Internet-Based Osteoarthritis Pain Coping Skills Intervention

Twenty-one million Americans live with osteoarthritis (OA), a progressive joint disease that
causes stiffness, pain, reduced range of motion, distress, and decrements in physical,
social, and role functioning. Medical treatments for OA pain are limited and present risks,
especially for older populations. However, cognitive behavioral pain coping skills
interventions have proven effective for decreasing OA pain, disability, and distress.
Unfortunately, existing programs reach a limited number of patients because they require
patients to travel to receive in-person training. There is a need for interventions that
address the needs of a larger proportion of the rapidly growing population of people whose
functioning and quality of life are severely diminished by OA. Delivering proven pain
management interventions via the Internet is a promising way to address this need, especially
in light of increasing use of the Internet by older Americans. To be most effective, an
Internet-based intervention would need to mimic key features of in-person interventions. The
proposed intervention will do that by translating a proven in-person pain coping skills
protocol into an interactive Internet-based application that uses multimedia and expert
systems technology to mimic in-person interventions. It will provide individualized feedback,
interactive problem solving, and animated demonstrations, and it will incorporate learning
techniques from Bandura's Social Cognitive Theory, including modeling, mastery experiences,
and social reinforcement. The project includes two phases, corresponding to two specific
aims. In Phase I the investigators will translate the in-person intervention for delivery on
the Internet. This phase will including gathering feedback from patient and expert therapist
focus groups, which will help refine the program. In Phase II the investigators will conduct
a small-scale randomized controlled trial that will enable us to examine and refine features
designed to increase motivation and adherence over the course of the 8-week Internet-based
intervention. The trial will also enable the investigators to demonstrate its feasibility,
tolerability, safety, and promise. The investigators hypothesize that the trial will
demonstrate the effectiveness of the Internet for delivery of this OA pain coping skills
intervention. Taken together, these activities will prepare the program for testing in a
full-scale randomized controlled trial in the next stage of this research. The promise of
this project is enhanced by the multi-disciplinary research team, which has expertise in the
conduct of cognitive behavioral interventions that teach OA patients to use coping skills to
manage their pain, developing and implementing individualized computerized feedback reports
using expert systems technology, and development of engaging, user-friendly, interactive
computer-based programs for learning and assessment. Relevance: This Internet-based OA pain
coping skills intervention targets a significant individual and public health problem and
expands access to an empirically-supported pain self-management program so that it can reach
a greater proportion of the large and growing population of people suffering from OA pain and
related disability.

Inclusion Criteria:

- A formal clinical diagnosis of OA affecting one or both knees or hips

- Significant OA pain

- Must be aged 18 or older

- Must be English speaking

Exclusion Criteria:

- Not fluent in English

- Have less than 7th grade English reading proficiency

- Show signs of cognitive impairment that would prevent comprehension of consent
procedures or study measures and procedures

- Have a medical condition that would contraindicate safe participation in the study (as
determined by study physician)