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Effectiveness of a cognitive-behavioural group intervention for knee osteoarthritis pain: a randomized controlled
Eeva-Eerika Helminen1, Sanna H Sinikallio2, Anna L Valjakka3
1Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland Psychiatry, City of Helsinki Health Centre, Helsinki, Finland eeva-eerika.helminen@fimnet.fi.
Objective:
To assess the effectiveness of a six week cognitive-behavioural group intervention in patients with knee osteoarthritis pain.
Design:
Single-blinded randomized controlled trial.
Study Setting:
Primary care providers in a medium-sized city in Finland.
Patients:
A total of 111 participants aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2-4) of knee osteoarthritis were included.
Interventions:
In the intervention group, 55 participants attended a cognitive-behavioural training programme for pain management with six weekly group sessions supervised by a psychologist and a physiotherapist. Concurrently, they and the 56 participants of the control group continued in ordinary GP care that was not altered by the study.
Main Measures:
The primary outcome on three-month and 12-month follow-up was the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index pain subscale. Secondary outcome measures included self-reports of pain and physical function, health-related quality of life, and a comprehensive set of psychological questionnaires.
Results:
Mixed model results showed no significant differences between the intervention and control group for any measures of pain or function. A significant difference between the groups was found in the Pain Self-Efficacy Questionnaire (Pr = 0.022) in favour of the control group, and in the RAND-36 emotional well-being subscale in favour of the intervention group (Pr = 0.038). Conventional group comparisons of mean follow-up values showed no significant differences in any of the outcome variables.
Conclusion:
This trial could not confirm the hypothesized advantage of a cognitive-behavioural training programme over ordinary GP care in knee osteoarthritis pain patients.
Trial Registration:
Current Controlled Trials ISRCTN64794760.
