Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study

TLDR

Overweight and obese osteoarthritis patients experience greater pain and disability than non‑overweight patients. The study evaluated the long‑term effectiveness of a combined pain‑coping skills training and lifestyle weight‑management program for overweight and obese OA patients. Two hundred thirty‑two participants were randomized to a 6‑month PCST + BWM, PCST‑only, BWM‑only, or standard care arm, with pain, disability, and weight outcomes measured at baseline, post‑treatment, and at 6‑ and 12‑month follow‑ups. The combined PCST + BWM arm produced significantly greater improvements in pain, physical disability, stiffness, activity, weight self‑efficacy, and weight, and superior gains in psychological disability, pain catastrophizing, and arthritis self‑efficacy compared with the other three conditions, indicating comprehensive long‑term benefits.

Abstract

Overweight and obese patients with osteoarthritis (OA) experience more OA pain and disability than patients who are not overweight. This study examined the long-term efficacy of a combined pain coping skills training (PCST) and lifestyle behavioral weight management (BWM) intervention in overweight and obese OA patients. Patients (n=232) were randomized to a 6-month program of: 1) PCST+BWM; 2) PCST-only; 3) BWM-only; or 4) standard care control. Assessments of pain, physical disability (Arthritis Impact Measurement Scales [AIMS] physical disability, stiffness, activity, and gait), psychological disability (AIMS psychological disability, pain catastrophizing, arthritis self-efficacy, weight self-efficacy), and body weight were collected at 4 time points (pretreatment, posttreatment, and 6 months and 12 months after the completion of treatment). Patients randomized to PCST+BWM demonstrated significantly better treatment outcomes (average of all 3 posttreatment values) in terms of pain, physical disability, stiffness, activity, weight self-efficacy, and weight when compared to the other 3 conditions (Ps<0.05). PCST+BWM also did significantly better than at least one of the other conditions (ie, PCST-only, BWM-only, or standard care) in terms of psychological disability, pain catastrophizing, and arthritis self-efficacy. Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long-term benefits.