Background
Methods
Overview of STAART study
STAART participants and recruitment methods
Measures
Characteristic | Total Sample Mean ± SD or N(%) | DVAHCS Mean ± SD or N(%) | UNC Mean ± SD or N(%) |
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Sociocultural Environment | |||
Age | 59.0 ± 10.3 | 57.8 ± 10.0 | 60.2 ± 10.5 |
Female | 122 (49.2%) | 26 (21.0%) | 96 (77.4%) |
Hispanic | 7 (2.9%) | 2 (1.6%) | 5 (4.3%) |
Some education above high school | 187 (75.4%) | 101 (81.5%) | 86 (69.4%) |
Working | 86 (34.7%) | 47 (37.9%) | 39 (31.5%) |
Married or living with partner | 103 (41.5%) | 63 (50.8%) | 40 (32.3%) |
Low Perceived Incomea | 83 (33.6%) | 39 (31.7%) | 44 (35.5%) |
Duke University Religion Index | |||
Attendance at Religious Activities | 4.4 ± 1.4 | 4.1 ± 1.5 | 4.8 ± 1.2 |
Private Religious Activities | 4.0 ± 1.6 | 3.8 ± 1.6 | 4.2 ± 1.5 |
Intrinsic Religiosity | 13.1 ± 2.5 | 13.1 ± 2.4 | 13.2 ± 2.6 |
Biological Vulnerability and Mechanisms | |||
WOMAC Totalb | 53.0 ± 17.8 | 56.0 ± 16.6 | 49.9 ± 18.5 |
WOMAC Pain | 11.0 ± 3.9 | 11.6 ± 3.8 | 10.4 ± 3.9 |
WOMAC Function | 37.0 ± 13.2 | 39.1 ± 12.4 | 34.9 ± 13.7 |
PROMIS Pain Interference Score | 63.8 ± 6.9 | 64.0 ± 6.3 | 63.5 ± 7.5 |
Short Form-12 - Mental | 50.7 ± 11.1 | 49.8 ± 11.6 | 51.5 ± 10.7 |
Short Form-12 - Physical | 33.1 ± 9.1 | 33.1 ± 8.4 | 33.1 ± 9.7 |
Duration of Arthritis Symptoms | 13.1 ± 10.0 | 14.6 ± 10.6 | 11.5 ± 9.1 |
Number of Self-Reported Comorbidities | 8.5 ± 3.9 | 8.2 ± 3.5 | 8.8 ± 4.3 |
Body Mass Index (kg/m2) | 35.2 ± 8.2 | 33.1 ± 6.5 | 37.5 ± 9.1 |
Health Behaviors & Coping Strategies | |||
CSQ – Total Coping Attempts | 93.9 ± 36.6 | 91.9 ± 39.7 | 95.8 ± 33.3 |
CSQ – Diverting Attention | 13.9 ± 8.4 | 12.9 ± 8.6 | 14.8 ± 8.2 |
CSQ – Ignoring Sensations | 14.1 ± 8.7 | 15.0 ± 9.6 | 13.2 ± 7.7 |
CSQ – Coping Self-Statements | 23.6 ± 7.6 | 23.4 ± 8.2 | 23.7 ± 6.8 |
CSQ – Reinterpreting Pain Sensations | 8.9 ± 8.4 | 9.7 ± 8.8 | 8.1 ± 8.0 |
CSQ – Praying, Hoping | 20.8 ± 8.0 | 19.8 ± 8.0 | 21.9 ± 7.9 |
CSQ – Increasing Behavioral Activities | 12.5 ± 7.1 | 11.0 ± 7.0 | 14.0 ± 6.9 |
CSQ – Catastrophizing | 11.4 ± 7.6 | 11.1 ± 7.3 | 11.7 ± 7.8 |
Pain Catastrophizing Scale | 19.8 ± 12.3 | 20.4 ± 12.4 | 19.2 ± 12.1 |
PHQ-8 | 6.2 ± 5.3 | 6.6 ± 5.3 | 5.7 ± 5.3 |
Arthritis Self-Efficacy Scale | 5.9 ± 2.0 | 5.6 ± 2.1 | 6.1 ± 1.8 |
Self-Efficacy for Pain Communication | 78.7 ± 22.0 | 77.4 ± 22.9 | 80.1 ± 21.1 |
Brief Fear of Movement Scale | 14.8 (3.5) | 14.4 (3.9) | 15.2 (3.1) |
Sociodemographics (individual level sociocultural environment domain)
Biological vulnerability and mechanisms (individual level biological domain)
Health behaviors & coping strategies (individual level behavioral domain)
Comparator studies
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Participants: 148 patients with knee pain.
