Cognitive Mediators of Change in Physical Functioning in Response to a Multifaceted Intervention for Managing Osteoarthritis
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Although non-pharmacological interventions have been shown to improve physical functioning in individuals with osteoarthritis (OA), the mechanisms by which this occurs are often unclear. This study assessed whether changes in arthritis self-efficacy, perceived pain control, and pain catastrophizing mediated changes in physical functioning following an osteoarthritis intervention involving weight management, physical activity, and cognitive-behavioral pain management.
Three hundred Veteran patients of 30 primary care providers with knee and/or hip OA were cluster randomized to an OA intervention group or usual care. The OA intervention included a 12-month phone-based patient behavioral protocol (weight management, physical activity, and cognitive-behavioral pain management) plus patient-specific OA treatment recommendations delivered to primary care providers.
Using linear mixed models adjusted for provider clustering, we observed that baseline to 6-month changes in arthritis self-efficacy and pain control partially mediated baseline to 12-month physical functioning improvements for the intervention group; catastrophizing did not.
Findings of a mediating role of arthritis self-efficacy and pain control in intervention-related functional changes are consistent with hypotheses and align with theoretical assertions of the role of cognitions in cognitive and behavioral interventions for chronic pain. However, contrary to hypotheses, catastrophizing was not found to be a mediator of these changes.
KeywordsOsteoarthritis Chronic pain Behavioral intervention Mediation Self-efficacy
This project was supported by the Department of Veterans Affairs, Health Services Research and Development Service (IIR 10-126). This work was also supported by the Center of Innovation for Health Services Research in Primary Care (CIN 13-410) at the Durham Veterans Affairs HealthCare System. Dr. Taylor is funded by a VA Office of Academic Affiliations, Health Services Research and Development Service postdoctoral fellowship (TPH 21-000). Dr. Bosworth is funded by a Veterans Affairs Career Scientist award (08-027).
Compliance with Ethical Standards
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Veterans Affairs.
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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