Background and Objectives: Coping Skills Training (CST) is an intervention that teaches patients specific cognitive and behavioral skills for controlling and decreasing pain. The objectives of this project are to assess the cultural sensitivity and appropriateness of a CST intervention for African American veterans with osteoarthritis (OA), tailor the CST intervention accordingly, and perform a pilot trial of the tailored CST intervention. Methods: Two focus groups will be conducted, each involving 6-8 African Americans who have hip and / or knee OA. These focus groups will involve verbally presenting all previously developed CST intervention components to participants and obtaining feedback about issues of cultural appropriateness via group discussion and individual responses to written questions. The study team will then incorporate ideas and feedback from this focus group into the CST intervention, resulting in elements that can be integrated according to patient preferences. Next, a pilot trial of the new tailored CST intervention will be conducted, involving 30 veterans with hip and / or knee OA; all will take part in the CST intervention. Patients of any racial / ethnic group will be eligible to participate in this phase of the project, because although this research aims to reduce disparities in OA symptoms (particularly among African Americans), the ultimate goal is to develop and test an intervention that is appropriate and effective across racial groups and can be broadly distributed to patients within the VA health care system. The CST intervention will involve one in-person session and 9 weekly telephone calls. A trained CST counselor will deliver all intervention sessions. Intervention sessions will involve teaching coping skills (including cognitive restructuring, relaxation, imagery, and activity pacing) and providing guidance for home practice and use of coping skills during daily life situations. Outcomes will be assessed at baseline and following the intervention. The primary outcome will be the Arthritis Impact Measurement Scales-2; secondary outcomes will include the Coping Strategies Questionnaire and Arthritis Self-Efficacy Scale. Participant feedback about the intervention will also be obtained. Analyses will compare study outcomes at baseline and follow-up, including calculation of effect sizes. Sample size estimates will be generated for a larger clinical trial.
Osteoarthritis (OA) is one of the most common conditions and a leading cause of pain and disability among veterans. African Americans with OA report worse outcomes than Caucasians, and recent data indicate pain coping and other psychological variables are key factors underlying racial disparities in OA-related outcomes. Coping Skills Training (CST) interventions may be an important way to improve OA outcomes among African Americans, but CST has primarily been tested among Caucasians, and the cultural appropriateness and usefulness of existing CST programs among African Americans is not known. CST interventions have also not been studied among veterans. This pilot study is a first step in developing and testing a telephone-based CST intervention to improve pain, function, psychological health, and other outcomes among veterans with OA, with a focus on African Americans.