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Intervention: online educational materials, an interactive, automated 8-module pain CST program (PainCOACH), and seven Skype sessions with a physiotherapist for 12 weeks, focusing on a home exercise program.
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Comparator group: online educational materials only.
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Participants: 222 patients with symptomatic knee OA.
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Interventions: pain CST only, exercise only or pain CST/exercise combined. All groups attended 10 individual sessions with a physical therapist for 12 weeks, plus a home program.
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Participants: 113 participants with hip or knee OA
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Interventions: Internet-based PCST (PainCOACH), eight modules in a self-directed manner at a rate of one per week
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Comparator group: assessment-only control group
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Participants: 256 participants with symptomatic knee or hip OA
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Intervention: 10 individual weekly sessions of pain CST
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Comparator group: usual care
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Participants: 111 patients with symptomatic knee OA
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Intervention: CBT program for pain management, delivered in 6 weekly group sessions led by both a psychologist and a physiotherapist
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Comparator group: regular general practitioner care only
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Participants: 367 individuals with symptomatic OA and insomnia,
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Interventions: CBT for pain and insomnia, CBT for pain or education. CBT interventions were delivered in groups at primary care clinics and consisted of 6 weekly 90-min sessions.
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Comparator group: usual care
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Participants: 232 individuals with symptomatic knee OA
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Interventions: pain CST plus lifestyle behavioral weight management (BWM), pain CST only, BMW only. Pain CST only and BWM only interventions had 12 weekly 60-min sessions, followed by bi-weekly 60-min sessions for 12 weeks. The BWM only group also had three weekly supervised sessions weekly for the first 12 weeks. The pain CST + BWM group had 12 weekly 120 min sessions, in addition to 3 weekly supervised exercise sessions, followed by bi-weekly 120-min sessions for 12 weeks.
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Comparator group: standard care
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Participants: 418 individuals with knee pain.
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Interventions: individual rehabilitation, group rehabilitation (8 patients per group). Both individual and group rehabilitation involved 12 sessions (twice weekly for 6 weeks), supervised by a physiotherapist. Content included instruction in pain coping and self-management, as well as an individualized progressive exercise program.
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Comparator group: usual care
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Participants: 88 married persons with knee OA
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Interventions: spouse assisted pain CST, conventional pain CST with no spouse involvement arthritis education-spousal support control. Participants in all three interventions met in groups of 4 to 6 patients (or couples) for 10 weekly, 2-h group sessions.
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Participants: 99 patients with knee OA
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Interventions: pain CST, arthritis education. Both interventions met in small groups (6 to 9 patients) for 10 weekly 90-min sessions.
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Comparator: standard care control
Results
Participant Characteristic | STAART | Bennell et al, 2017 [45] | Bennell et al, 2016 [55] | Rini et al, 2015 [57] | Broderick et al, 2014 [58] | Helminen, 2014 [59] | Vitiello, 2013 [60] | Somers et al, 2012 [25] | Hurley, 2007 [61] | Keefe et al, 1996 [46] | Keefe et al, 1990 [62] |
---|---|---|---|---|---|---|---|---|---|---|---|
Sociocultural Environment | |||||||||||
Geographic Region | United States (Central North Carolina) | Australia (7 of 8 states) | Australia (Melbourne and Brisbane) | United States (Central North Carolina) | United States (New York, Virginia and North Carolina) | Finland (Kuopio, Eastern Finland) | United States (Washington State) | United States (Central North Carolina) | United Kingdom (Southeast London) | United States (Central North Carolina) | United States (Central North Carolina) |
Agea | 59.0 ± 10.3 | 61.2 ± 7.1 | 63.4 ± 8.1 | 67.6 ± 9.4 | 67.2 ± 9.5 | CBT: 64.5 ± 7.3 Control Group: 62.8 ± 7.2 | 73.0 ± 8.0 | 58.0 ± 10.4 | Individual Rehab: 66 (50-91) f Group Rehab:68 (51-84) Control Group: 67 (51-89) | 62.6 ± 10.1 | 64.0 ± 11.5 |
Female | 49% | 56% | 60% | 81% | 77% | 69% | 78% | 79% | 70% | 61% | 72% |
Race | 100% African American | -- | -- | 70% White 29% African American 2% Other | 13% Non-white | -- | 9% Non-white | 38% Non-white | -- | -- | -- |
Ethnicity | 3% Hispanic/Latino | -- | -- | 11% Hispanic/ Latino | -- | -- | -- | -- | -- | -- | |
Education | 75% Above High School | 75% Above High School | 61% Above High School | 71% Above High School | 72% Above High School | -- | -- | 86% Above High School | -- | -- | -- |
Work Status | 35% Currently Working | 57% Currently Working | 51% Currently Working | 21% Currently Working | 30% Currently Working | 68% Senior High/ Vocational School or more | 86% Above High School | -- | -- | -- | -- |
Marital Status | 41% Married/Living with Partner | -- | -- | 62% Married/Living with Partner | 63% Married/Living with Partner | 21% Currently Working 66% Married/Living with Partner | 78% Retired | -- | -- | -- | -- |
Biological Vulnerability & Mechanisms | |||||||||||
WOMAC Total Scorea | b53.0 ± 17.8 c53.7 ± 19.1 | -- | -- | -- | -- | -- | - | bIndividual Rehab: 37.5±19.4 Group Rehab: 39.1±19.7 Control Group: 38.6±19.6 | -- | -- | |
WOMAC Pain Subscale Scorea | b11.0 ± 3.9 c55.0 ± 19.4 | b CST + Exercise: 9.0 ± 2.4 Control: 9.2 ± 2.5 | b Exercise: 8.6 ± 2.7 CST: 8.7 ± 2.8 CST + Exercise: 9.0 ± 2.8 | -- | c 54.8 (17.4) | c CBT: 57.6 (53.9−61.3) eControl Group: 56.4 (52.9−60.0) | -- | cCST+Weight Management (WM): 47.7 (42.1-55.3) e WM: 42.6 (37.7-47.5) CST: 42.8 (42.1-53.3) Control Group: 43.4 (37.4-49.5) | bIndividual Rehab: 7.4 ±4.0 Group Rehab: 7.69±4.1 Control Group: 7.7±4.0 | -- | -- |
