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Effects of internet-based pain coping skills training before home exercise for individuals with hip osteoarthritis (HOPE trial): a randomised controlled trial

Bennell, Kim L.a,*; Nelligan, Rachel K.a; Rini, Christineb; Keefe, Francis J.c; Kasza, Jessicad; French, Simona,e; Forbes, Andrewd; Dobson, Fionaa; Abbott, J. Haxbyf; Dalwood, Andrewg; Harris, Anthonyh; Vicenzino, Billi; Hodges, Paul W.i; Hinman, Rana S.a

doi: 10.1097/j.pain.0000000000001281
Research Paper
Global Year 2018

This assessor-, therapist-, and participant-blinded randomised controlled trial evaluated the effects of an automated internet-based pain coping skills training (PCST) program before home exercise for people with clinically diagnosed hip osteoarthritis. One hundred forty-four people were randomised to either the PCST group or the comparator group. In the first 8 weeks, the PCST group received online education and PCST, whereas the comparison group received online education only. From weeks 8 to 24, both groups visited a physiotherapist 5 times for home exercise prescription. Assessments were performed at baseline, 8, 24, and 52 weeks. Primary outcomes were hip pain on walking (11-point numerical rating scale) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) at 24 weeks. Secondary outcomes were other measures of pain, quality-of-life, global change, self-efficacy, pain coping, pain catastrophizing, depression, anxiety, stress, physical activity, and adverse events. Primary outcomes were completed by 137 (95%), 131 (91%), and 127 (88%) participants at 8, 24, and 52 weeks, respectively. There were no significant between-group differences in primary outcomes at week 24 (change in: walking pain [mean difference 0.5 units; 95% confidence interval, −0.3 to 1.3] and function [−0.9 units; 95% confidence interval, −4.8 to 2.9]), with both groups showing clinically relevant improvements. At week 8, the PCST group had greater improvements in function, pain coping, and global improvement than comparison. Greater pain coping improvements persisted at 24 and 52 weeks. In summary, online PCST immediately improved pain coping and function but did not confer additional benefits to a subsequent exercise program, despite sustained pain coping improvements.

In people with hip osteoarthritis, an online pain coping skills training program immediately improved pain coping and function but did not confer additional clinical benefits to a subsequent exercise program, despite sustained improvements in pain coping.

aDepartment of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, The University of Melbourne, Carlton, Victoria, Australia

bJohn Theurer Cancer Center, Hackensack University Medical Center, Bergen County, NJ, United States

cDepartment of Psychiatry and Behavioral Sciences, Pain Prevention and Treatment Research Program, Duke University, Durham, NC, United States

dDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

eSchool of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada

fDepartment of Surgical Sciences, Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand

gPhysioworks Health Group, Camberwell, Victoria, Australia

hFaculty of Business & Economics, Centre for Health Economics, Monash University, Melbourne, Victoria, Australia

iFaculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia

Corresponding author. Address: Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia. Tel.: +61 3 8344 4135. E-mail address: k.bennell@unimelb.edu.au (K.L. Bennell).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received August 24, 2017

Received in revised form May 06, 2018

Accepted May 10, 2018

© 2018 International Association for the Study of Pain
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