Knee Arthroplasty Pain Coping Skills Training (KASTPain): A Randomized Trial

Not Applicable

Completed

Interventions: Behavioral: Pain Coping Skills Training
Behavioral: Arthritis Education
Other: Usual Care

Brief Summary: Patients undergoing knee replacement surgery and who have high levels of pain catastrophizing are at risk for poor outcome. The clinical trial is designed to determine if a pain coping skills training intervention delivered by physical therapists and supervised by psychologists is more effective at reducing pain and improving function and is more cost effective than arthritis education or usual care.

Detailed Description: Approximately 25% of patients following knee arthroplasty have disabling pain following apparently successful surgery. Recent research suggests that pain catastrophizing plays a key role in determining which patients with knee arthroplasty have a poor outcome. In addition to this evidence, a substantial literature suggests that pain coping skills training is effective for patients with chronic pain but the intervention has not been studied for surgical patients with severe arthritic knee pain. We designed the Knee Arthroplasty pain coping Skills Training (KASTPain) trial to address this research need. This Phase III three-arm randomized clinical trial seeks to combine a strong and diverse group of researchers to examine an important and understudied area in the joint arthroplasty literature. The KASTPain trial will be the first to examine the utility of a perioperative pain coping intervention for this substantial population of patients.

Recruitment & Eligibility

Inclusion Criteria

Adults 45 years and older and capable of providing informed consent
Diagnosis of osteoarthritis as determined by participating orthopaedic surgeons
Scheduled for an elective unilateral total or unicompartmental knee arthroplasty no sooner than 1 week and no later than 8 weeks from the time of recruitment
Score of greater than or = to 16 on the Pain Catastrophizing Scale
Score of greater than or = to 5 on the WOMAC Pain Scale
Able to read and speak English

Exclusion Criteria

Scheduled for revision arthroplasty surgery
Underwent contralateral knee arthroplasty surgery or hip arthroplasty surgery within 6 months of currently planned surgery
Unable to or declines study participation
Self-reported diagnosis of rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosis, ankylosing spondylitis
Arthroplasty surgery scheduled because of fracture, malignancy or infection
Scheduled for bilateral arthroplasty surgery
Scheduled to undergo hip or knee arthroplasty within 6 months of current knee arthroplasty
Score of 20 or greater on the PHQ-8 depression scale
Score of less than 3 on the six-item cognitive screener

Arm && Interventions

Group	Intervention	Description
Pain Coping Skills Training	Pain Coping Skills Training	The pain coping skills training will be delivered by physical therapists in eight one-hour sessions by telephone over a 2-month perioperative period. Patients will be taught a variety of skills designed to improve maladaptive pain related thoughts and actions to enhance recovery following arthroplasty.
Arthritis Education	Arthritis Education	The eight one-hour perioperative arthritis education sessions will be delivered by nurse educators via telephone and will use a presentation and discussion format. Figures and discussion sessions will present information on the nature of arthritis, what to expect following knee arthroplasty, treatment of osteoarthritis, the role of exercise, joint protection and making future treatment decisions.
Usual Care	Usual Care	Patients randomly assigned to this arm will undergo usual care following knee arthroplasty.

Primary Outcome Measures

Name	Time	Method
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain Scale	twelve months	A self report scale that quantifies the extent of function limiting pain. The scale ranges from 0 to 20 with higher scores denoting worse activity related pain.

Secondary Outcome Measures

Name	Time	Method
Six-minute Walk Test	twelve months	Distance walked in six minutes.
0 to 10 Verbal Pain Rating Scale	twelve months	An 11 point verbal pain rating scale with higher scores denoting higher pain intensity.
WOMAC Physical Function Scale	twelve months	A self report scale that quantifies the extent of difficulty with everyday activity. The scale ranges from 0 to 68 with higher scores denoting greater difficulty with daily function.
Pain Catastrophizing Scale	twelve months	A scale that quantifies the extent to which a participant catastrophizes about their pain. Score range from 0 to 52 with higher scores denoting greater pain catastrophizing.
Global Rating of Change Scale	twelve months	11 point scale ranging from -5 to +5 with higher scores denoting a greater recovery.
Short Physical Performance Battery	twelve months	The Short Physical Performance Battery measures actual physical performance of four common daily physical activities including standing balance, single standing from a chair, repeated standing from a chair, and a 4 meter walk test. Scores range from 0 to 12 with higher scores indicating better physical performance.

Locations (5): New York University
🇺🇸
New York, New York, United States
Duke University
🇺🇸
Durham, North Carolina, United States
Wake Forest University
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Winston-Salem, North Carolina, United States
Southern Illinois University
🇺🇸
Springfield, Illinois, United States
Virginia Commonwealth University
🇺🇸
Richmond, Virginia, United States