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Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study.

ABSTRACT: To examine effects of activity strategy training (AST), a structured rehabilitation program taught by occupational therapists and designed to teach adaptive strategies for symptom control and engagement in physical activity (PA).A randomized controlled pilot trial was conducted at 4 sites (3 senior housing facilities and 1 senior center) in southeastern, lower Michigan. Fifty-four older adults with hip or knee osteoarthritis (mean +/- SD age 75.3+/-7.1 years) participated. At each site, older adults were randomly assigned to 1 of 2 programs: exercise plus AST (Ex + AST) or exercise plus health education (Ex + Ed). The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period, and were conducted concurrently within each site. Pain, total PA and PA intensity (measured objectively by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors questionnaire), arthritis self-efficacy, and physical function were assessed at baseline and posttest.At posttest, participants who received Ex + AST had significantly higher levels of objective peak PA (P=0.02) compared with participants who received Ex + Ed. Although not statistically significant, participants in Ex + AST tended to have larger pain decreases, increased total objective and subjective PA, and increased physical function. No effects were found for arthritis self-efficacy.Although participants were involved in identical exercise programs, participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education. Future studies will be needed to examine larger samples and long-term effects of AST.

SUBMITTER: Murphy SL

PROVIDER: S-EPMC3046422 | biostudies-literature | 2008 Oct

REPOSITORIES: biostudies-literature

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Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study.

Murphy Susan L SL Strasburg Debra M DM Lyden Angela K AK Smith Dylan M DM Koliba Jessica F JF Dadabhoy Dina P DP Wallis Susan M SM

Arthritis and rheumatism 20081001 10

<h4>Objective</h4>To examine effects of activity strategy training (AST), a structured rehabilitation program taught by occupational therapists and designed to teach adaptive strategies for symptom control and engagement in physical activity (PA).<h4>Methods</h4>A randomized controlled pilot trial was conducted at 4 sites (3 senior housing facilities and 1 senior center) in southeastern, lower Michigan. Fifty-four older adults with hip or knee osteoarthritis (mean +/- SD age 75.3+/-7.1 years) pa ...[more]

PMID: 18821646

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Project description:IntroductionRecent research showed that physical activity (PA)-adjusted pain measures were more strongly associated with radiographic osteoarthritis (OA) severity than an unadjusted pain measure. This exploratory study examined whether PA-adjusted pain measures were more closely associated with other key OA-related measures, compared to unadjusted pain scores.MethodParticipants were 122 Veterans (mean age = 61.2 years, 88.5% male) with knee OA. Baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores were adjusted for accelerometer-derived daily: (1) step counts, (2) minutes of any activity, (3) minutes of moderate or greater intensity activity, (4) minutes of light intensity activity, and (5) energy expenditure. Partial correlations, adjusted for age, sex, and body mass index, estimated associations of unadjusted and PA-adjusted WOMAC pain scores with functional assessments (6-minute walk test, 8-foot walk test, chair stand test, satisfaction with physical function), fatigue (Brief Fatigue Inventory), and anxiety/depressive symptoms (single item).ResultsSignificant (p < 0.05) associations were found in 29 of 36 of models. For the four function-related assessments, step count and energy expenditure-adjusted WOMAC pain scores had stronger associations (partial rs = 0.24-0.48) than WOMAC pain score (partial rs = 0.19-0.25). For fatigue and anxiety/depressive symptoms, WOMAC pain score had stronger, positive associations than most PA-adjusted pain scores. Of the PA-adjusted measures, the strongest associations overall were observed for step count and energy expenditure.ConclusionPA-adjusted pain scores may have particular value for OA studies involving functional assessments, whereas unadjusted WOMAC pain scores are more closely associated with psychological symptoms. This has implications for measurement in clinical OA studies.Trial registrationNCT01058304 KEY POINTS: • Among patents with osteoarthritis, physical activity-adjusted pain measures (particularly those adjusted for step count and energy expenditure) were more strongly associated with measures of physical function, compared to unadjusted pain scores, whereas unadjusted pain score was more strongly associated with a measure of psychological symptoms. • In clinical osteoarthritis research, the most appropriate or sensitive symptom measure (pain vs. physical activity-adjusted pain) may depend on the type of intervention or outcome being studied.

Project description: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://clinicaltrials.gov/ct2/show/NCT04490395.

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Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study.

Publications

Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study.

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