Abstract
Effective use of coping strategies by people with chronic pain conditions is associated with better functioning and adjustment to chronic disease. Although the effects of coping on pain have been well studied, less is known about how specific coping strategies relate to actual physical activity patterns in daily life. The purpose of this study was to evaluate how different coping strategies relate to symptoms and physical activity patterns in a sample of adults with knee and hip osteoarthritis (OA; N = 44). Physical activity was assessed by wrist-worn accelerometry; coping strategy use was assessed by the Chronic Pain Coping Inventory. We hypothesized that the use of coping strategies that reflect approach behaviors (e.g., Task Persistence), would be associated with higher average levels of physical activity, whereas avoidance coping behaviors (e.g., Resting, Asking for Assistance, Guarding) and Pacing would be associated with lower average levels of physical activity. We also evaluated whether coping strategies moderated the association between momentary symptoms (pain and fatigue) and activity. We hypothesized that higher levels of approach coping would be associated with a weaker association between symptoms and activity compared to lower levels of this type of coping. Multilevel modeling was used to analyze the momentary association between coping and physical activity. We found that higher body mass index, fatigue, and the use of Guarding were significantly related to lower activity levels, whereas Asking for Assistance was significantly related to higher activity levels. Only Resting moderated the association between pain and activity. Guarding, Resting, Task Persistence, and Pacing moderated the association between fatigue and activity. This study provides an initial understanding of how people with OA cope with symptoms as they engage in daily life activities using ecological momentary assessment and objective physical activity measurement.
Highlights
Osteoarthritis (OA) is a chronic condition that affects 27 million people in the United States and is a leading cause of disability in adults
In a previous pilot study in which activity pacing behaviors and symptoms of pain and fatigue were measured using ecological momentary assessment (Murphy et al, 2008a), we found that people used pacing more frequently as symptoms were increasing throughout a day instead of using pacing as a pre-planned strategy as would be taught in chronic pain management programs
Results indicate that the sample reported “mild” levels of pain intensity, fatigue, and stiffness and was, on average, obese according to body mass index (BMI) scores
Summary
Osteoarthritis (OA) is a chronic condition that affects 27 million people in the United States and is a leading cause of disability in adults. Not as well studied in OA, is one of the most frequently reported OA symptoms (Wolfe et al, 1996; Power et al, 2008), and one of the strongest predictors of functional disability (Wolfe, 1999). To assess general symptoms and reported physical and mental health, several scales were used. To measure symptom severity and interference, the Brief Pain Inventory (BPI; Keller et al, 2004) and Brief Fatigue Inventory (BFI; Mendoza et al, 1999) were used. Depressive symptoms were measured using the Center of Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977). The Short Form 12 was used to measure mental and physical health domains (Ware et al, 1996). Internal consistency on all of these scales was acceptable ranging from 0.74 on the CES-D to 0.92 on the BFI
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