 1;57(5):M262–82.
    1. Physical Activity Fundamental To Preventing Disease [Internet]. ASPE. 2015. [cited 2020 Jan 28]. Available from:
    1. Kanavaki AM, Rushton A, Efstathiou N, Alrushud A, Klocke R, Abhishek A, et al. Barriers and facilitators of physical activity in knee and hip osteoarthritis: a systematic review of qualitative evidence. BMJ Open [Internet]. 2017. Dec 26 [cited 2020 Jan 28];7(12). Available from:
    1. Keefe FJ, Kashikar-Zuck S, Opiteck J, Hage E, Dalrymple L, Blumenthal JA. Pain in Arthritis and Musculoskeletal Disorders: The Role of Coping Skills Training and Exercise Interventions. J Orthop Sports Phys Ther. 1996. Oct 1;24(4):279–90.
    1. Somers TJ, Blumenthal JA, Guilak F, Kraus VB, Schmitt DO, Babyak MA, et al. Pain Coping Skills Training and Lifestyle Behavioral Weight Management in Patients with Knee Osteoarthritis: A Randomized Controlled Study. Pain. 2012. Jun;153(6):1199–209.
    1. Barreto M, Gaynor ST. A single-session of acceptance and commitment therapy for health-related behavior change: Protocol description and initial case examples. Behavior Analysis: Research and Practice. 2019. Feb;19(1):47–59.
    1. Kwasnicka D, Dombrowski SU, White M, Sniehotta F. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychol Rev. 2016. Jul 2;10(3):277–96.
    1. Rahal GM, Gon MCC. A Systematic Review of Values Interventions in Acceptance and Commitment Therapy. International journal of psychology and psychological therapy. 2020;20(3):355–72.
    1. Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy, Second Edition: The Process and Practice of Mindful Change. Guilford Press; 2011. 417 p.
    1. Zhang C-Q, Leeming E, Smith P, Chung P-K, Hagger MS, Hayes SC. Acceptance and Commitment Therapy for Health Behavior Change: A Contextually-Driven Approach. Front Psychol. 2018. Jan 11;8:2350.
    1. Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013. Jun;44(2):180–98.
    1. Plumb JC, Stewart I, Dahl J, Lundgren T. In search of meaning: values in modern clinical behavior analysis. Behav Anal. 2009;32(1):85–103.
    1. Bricker JB, Mull K, Kientz JA, Vilardaga RM, Mercer LD, Akioka K, et al. Randomized, Controlled Pilot Trial of a Smartphone App for Smoking Cessation Using Acceptance and Commitment Therapy. Drug Alcohol Depend. 2014. Oct 1;143:87–94.
    1. Lillis J, Kendra KE. Acceptance and Commitment Therapy for weight control: Model, evidence, and future directions. J Contextual Behav Sci. 2014. Jan;3(1):1–7.
    1. Butryn ML, Forman E, Hoffman K, Shaw J, Juarascio A. A pilot study of acceptance and commitment therapy for promotion of physical activity. J Phys Act Health. 2011. May;8(4):516–22.
    1. VanBuskirk K, Roesch S, Afari N, Wetherell JL. Physical Activity of Patients With Chronic Pain Receiving Acceptance and Commitment Therapy or Cognitive Behavioural Therapy. Behaviour Change. 2014. Jun;31(2):131–43.
    1. Vowles KE, McCracken LM, O’Brien JZ. Acceptance and values-based action in chronic pain: a three-year follow-up analysis of treatment effectiveness and process. Behav Res Ther. 2011. Nov;49(11):748–55.
    1. Keefe FJ, Abernethy AP, C Campbell L. Psychological approaches to understanding and treating disease-related pain. Annu Rev Psychol. 2005;56:601–30.
    1. Somers TJ, Abernethy AP, Edmond SN, Kelleher SA, Wren AA, Samsa GP, et al. A Pilot Study of a Mobile Health Pain Coping Skills Training Protocol for Patients With Persistent Cancer Pain. J Pain Symptom Manage. 2015. Oct;50(4):553–8.
    1. Somers TJ, Kelleher SA, Westbrook KW, Kimmick GG, Shelby RA, Abernethy AP, et al. A Small Randomized Controlled Pilot Trial Comparing Mobile and Traditional Pain Coping Skills Training Protocols for Cancer Patients with Pain. Pain Res Treat. 2016;2016:2473629.
