Effects of Pain Neuroscience Education Compared to Biomedical Education on Disease Conceptualization for Older Adults With Knee Osteoarthritis: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 82
- 主要终点
- Osteoarthritis Conceptualization Questionnaire (OACQ) score
研究概览
简要总结
Knee osteoarthritis (OA) is a common cause of pain and disability in older adults. Many people with knee OA believe that pain is primarily caused by joint damage or "wear and tear." These beliefs may contribute to fear of movement, reduced physical activity, and lower engagement in recommended self-management strategies. However, current evidence suggests that pain is influenced by multiple biological, psychological, and social factors and is not always directly related to the degree of structural joint changes visible on imaging.
Pain Science Education (PSE) is an educational approach designed to improve understanding of pain by explaining the complex factors that contribute to the pain experience. In contrast, traditional biomedical education focuses primarily on structural joint pathology as the source of symptoms. Although patient education is recommended as a first-line intervention for knee OA, little is known about whether PSE is more effective than biomedical education in changing beliefs, improving disease understanding, or influencing behavior and physiological responses in older adults with knee OA.
The purpose of this randomized controlled trial is to compare the effectiveness of PSE with standard biomedical education in community-dwelling older adults aged 55 years and older with knee OA. Eighty-two participants will be randomly allocated to receive either PSE or biomedical education through an interactive website-based educational platform.
The primary outcome is osteoarthritis conceptualization, assessed using the Osteoarthritis Conceptualization Questionnaire (OACQ). Secondary outcomes include physiological measures of nervous system functioning, including heart rate variability, electrodermal activity, eye-tracking measures, and temporal summation testing. The study will also assess movement behaviors using accelerometry, including sleep, sedentary behavior, and physical activity across a 24-hour day. Additional outcomes include self-efficacy, fear of movement, knee pain, physical function, well-being, exercise intentions, and intentions regarding knee replacement surgery.
Participants will complete baseline questionnaires and one week of physical activity monitoring before attending an in-person assessment. During the in-person visit, participants will complete physiological and sensory testing and review the educational materials assigned to their group. Participants will then complete a talk-aloud exercise to explore how they interpret and engage with the educational content. Following the visit, participants will complete a second week of physical activity monitoring and follow-up questionnaires.
The investigators hypothesize that participants receiving PSE will demonstrate greater improvements in OA conceptualization than those receiving biomedical education. Exploratory analyses will examine whether PSE is associated with differences in nervous system responses, movement behaviors, self-reported outcomes, and whether these effects differ according to sex and gender. Findings from this study may help inform evidence-based educational strategies for older adults living with knee OA.
详细描述
Knee osteoarthritis (OA) is one of the leading causes of persistent pain and disability among older adults worldwide. Contemporary clinical guidelines consistently recommend patient education, exercise, physical activity, and self-management as first-line interventions for individuals with knee OA. Despite these recommendations, many people with knee OA continue to hold beliefs that pain is primarily a consequence of structural joint damage, cartilage loss, or joint degeneration. These beliefs may contribute to fear of movement, reduced participation in physical activity, lower self-efficacy, and pessimistic expectations regarding recovery and long-term management.
Historically, OA has often been communicated through a biomedical framework emphasizing structural pathology and "wear-and-tear" explanations. Although structural changes can contribute to symptoms, growing evidence suggests that the relationship between imaging findings and pain severity is modest. Structural abnormalities commonly observed on imaging are frequently present in asymptomatic individuals and may reflect age-related changes rather than direct causes of pain. Nevertheless, many patients continue to receive messages that reinforce damage-focused beliefs and may discourage engagement in recommended management strategies.
Pain Science Education (PSE) was developed to address misconceptions regarding pain and musculoskeletal conditions. PSE aims to promote a contemporary understanding of pain by explaining the interaction of biological, psychological, and social contributors to the pain experience. In the context of knee OA, PSE emphasizes that pain is influenced by multiple factors and does not necessarily reflect ongoing tissue damage. It also promotes the understanding that movement and physical activity are generally safe, beneficial, and important components of OA management.
