Activity pacing for osteoarthritis symptom management: study design and methodology of a randomized trial testing a tailored clinical approach using accelerometers for veterans and non-veterans

Susan L Murphy, Angela K Lyden, Maria Clary, Michael E Geisser, Raymond L Yung, Daniel J Clauw, David A Williams, Susan L Murphy, Angela K Lyden, Maria Clary, Michael E Geisser, Raymond L Yung, Daniel J Clauw, David A Williams

Abstract

Background: Osteoarthritis (OA) is a prevalent chronic disease and a leading cause of disability in adults. For people with knee and hip OA, symptoms (e.g., pain and fatigue) can interfere with mobility and physical activity. Whereas symptom management is a cornerstone of treatment for knee and hip OA, limited evidence exists for behavioral interventions delivered by rehabilitation professionals within the context of clinical care that address how symptoms affect participation in daily activities. Activity pacing, a strategy in which people learn to preplan rest breaks to avoid symptom exacerbations, has been effective as part of multi-component interventions, but hasn't been tested as a stand-alone intervention in OA or as a tailored treatment using accelerometers. In a pilot study, we found that participants who underwent a tailored activity pacing intervention had reduced fatigue interference with daily activities. We are now conducting a full-scale trial.

Methods/design: This paper provides a description of our methods and rationale for a trial that evaluates a tailored activity pacing intervention led by occupational therapists for adults with knee and hip OA. The intervention uses a wrist accelerometer worn during the baseline home monitoring period to glean recent symptom and physical activity patterns and to tailor activity pacing instruction based on how symptoms relate to physical activity. At 10 weeks and 6 months post baseline, we will examine the effectiveness of a tailored activity pacing intervention on fatigue, pain, and physical function compared to general activity pacing and usual care groups. We will also evaluate the effect of tailored activity pacing on physical activity (PA).

Discussion: Managing OA symptoms during daily life activity performance can be challenging to people with knee and hip OA, yet few clinical interventions address this issue. The activity pacing intervention tested in this trial is designed to help people modulate their activity levels and reduce symptom flares caused by too much or too little activity. As a result of this trial, we will be able to determine if activity pacing is more effective than usual care, and among the intervention groups, if an individually tailored approach improves fatigue and pain more than a general activity pacing approach.

Trial registration: ClinicalTrials.gov: NCT01192516.

Figures

Figure 1
Figure 1
Model of Symptoms, Self-Efficacy, Physical Function and PA in Adults with Osteoarthritis.
Figure 2
Figure 2
Study Flow Chart.

