Effectiveness of Tailored Activity Pacing for Symptomatic Osteoarthritis

Not Applicable

Completed

Interventions: Behavioral: General Activity Pacing
Behavioral: Tailored Activity Pacing

Brief Summary: The primary objective of this project is to examine effectiveness of a tailored pacing intervention on fatigue, pain, and physical function compared to general pacing intervention and usual care groups. A secondary objective is to evaluate the natural history of symptoms and physical disability over time among people with knee and hip osteoarthritis.

Detailed Description: In the United States, osteoarthritis is a growing public health issue and a leading cause of disability among older adults. Almost 50% of users of the Veterans Affairs (VA) system present with osteoarthritis. Veterans are a particularly important group to target for symptom management interventions as they are twice as likely as non-veterans to report chronic joint symptoms and activity limitations. There are few evidence-based symptom management interventions offered by health care professionals, such as occupational and physical therapists, at the time when people are seeking treatment for their symptoms. The proposed activity pacing intervention is individually-tailored to a person's symptom and activity patterns. This tailoring provides a personally-relevant and focused intervention that may help people adopt this strategy into their daily lives.

Recruitment & Eligibility

Inclusion Criteria

Age of 50 years and older
Reported pain for at least 3 months
Mild-moderate pain severity according to the WOMAC pain scale
Radiographic evidence of knee or hip osteoarthritis (Kellgren-Lawrence score of 2 in at least one joint)
Community-dwelling (i.e. own home, apartment, senior residence)
Ambulatory with or without a cane or walker
Adequate cognition to complete study activities (score of 5 on the 6-Item Screener)
Ability to use the Actiwatch-S (Phillips-Respironics, Mini-Mitter, Bend OR)accelerometer to record symptoms and activity patterns (ascertained by completion of a learning module specific to the use of the device in this study)
English-speaking

Exclusion Criteria

Self-reported medical history of conditions with pain and/or fatigue as a known and marked symptom (e.g multiple sclerosis, rheumatoid arthritis)
Medically unstable (e.g. acute conditions or acute presentations of chronic conditions)
Anemia (hemoglobin of <10 for men and <11 for women)
Unmanaged thyroid dysfunction (Thyroid stimulating hormone <.035>5.5 mg/dl)
2 or more days of complete bed rest within the last month
Limb hemiplegia or amputation
Arthroscopic procedure within the previous 2 months
Joint injection within the previous 3 months
Total or partial joint replacement within the previous 6 months
Self-reported illness or conditions that impair cooperation with the study team or ability to complete study procedures
Current enrollee in physical or occupational therapy for symptoms associated with osteoarthritis
Current attendance or attendance within the previous year in a cognitive behavioral therapy program or other self-management program that includes activity pacing instruction
Any other unforeseen exclusion criteria that, by the opinion of the study personnel, would make the participant unable to safely or effectively complete the study.

Arm && Interventions

Group	Intervention	Description
Arm 2	General Activity Pacing	General activity pacing and symptom management (Occupational therapy)
Arm 1	Tailored Activity Pacing	Tailored activity pacing

Primary Outcome Measures

Name	Time	Method
Fatigue-BFI	6 months post-baseline	This is a summary measure of fatigue severity and interference items in which the average of 9 items is taken. Each item is rated on a scale of 0 - 10. A higher score indicates worse fatigue.
Pain- Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)	Baseline	This is a summary of reported pain in specific activities. It is 5 questions with answers ranging from 0 - 4. Total possible score is 20 in which a higher score is worse pain.
Pain- WOMAC	6 months post baseline	This is a 5 item pain scale in which items on a scale of 0 - 4 are summed. A higher score means more pain.
Fatigue- Brief Fatigue Inventory (BFI)	Baseline	This is a summary measure of fatigue severity and fatigue interference items in which the average of 9 items is taken. Each item is rated on a scale of 0 - 10. A higher score is worse fatigue.