    1. Teo I, Plumb Vilardaga J, Phang F, Pan Y, Shelby RA, Finkelstein E, et al. Behavioral symptom management for patients with advanced breast cancer: The feasibility and acceptability of a cross-cultural intervention. In: Poster Presented at Annual Meeting of the Association for Behavioral And Cognitive Therapies. San Diego, CA; 2017.
    1. O’Sullivan ML, Shelby RA, Dorfman CS, Kelleher SA, Fisher HM, Rowe Nichols KA, et al. The effect of pre-transplant pain and chronic disease self-efficacy on quality of life domains in the year following hematopoietic stem cell transplantation. Support Care Cancer. 2018. Apr;26(4):1243–52.
    1. Kelleher SA, Fisher HM, Winger JG, Somers TJ, Uronis HE, Wright AN, et al. Feasibility, engagement, and acceptability of a behavioral pain management intervention for colorectal cancer survivors with pain and psychological distress: data from a pilot randomized controlled trial. Support Care Cancer. 2021. Sep 1;29(9):5361–9.
    1. Dorfman CS, Kelleher SA, Winger JG, Shelby RA, Thorn BE, Sutton LM, et al. Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities. J Psychosoc Oncol. 2019. Jun;37(3):335–49.
    1. Wang L, Zhang L, Yang L, Cheng-qi H. Effectiveness of pain coping skills training on pain, physical function, and psychological outcomes in patients with osteoarthritis: A systemic review and meta-analysis. Clin Rehabil. 2021. Mar 1;35(3):342–55.
    1. Allen K, Somers T, Campbell L, Arbeeva L, Coffman C, Cene C, et al. Pain coping skills training for African Americans with osteoarthritis: results of a randomized controlled trial. Pain. 2019. Jun;160(6):1297–307.
    1. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26.
    1. Teo I, Vilardaga JP, Tan YP, Winger J, Cheung YB, Yang GM, et al. A feasible and acceptable multicultural psychosocial intervention targeting symptom management in the context of advanced breast cancer. Psychooncology. 2020. Feb;29(2):389–97.
    1. Plumb Vilardaga JC, Winger JG, Teo I, Owen L, Sutton LM, Keefe FJ, et al. Coping Skills Training and Acceptance and Commitment Therapy for Symptom Management: Feasibility and Acceptability of a Brief Telephone-Delivered Protocol for Patients With Advanced Cancer. Journal of Pain and Symptom Management. 2020. Feb 1;59(2):270–8.
    1. Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016. Oct 24;355:i5239.
    1. Warburton DER, Jamnik V, Bredin SSD, Shephard RJ, Gledhill N. The 2020 Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) and electronic Physical Activity Readiness Medical Examination (ePARmed-X+): Health Fit J Can. 2019. Dec 30;12(4):58–61.
    1. Attkisson CC, Zwick R. The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome. Eval Program Plann. 1982;5(3):233–7.
    1. Attkisson CC, Greenfield TK. The UCSF Client Satisfaction Scales: I. The Client Satisfaction Questionnaire-8. In: The use of psychological testing for treatment planning and outcomes assessment: Instruments for adults, Volume 3, 3rd ed. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 2004. p. 799–811.
    1. Meenan RF, Mason JH, Anderson JJ, Guccione AA, Kazis LE. AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire. Arthritis Rheum. 1992. Jan;35(1):1–10.
    1. Topolski TD, LeGerfo J, Patrick DL, Williams B, Walwick J, Patrick MB. The Rapid Assessment of Physical Activity (RAPA) Among Older Adults. Prev Chronic Dis. 2006;[serial online]:Available from: .
    1. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary Psychometric Properties of the Acceptance and Action Questionnaire–II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance. Behavior Therapy. 2011. Dec 1;42(4):676–88.
    1. Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther. 2006. Jan;44(1):1–25.
    1. Graham CD, Gouick J, Krahé C, Gillanders D. A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clin Psychol Rev. 2016. Jun;46:46–58.
    1. Lundgren T, Luoma JB, Dahl J, Strosahl K, Melin L. The Bull’s-Eye Values Survey: A Psychometric Evaluation. Cognitive and Behavioral Practice. 2012. Nov 1;19(4):518–26.
    1. Lundgren T, Dahl J, Hayes SC. Evaluation of mediators of change in the treatment of epilepsy with acceptance and commitment therapy. J Behav Med. 2008. Jun 1;31(3):225–35.
    1. Stoddard J, Kaufman J. Coronavirus Impact Scale. 2020; Available from:
    1. Leon AC, Davis LL, Kraemer HC. The Role and Interpretation of Pilot Studies in Clinical Research. J Psychiatr Res. 2011. May;45(5):626–9.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren