The leading cause of disability in the U.S. is arthritis, affecting approximately 60 percent of those over 65 years of age. Biomedical treatments are limited in their ability to curb osteoarthritis (OA) disease progression and to eliminate pain and functional impairment. Health-related quality of life measures consistently document significant impairment in persons with arthritis. Efficacy trials have documented that Pain Coping Skills Training (CST) for arthritis reduces pain, improves physical and social functioning, increases self-efficacy, and reduces psychological distress. Despite this, CST is unavailable to the vast majority of OA patients. Increasing patient access to CST will require an innovative healthcare model. Ideally, CST should be integrated into patients'community medical settings. Among providers in these settings, nurse practitioners (NP) with their training in patient education, seem well-suited to deliver CST. This application is the first effectiveness trial -bringing CST from academic settings into community primary care offices where NPs will be trained to deliver manualized, 10-session CST. A randomized, controlled (treatment vs. usual care) multi- site trial (N=272) for OA patients with chronic pain is proposed. Intent-to-treat analyses will evaluate whether this treatment delivery model yields significant benefits compared with a usual-care control group. Assessments of pain, physical and psychological disability, self-efficacy, pain coping skills, and quality of life will be conducted pre-treatment, post-treatment, and at 6-month, 1-, 2-year follow-ups. Cost-effectiveness analyses will be conducted. This study will make important contributions to the science of effectiveness research through comprehensive assessment of outcomes specific to effectiveness research. Analyses will examine reach into the target population, assessment of treatment fidelity by NPs, patient uptake of treatment, consumer satisfaction, and utilization of medication and other arthritis treatments. If this trial is successful, it will set the stage for subsequent studies to investigate innovative strategies to enhance maintenance of CST effects, to incorporate telephone and computer delivery of CST, and to conduct health economic analyses. This research will test an innovative health care delivery model designed to make pain coping skills training (CST) more widely available to patients with arthritis. CST has been shown to improve patients'functioning and quality of life beyond what medications and other medical treatment offer. This R01 reapplication proposes to examine the effectiveness of having nurse practitioners in primary care practices deliver a psychological intervention--Pain Coping Skill Training (CST) -- to osteoarthritis patients. Patients'pain, psychological disability, self-efficacy, pain coping skills, and quality of life as well as cost effectiveness will be measured.
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