Online training program helps patients with knee OA cope with pain

Patients with knee osteoarthritis who completed an online pain coping skills training program reported that the intervention was easy to follow and helped them better control their pain, according to findings published in Arthritis Care & Research.

OssKin Evoke

by Jason Laday, Healio November 7, 2019

“Given that pain is the most common and debilitating symptom experienced by people with osteoarthritis, the development of effective and accessible psychological interventions that help people cope with their pain is important,” Belinda J. Lawford, BMedSci, BHlthSci, PhD, of the University of Melbourne, told Healio Rheumatology.

“Pain coping skills training (PCST) can help people with osteoarthritis learn how thoughts, feelings and behaviors influence pain and teaches skills such as relaxation, goal setting and the use of positive coping thoughts to reduce pain catastrophizing,” she added. “Delivering pain coping skills training online is one potential way to increase accessibility, but at the moment little is known about user perceptions of such programs, including whether they are seen to be safe, effective, or useful.”

To assess the experiences and feelings of patients with knee OA who participated in an online PCST program, Lawford and colleagues conducted a qualitative study nested within the randomized, controlled IMPACT trial. In that trial, a subset of 12 participants aged 50 years and older with persistent knee pain for more than 3 months were invited to use an 8-week online PCST program at home.

Patients with knee OA who completed an online pain coping skills training program reported that the intervention was easy to follow and helped them better control their pain, according to findings. Healio

This program included eight 35- to-45-minute online modules, which included tutorials on brief relaxation practices, activity-rest cycling, pleasant activity scheduling, cognitive restructuring and coping thoughts, pleasant imagery, problem solving and strategies to improve long-term pain coping skills. In addition, the participants also received exercise advice and support from a physiotherapist through Skype. Lawford and colleagues conducted individual semi-structured interviews with the 12 participants. These interviews focused primarily on the online PCST program rather than the physiotherapy intervention.

According to the researchers, patients who completed the PCST program found it easy to understand and follow, and that it was clearly explained and well-presented. In addition, participants reported that the program helped them to better cope with and control their pain. Similarly, the program helped participants improve relaxation, self-pacing and include these new skills into their exercise program. Patients also responded positively to the program’s anonymity and flexibility, which allowed them to work at their own pace and without any outside judgement.

However, patients also found that the content was not always relatable or engaging, with some techniques deemed not useful, too Americanized, time consuming, slow-paced or annoying. In addition, patients reported that a follow-up visit with a clinician would be beneficial. Participants added that they wanted a referral to the program from a trusted source.

“We found that people with knee osteoarthritis who completed a pain coping skills training program online had generally positive experiences, suggesting that it is a broadly acceptable and accessible way to help people manage their pain,” Lawford said.

“Our findings suggest user engagement may be enhanced by making some aspects optional and ensuring the program is delivered in a context-specific way that is relevant to the local culture or patient group,” she added. “The program was perceived to work effectively in tandem with a physiotherapist prescribed exercise program, suggesting that physiotherapists and other clinicians should consider incorporating online pain coping skills training programs in addition to recommended core management approaches like exercise.”

Disclosure: The researchers report no relevant financial disclosures

Source Healio


“I could do it in my own time and when I really needed it”: perceptions of online pain coping skills training for people with knee osteoarthritis, Lawford BJ, Hinman RS, Nelligan RK, Keefe F, Rini C, Bennell KL. Arthritis Care Res (Hoboken). 2019 Oct 18. doi: 10.1002/acr.24093. [Epub ahead of print]

  Further reading

Improving osteoarthritis care by digital means – Effects of a digital self-management program after 24- or 48-weeks of treatment, Dahlberg LE, Dell’Isola A, Lohmander LS, Nero H. PLoS One. 2020 Mar 4;15(3):e0229783. doi: 10.1371/journal.pone.0229783. Full text

Effect of Intra-Articular Sprifermin vs Placebo on Femorotibial Joint Cartilage Thickness in Patients With Osteoarthritis: The FORWARD Randomized Clinical Trial, Hochberg MC, Guermazi A, Guehring H, Aydemir A, Wax S, Fleuranceau-Morel P, Reinstrup Bihlet A, Byrjalsen I, Ragnar Andersen J, Eckstein F. JAMA. 2019 Oct 8;322(14):1360-1370. doi: 10.1001/jama.2019.14735. Full text

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