References

    1. Lawrence R, Felson D, Helmick C, Arnold L, Choi H, Deyo R, Gabriel S, Hirsch R, Hochberg M, Hunder G, Jordan JM, Katz JN, Kremers HM, Wolfe F. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26–35.
    1. Dominick KL, Golightly YM, Jackson GL. Arthritis prevalence and symptoms among US non-veterans, veterans, and veterans receiving Department of Veterans Affairs Healthcare. J Rheumatol. 2006;33:348–354.
    1. Arthritis prevalence and activity limitations--United States 1990. MMWR Morb Mortal Wkly Rep. 1994;43:433–438.
    1. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007;15:981–1000.
    1. Dieppe PA, Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005;365:965–973.
    1. Superio-Cabuslay E, Ward MM, Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis: a meta-analytic comparison with nonsteroidal antiinflammatory drug treatment. Arthritis Care Res. 1996;9:292–301.
    1. Warsi A, Wang P, LaValley M, Avorn J, Solomon D. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch Intern Med. 2004;164:1641–1649.
    1. Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden NK, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis: Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage. 2010;18:476–499.
    1. Kerns RD, Rosenberg R. Predicting responses to self-management treatments for chronic pain: application of the pain stages of change model. Pain. 2000;84:49–55.
    1. Marcus BH, Forsyth LH. Tailoring interventions to promote physically active lifestyles in women. Womens Health Issues. 1998;8:104–111.
    1. Shin Y, Hur H, Pender N, Jang H, Kim MS. Exercise self-efficacy, exercise benefits and barriers, and commitment to a plan for exercise among Korean women with osteoporosis and osteoarthritis. Int J Nurs Stud. 2006;43:3–10.
    1. Theis K, Helmick C, Hootman J. Arthritis burden and impact are greater among U.S. women than men: intervention opportunities. J Womens Health. 2007;16:441–453.
    1. Damush T, Wu J, Bair M, Sutherland J, Kroenke K. Self-management practices among primary care patients with musculoskeletal pain and depression. J Behav Med. 2008;31:301–307.
    1. Turk DC, Rudy TE, Kubinski JA, Zaki HS, Greco CM. Dysfunctional patients with temporomandibular disorders: evaluating the efficacy of a tailored treatment protocol. J Consult Clin Psychol. 1996;64:139–146.
    1. Strecher V, Wang C, Derry H, Wildenhaus K, Johnson C. Tailored interventions for multiple risk behaviors. Health Educ Res. 2002;17:619–626.
    1. Prochaska JO, DiClemente CC, Velicer WF, Rossi JS. Standardized, individualized, interactive, and personalized self-help programs for smoking cessation. Health Psychol. 1993;12:399–405.
    1. Greaney M, Riebe D, Garber C, Rossi J, Lees F, Burbank P, Nigg C, Ferrone C, Clark P. Long-term effects of a stage-based intervention for changing exercise intentions and behavior in older adults. Gerontologist. 2008;48:358–367.
    1. van Sluijs EMF, van Poppel MNM, van Mechelen W. Stage-based lifestyle interventions in primary care: are they effective? Am J Prev Med. 2004;26:330–343.
    1. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum. 1993;36:439–446.
    1. Hughes SL, Seymour RB, Campbell R, Pollak N, Huber G, Sharma L. Impact of the fit and strong intervention on older adults with osteoarthritis. Gerontologist. 2004;44:217–228.
    1. Bandura A. In: Self-Efficacy: The Exercise of Control. Freeman WH, editor. 1997.
    1. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31:143–164.
    1. Keefe FJ, Caldwell DS, Williams DA, Gil KM, Mitchell D, Robertson C, Martinez S, Nunley J, Beckham JC, Crisson JE, Helms M. Pain coping skills training in the management of osteoarthritic knee pain: a comparative study. Behav Ther. 1990;21:49–62.
    1. Keefe FJ, Caldwell DS, Williams DA, Gil KM, Mitchell D, Robertson C, Martinez S, Nunley J, Beckham JC, Helms M. Pain coping skills training in the management of osteoarthritic knee pain-II: follow-up results. Behav Ther. 1990;21:435–447.
    1. Hill CL, Parsons J, Taylor A, Leach G. Health related quality of life in a population sample with arthritis. J Rheumatol. 1999;26:2029–2035.
    1. Boutron I, Rannou F, Jardinaud-Lopez M, Meric G, Revel M, Poiraudeau S. Disability and quality of life of patients with knee or hip osteoarthritis in the primary care setting and factors associated with general practitioners' indication for prosthetic replacement within 1 year. Osteoarthritis Cartilage. 2008;16:1024–1031.
    1. Grotle M, Hagen K, Natvig B, Dahl F, Kvien T. Prevalence and burden of osteoarthritis: results from a population survey in Norway. J Rheumatol. 2008;35:677–684.
    1. Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheumatol. 1996;23:1407–1417.
    1. Power JD, Badley E, French M, Wall A, Hawker G. Fatigue in osteoarthritis: a qualitative study. BMC Musculoskelet Disord. 2008;9:63.
    1. Sale JEM, Gignac M, Hawker G. The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis. J Rheumatol. 2008;35:335–342.
    1. Wolfe F. Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia. Rheumatology. 1999;38:355–361.
    1. Fishbain D, Cole B, Cutler RB, Lewis J, Rosomoff HL, Fosomoff RS. Is pain fatiguing? A structured evidence-based review. Pain Med. 2003;4:51–62.
