Occupational Therapy-Delivered Cognitive Behavioral Therapy for Symptomatic Knee Osteoarthritis



Status:Completed
Conditions:Arthritis, Osteoarthritis (OA)
Therapuetic Areas:Rheumatology
Healthy:No
Age Range:50 - Any
Updated:4/21/2016
Start Date:March 2013
End Date:January 2015

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Occupational Therapy-Delivered Cognitive Behavioral Therapy for Symptomatic Knee Osteoarthritis: A Pilot Study

Knee osteoarthritis (OA) affects 27 million US adults and is a leading cause of pain and
disability. Non-pharmacological interventions are recommended but are underutilized.
Exercise reduces pain and improves physical function, but benefits tend to wane without a
component to facilitate behavior change. Cognitive behavioral therapy (CBT) has long term
benefits on pain and physical function in individuals with OA, but is not typically offered
in clinical care. CBT could be taught in the context of clinical care by occupational
therapists (OT). OTs help people manage chronic conditions by teaching behavioral strategies
that promote health and function. The purpose of this study is to test the feasibility and
efficacy of an OT-delivered cognitive behavioral therapy program to help people manage their
knee OA.

Knee OA, in particular, is a major driver of health care costs and is also a leading cause
of arthritis-related activity limitations. A common assumption in knee OA treatment is that
relief of joint pain will lead to improvements in physical function. However, many factors
can influence disability in OA, not only the biomechanical factors which have been the focus
of traditional rehabilitation. Although research supports a broader biopsychosocial approach
to knee OA treatment, it has not been broadly adopted into clinical treatments. The
biopsychosocial model posits that pain and disability are not only affected by pathophysical
(e.g., biological) factors, but also psychological (e.g., depression, coping, self-efficacy)
and social factors (e.g., social support, response of significant other).

One approach to offering psychosocial aspects in the context of pain treatment has been via
CBT, a common psychosocial intervention, with evidence supporting its efficacy in OA.
Despite the evidence, CBT is rarely integrated into actual clinical practice for people with
knee OA. Barriers to integration have included limited access to psychologists (particularly
in rural settings), difficulties coordinating primary care physicians with psychological
practices, inconsistent reimbursement of psychological services for OA pain, and
inconsistent standardization of treatments across settings. The current study aims to
overcome barriers that have previously limited access to a biopsychosocial approach to knee
OA treatments by integrating cognitive and behaviorally-based self-management training into
a new rehabilitation intervention offered through occupational therapy, an allied medical
field which commonly teaches behavioral strategies to improve physical function in many
clinical populations. Because this approach will be manualized, it will provide the
opportunity for easy adoption into clinical practice.

Inclusion Criteria:

- community-living

- report of at least mild to moderate pain in knee with osteoarthritis

- clinical determination of knee osteoarthritis

- report of knee pain for > 3 months duration

- ambulatory with or without cane or walker

- has internet access and can use computer

Exclusion Criteria:

- severe physical impairment

- current cancer treatment

- knee injections or surgery in previous 3 months

- using long-acting narcotics

- shift workers

- participation in rehabilitation or behavioral therapy for OA in the previous year
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Ann Arbor, MI
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500 S State St
Ann Arbor, Michigan 48109
(734) 764-1817
University of Michigan The University of Michigan was founded in 1817 as one of the...
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mi
from
Ann Arbor, MI
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