WOMAC Function Subscale Scorea | b37.0 ± 13.2 c 53.7 ± 19.7 | b CST + Exercise: 33.1 ± 8.0 Control: 32.5 ± 8.3 | b Exercise: 34.3 ± 7.2 CST: 35.0 ± 7.4 CST + Exercise: 35.6 ± 7.3 | -- | c 54.6 (17.1) | c CBT: 53.0 (48.1−57.9) e Control Group: 48.4 (43.1−53.7) | -- | cCST+ WM: 47.7 (42.2-53.1) e WM: 44.3 (39.5-49.0) CST: 46.2 (41.1-51.3) Control Group: 46.1 (39.7-52.5) | bIndividual Rehab: 26.4±14.7 Group Rehab: 27.9 ±14.7 Control Group: 27.2±14.6 | -- | -- |
Arthritis Impact Measurement Scales 2- Pain Subscalea | -- | -- | -- | Internet CST: 4.8 ± 1.7 Control Group: 5.1 ± 1.8 | 5.1 ± 2.1 | CST+WM: 5.8 (5.3-6.2) WM: 5.3 (4.9–5.7) CST: 5.6 (5.2–6.0) Control Group: 5.5 (4.9–6.1) | -- | CST: 5.4 ± 2.1 Spouse Assisted CST: 5.1 ± 1.7 Control Group: 5.2 ± 2.2 | CST: 5.4 ± 2.1 Arthritis Education: 5.6 ± 1.9 Control Group: 5.8 ± 1.62 | ||
Arthritis Impact Measurement Scales 2 - Physical Function Subscalea | -- | -- | -- | Internet CST: 1.7 ± 1.3 Control Group: 1.8 ± 1.0 | 1.8 ± 1.2 | -- | -- | CST+WM: 1.7 (1.4–1.9) WM: 1.8: (1.1–1.7) CST: 1.6: (1.3–1.8) Control Group: 1.6 (1.2–1.9) | - | CST: 1.8 ± 0.9 Spouse Assisted CST: 1.7 ± 1.1 Control Group: 1.6 ± 0.7 | CST: 2.0 ± 1.0 Arthritis Education: 2.1 ± 1.22 Control Group: 1.9 ± 1.2 |
Years with Arthritis Symptomsa | 13.1 ± 10.0 | CST + Exercise: 15% < 2 years, 51% 2-10 years, 34% >10 years Control: 32% < 2 years, 47% 2-10 years, 20% >10 years | Exercise: 6.0 (3-10)d CST: 5.5 (4-10) CST + Exercise: 5.5 (2-10) | -- | 13.8 ± 9.9 | CBT: 8.9 ± 8.7 Control Group: 6.6 ± 4.5 | -- | -- | Individual Rehab: 7 (3–15) d Group Rehab: 5 (2.5–11) Control Group: 6 (3–15) | -- | -- |
Number of Comorbiditiesa | 8.5 ± 3.9 | -- | -- | 1.3 ± 1.1 | -- | CBT: 5.3 ± 2.8 Control Group: 4.9 ± 3.6 | -- | -- | -- | -- | -- |
BMI, kg/m2 a | 35.2 ± 8.2 | 31.4 ± 8.0 | 31.3 ± 6.1 | -- | 33.4 ± 8.0 | CBT: 30.1 ± 6.0 Control Group: 29.9 ± 6.3 | -- | CST+ WM: 34.1 (33.0–35.2) WM: 33.5 (32.4–34.7) CST: 34.4 (33.3–35.5) Control Group: 34.1 (32.8–35.4) | Individual Rehab: 30.0 (18–45) f Group Rehab: 30.18 (20–50) Control Group: 30.3 (20–51) | -- | -- |
Health Behaviors and Coping Strategies | |||||||||||
Coping Skills Questionnaire – Total Coping Attemptsa | 93.9 ± 36.6 | CST + Exercise: 61.7 ± 24.9 Control: 65.7 ± 24.9 | -- | -- | -- | -- | -- | -- | -- | CST: 69.2 ± 26.7 Spouse Assisted CST: 67.8 ± 23.2 Control Group: 58.9 ± 22.3 | -- |
Coping Skills Questionnaire – Catastrophizing Subscale a | 11.4 ± 7.6 | -- | -- | -- | 7.0 ± 6.4 | -- | -- | CST+WM: 7.4 (5.5–9.3) WM: 6.6 (4.8–8.2) CST: 7.2 (5.5–8.9) Control Group: 6.9 (4.9–8.9) | -- | -- | -- |
Pain Catastrophizing Scalea | 19.8 ± 12.3 | CST + Exercise: 8.8 ± 9.2 Control: 10.1 ± 9.6 | Exercise: 14.9 ± 8.1 CST: 14.8 ± 9.3 CST+ Exercise: 14.4 ± 9.7 | -- | -- | CBT: 16.9 (13.8-20.0) e Control Group: 13.5 (10.7-16.2) | -- | -- | -- | -- | |
Arthritis Self-Efficacy Scalea | 5.9 ± 2.0 | --. | -- | Internet CST: 6.7 ± 1.8 Control Group: 6.3 ± 2.1 | 6.0 ± 1.9 | -- | -- | -- | -- | -- | -- |