Abstract
BackgroundAfrican Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. One key barrier to addressing these disparities has been limited engagement of African Americans in the development and evaluation of behavioral interventions for management of OA. Pain Coping Skills Training (CST) is a cognitive-behavioral intervention with shown efficacy to improve OA-related pain and other outcomes. Emerging data indicate pain CST may be a promising intervention for reducing racial disparities in OA symptom severity. However, there are important gaps in this research, including incorporation of stakeholder perspectives (e.g. cultural appropriateness, strategies for implementation into clinical practice) and testing pain CST specifically among African Americans with OA. This study will evaluate the effectiveness of a culturally enhanced pain CST program among African Americans with OA.Methods/DesignThis is a randomized controlled trial among 248 participants with symptomatic hip or knee OA, with equal allocation to a pain CST group and a wait list (WL) control group. The pain CST program incorporated feedback from patients and other stakeholders and involves 11 weekly telephone-based sessions. Outcomes are assessed at baseline, 12 weeks (primary time point), and 36 weeks (to assess maintenance of treatment effects). The primary outcome is the Western Ontario and McMaster Universities Osteoarthritis Index, and secondary outcomes include self-efficacy, pain coping, pain interference, quality of life, depressive symptoms, and global assessment of change. Linear mixed models will be used to compare the pain CST group to the WL control group and explore whether participant characteristics are associated with differential improvement in the pain CST program. This research is in compliance with the Helsinki Declaration and was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, Durham Veterans Affairs Medical Center, East Carolina University, and Duke University Health System.DiscussionThis culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities.Trial registrationClinicalTrials.gov, NCT02560922, registered 9/22/2015.
Highlights
Participants are provided with a brief overview of the session formats, as well as the Coping Skills Training (CST) participant manual
This culturally enhanced pain CST program could have a substantial impact on outcomes for African Americans with OA and may be a key strategy in the reduction of racial health disparities
Our goal is to achieve less than 20 % attrition, which is very reasonable based on our prior and ongoing OA studies that include large proportions of African Americans [39, 63, 64]; we will use the same strategies of reminder calls, reminder letters and flexible scheduling to minimize attrition
Summary
Participants are provided with a brief overview of the session formats, as well as the CST participant manual. Participants are provided with a brief rationale for the CST intervention, including components of gate control theory This helps participants to understand how their thoughts, feelings, and behaviors can influence pain, as well as how coping skills can enhance their ability to control pain. Participants are introduced to progressive muscle relaxation in this session This technique enhances one’s ability to identify and decrease tension throughout the body. African Americans bear a disproportionate burden of osteoarthritis (OA), with higher prevalence rates, more severe pain, and more functional limitations. A number of studies have shown that African Americans experience higher prevalence rates of OA than Caucasians, and more severe pain, functional limitations, and other adverse outcomes [9,10,11,12,13]. One review noted that key barriers to moving this research forward have included limited engagement by minority patient groups and a lack of testing of pain management interventions in these groups, including African Americans [15]
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