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O Astudypresentation
- 1. Pain Communication and Osteoarthritis: A couples-based Approach Georgia Hoyler April 16, 2009 Research Methods in Psychology PSY185cs
- 2. Overview of presentation Define Osteoarthritis (OA) Prevalence Treatment and Limitations Study Proposal Methods Anticipated Results Future Directions
- 5. Projected Increase in U.S. Arthritis Prevalence http://www.cdc.gov/arthritis/data_statistics/national_data_nhis.htm
- 9. Study Proposal Evaluate the Benefit of Couples-Based Pain Communication Skills Intervention on patient’s Health-Related Quality of Life Health-Related Quality of life: Pain severity, Pain-related Disability, and Psychological Functioning
- 10. Hypotheses: HYP 2: Reduced pain and disability will be associated with reduction in Caregiver strain and improved psychological well-being. HYP 1: Patients in intervention group will have higher HR-QoL scores than controls: lower pain, disability, and psychological distress. HYP 3: intervention group couples also report increased Marriage Satisfaction and Self-efficacy for pain communication compared to controls.
- 11. Approach Patients Patients who did not qualify to participate N=400 eligible couples Baseline Assessment Randomization Couples-therapy Pain Communication Skills Training Control Group Measures administered at 6 weeks, 6 and 12 month follow-ups OA disease education session
- 22. SECONDARY OUTCOMES Percent Difference, Post-Treatment
Notas del editor
- 33.6% = conservative estimate Numbers differ depending on whether collecting radiographic OA (70%), or symptomatic OA [explain diff.]
- Dr. diagnosed arthritis, ages 18+ on graph. This is all types of arthritis, including rheumatoid and other forms. But OA is most prevalent, and will account for most of this increase. Notice that women are more severely affected than men in every graph:
- Couples Therapy equally effective and economical as antidepressants in relieving depression (Leff, Vearnals et al. 2000)
- It’s okay just to hypothesize on these factors and ignore the mechanisms by which they happen, right? (for instance, I don’t need to hypothesize whether self-efficacy for pain communication or quality of marriage is a byproduct of the intervention or something mediated by the level of patient pain, right?)
- -50+ because standard diagnostic age 50+ is American College of Rheumatology criteria for some classifications of OA. -33% of individuals over 65 have osteoarthritis, and risks of side effects from pharm. Treatment are higher in elderly pop. Thus, more likely that a psychosocial intervention would be used in this age group. To Confirm OA: doctor reviews x-ray taken in last 6 months of affected area; if one hasn’t been taken, takes one. X-ray determines stage of severity. Not well correlated w/pain, so patients complete pain and disability subscales of AIMS. Must have chronic pain AND radiographic evidence of OA. Exclusion: will administer revised Symptom Checklist 90 [SCL-90-R], a self-report measure, to screen for current psychiatric illness and will ask participants to report any previous diagnoses. Established validity (cite), use in other studies with arthritic patients (KEEFE). Exclude other forms of RA in attempt to keep pain-related discussion to OA-specific pain. [RA is usually primary cause of pain in RA+OA patients]
- -AIMS=Arthritis Impact Measurement Scale, measures HR-QoL in patient: two of the areas completed in screening (disability and pain, now complete final subscale on psychol. Status) -Both complete BDI and BAI in order to have comparable measurements of Dep. and Anxiety -Measuring Caregiver Strain rather than Caregiver QoL b/c no OA-specific caregiver measure, one accepted caregiver QoL index but includes different aspects of life than AIMS, not comparable (includes measure of material/resourches, social well-being, etc.). Caregiver Strain is an important measure within Caregiver-QoL, found to be correlated with overall QoL.
- Therapists in both group will tape-record conversations to insure reliability among therapists, to be reviewed weekly by supervisor.
- Lorig et al (2005) found that self-administered pain management/educational materials predicted decrease in pain compared to controls, so we DO expect decrease in patient pain within control group here. -HR-QoL is composite of pain, physical disability, and psychological distress. Since pain is decreasing and psychological stress is expecting to decrease as well, we can expect to see an increase in this composite measure of quality of life, esp. in intervention group.
- -Changes we see in control group in Patient disability and pain are due to behavioral modifications from education intervention (increased exercise, better pain monitoring, etc.) -patient psychological distress could be because of beneficial effects of conversation with spouse--even unrelated to pain, can increase intimacy and strengthen marital satisfaction (which is associated with psy. distress); plus regression to the mean phenomenon
- Caregiver strain yields score from 0 to 13
- Self eff. Scale is from 1-100, Marriage satisfaction = 0 to 10 -Expect no within-group differences between caregiver and patient for marriage satis. Or self-eff., but as we predict higher levels of psychological distress to begin with, we also expect that intervention-patient would receive increased benefit from the counseling and would have more decrease in psy. Distress - marriage satisfaction increases for all due to intimacy of sharing thoughts/feelings and setting aside time to talk. B/c intervention requires sharing of personal concerns and feelings, increased sense of intimacy and satisfaction.
- Chart from U.S. Bureau of the Census, rural population is aging and will need these types of interventions more accessible.