A central objective of PSE is conceptual change. Conceptual change refers to modifications in how individuals understand and interpret their condition and pain experience. Improved conceptualization of OA may facilitate more adaptive beliefs about pain, increase confidence in self-management, and support engagement in evidence-based treatments such as exercise and physical activity. However, little is known about the effectiveness of PSE in older adults with knee OA, particularly when compared with more traditional biomedical educational approaches.
A pilot randomized controlled trial conducted by the investigative team found that participants receiving PSE demonstrated improvements in osteoarthritis conceptualization, whereas participants receiving biomedical education showed little change. Although between-group differences did not reach statistical significance, the pilot study was not powered to detect treatment effects. These findings support the need for a fully powered randomized controlled trial.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 55 Years 至 85 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Community-dwelling adults aged 55 years and older.
- •Self-reported diagnosis of knee osteoarthritis by a physician and/or fulfillment of the National Institute for Health and Care Excellence (NICE) clinical criteria for knee osteoarthritis (activity-related joint pain and either no morning joint-related stiffness or morning stiffness lasting no longer than 30 minutes).
- •Able to provide informed consent.
- •Able to read and speak English.
排除标准
- •Previous exposure to Pain Science Education (PSE), as determined by self-report.
- •Eyeglass prescription exceeding ±6 diopters for spherical correction and/or ±3 diopters for astigmatism, due to eye-tracking equipment requirements.
研究组 & 干预措施
Pain neuroscience education
Participants randomized to the experimental arm will receive a web-based Pain Science Education (PSE) intervention designed for older adults with knee osteoarthritis. The educational content presents contemporary evidence regarding pain and osteoarthritis using a biopsychosocial framework. Topics include the multidimensional nature of pain, the limited relationship between pain and structural joint changes, factors that influence the pain experience, and the role of physical activity and self-management in osteoarthritis care. Educational materials include OA-related images, myths and facts, explanatory concepts, and patient-provider statements. Participants will review the content during a single study session and subsequently complete outcome assessments and a structured talk-aloud activity exploring their interpretation of the educational material.
干预措施: Pain Science Education (Behavioral)
Biomedical Education
Participants randomized to the control arm will receive a web-based biomedical education intervention focused on the structural and pathological aspects of knee osteoarthritis. The educational content presents osteoarthritis primarily as a condition associated with joint degeneration, cartilage loss, and other structural changes commonly described in traditional OA education. Materials include OA-related images, myths and facts, disease-related concepts, and patient-provider statements emphasizing joint pathology and disease progression. Participants will review the content during a single study session and subsequently complete outcome assessments and a structured talk-aloud activity exploring their interpretation of the educational material.
干预措施: Biomedical Education (Behavioral)
结局指标
主要结局
Osteoarthritis Conceptualization Questionnaire (OACQ) score
时间窗: Change from baseline to 1 week post-intervention
Osteoarthritis conceptualization assessed using the Osteoarthritis Conceptualization Questionnaire (OACQ). The OACQ measures participants' understanding and beliefs about osteoarthritis, pain, and physical activity. Higher scores indicate greater alignment with contemporary evidence-based concepts of osteoarthritis and pain.
次要结局
- Heart Rate Variability (HRV)(during the intervention)
- Electrodermal Activity (EDA)(during the intervention)
- Eye tracking(during the intervention)
- Mechanical Temporal Summation(Change from pre-intervention to immediately post-intervention (same study visit))
- 24-hour movement behaviour composition(Change from baseline (7-day monitoring period before intervention) to follow-up (7-day monitoring period after intervention))
- Self-Efficacy for Managing Chronic Disease (SEMCD-6)(Change from baseline to 1 week post-intervention)
- Brief Fear of Movement Scale for Osteoarthritis (BFMSO)(Change from baseline to 1 week post-intervention)
- Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale(Change from baseline to 1 week post-intervention)
- Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living Subscale(Change from baseline to 1 week post-intervention)
- Well-being of Older People (WOOP)(Change from baseline to 1 week post-intervention)
- Intention to Exercise(Change from baseline to 1 week post-intervention)
- Intention to undergo knee replacement surgery(Change from baseline to 1 week post-intervention)
- Computer Proficiency Questionnaire-12 (CPQ-12)(Baseline)
- Attitudes Toward Technologies Questionnaire (ATTQ)(Baseline)
研究者
Lisa Carlesso
Associate Professor
McMaster University