Occupational Therapy-Delivered Cognitive Behavioral Therapy for Symptomatic Knee Osteoarthritis

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