    1. Gignac M, Davis A, Hawker G, Wright J, Mahomed N, Fortin P. "What do you expect? You're just getting older": A comparison of perceived osteoarthritis-related and aging-related health experiences in middle- and older-age adults. Arthritis Rheum. 2006;55:905–912.
    1. Allen K. The value of measuring variability in osteoarthritis pain. J Rheumatol. 2007;34:2132–2133.
    1. Allen KD, Coffman CJ, Golightly YM, Stechuchak KM, Keefe FJ. Daily pain variations among patients with hand, hip, and knee osteoarthritis. Osteoarthritis Cartilage. 2009;17:1275–1282.
    1. Affleck G, Tennen H, Keefe FJ, Lefebvre JC, Kashikar-Zuk S, Wright K, Starr K, Caldwell DS. Everyday life with osteoarthritis or rheumatoid arthritis: independent effects of disease and gender on daily pain, mood, and coping. Pain. 1999;83:601–609.
    1. Hutchings A, Calloway M, Choy E, Hooper M, Hunter DJ, Jordan JM, Zhang Y, Baser O, Long S, Palmer L. The longitudinal examination of arthritis pain (LEAP) study: relationships between weekly fluctuations in patient-related joint pain and other health outcomes. J Rheumatol. 2007;34:2291–2300.
    1. Keefe F, Affleck G, France C, Emery C, Waters S, Caldwell D, Stainbrook D, Hackshaw K, Fox L, Wilson K. Gender differences in pain, coping, and mood in individuals having osteoarthritic knee pain: a within-day analysis. Pain. 2004;110:571–577.
    1. Zautra AJ, Fasman R, Parish BP, Davis MC. Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain. 2007;128:128–135.
    1. Murphy SL, Smith DM, Clauw DJ, Alexander NB. The impact of momentary pain and fatigue on physical activity in women with osteoarthritis. Arthritis Rheumatism. 2008;59:849–856.
    1. Murphy S, Lyden A, Smith D, Dong Q, Koliba J. Effects of a tailored activity pacing intervention on pain and fatigue for older adults with osteoarthritis. Am J Occup Ther. 2010;64:869–876.
    1. Gill J, Brown C. A structured review of the evidence for pacing as a chronic pain intervention. Eur J Pain. 2009;13:214–216.
    1. Beissner K, Henderson C, Papaleontiou M, Olkhovskaya Y, Wigglesworth J, Reid MC. Physical therapists' use of cognitive-behavioral therapy for older adults with chronic pain: a nationwide survey. Phys Ther. 2009;89:456–469.
    1. Murphy SL, Clauw DJ. Activity pacing: what are we measuring and how does it relate to treatment? Pain. 2010;149:582–583.
    1. Golightly YM, Dominick KL. Racial variations in self-reported osteoarthritis symptom severity among veterans. Aging Clin Exp Res. 2005;17:264–269.
    1. Satish S, Postigo LG, Ray LA, Goodwin JS. Chronic rheumatologic symptoms in a tri-ethnic sample of men and women aged 75 and older. J Gerontol A Biol Sci Med Sci. 2001;56:M471–M476.
    1. Skinner J, Weinstein J, Sporer S, Wennberg J. Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients. N Engl J Med. 2003;349:1350–1359.
    1. Ibrahim SA, Siminoff LA, Burant CJ, Kwoh CK. Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients. Arthritis Rheum. 2001;45:340–345.
    1. Bellg A, Borrelli B, Resnick B, Hecht J, Minicucci D, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23:443–451.
    1. Borrelli B. The assessment, monitoring, and enhancement of treatment fidelity In public health clinical trials. J Public Health Dent. 2011;71:S52–S63.
    1. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999;85:1186–1196.
    1. Wolfe F. Fatigue assessments in rheumatoid arthritis: comparative performance of visual analog scales and longer fatigue questionnaires in 7760 patients. J Rheumatol. 2004;31:1896–1902.
    1. Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R. PROMIS Cooperative Group. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol. 2010;63:1179–1194.
    1. The Assessment Center.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL. Defining the clinically important difference in pain outcome measures. Pain. 2000;88:287–294.
    1. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. British Medical Journal Clinical Research Ed. 1982;284:1607–1608.
    1. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum. 1989;32:37–44.
    1. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17:37–49.
    1. Patterson SM, Krantz DS, Montgomery LC, Deuster PA, Hedges SM, Nebel LE. Automated physical activity monitoring: validation and comparison with physiological and self-report measures. Psychophysiology. 1993;30:296–305.
    1. Westerterp KR. Physical activity assessment with accelerometers. Int J Obes Relat Metab Disord. 1999;23:S45–S49.
    1. Swartz AM, Strath SJ, Bassett DR, O'Brien WL, King GA, Ainsworth BE. Estimation of energy expenditure using CSA accelerometers at hip and wrist sites. Med Sci Sports Exerc. 2000;32:S450–S456.
    1. Murphy SL. Review of physical activity measurement using accelerometers in older adults: considerations for research design and conduct. Prev Med. 2009;48:108–114.
    1. Murphy SL, Strasburg DM, Lyden AK, Smith DM, Koliba JF, Dadabhoy DP, Wallis SM. Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Arthritis Rheum. 2008;59:1480–1487.
    1. Cohen J. Statistical Analyses for the Behavioral Sciences. 2. Hillsdale: Lawrence Erlbaum Associates; 1988.
    1. Callahan C, Unverzagt F, Hui S, Perkins A, Hendrie H. Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care. 2002;40:771–781.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj