Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial.

OBJECTIVES: The aim was to evaluate an Acceptance commitment therapy (ACT) intervention for people with knee or hip osteoarthritis; a related aim was to compare treatment effects from Rasch-transformed and standard scales. METHODS: Participants were recruited from a research database and outpatient rheumatology and orthopaedic clinics at two hospitals. Eligible participants were randomly allocated to either intervention or usual care. Intervention comprised six-sessions of group ACT. Outcomes were assessed two and four months after randomization. Rasch-transformed and standard self-report measures were compared. Qualitative interviews also explored the acceptability of the intervention. RESULTS: Of 87 people assessed for eligibility, 31 (36%) were randomized. The main reason for non-randomization was that participants received surgery. Of the 16 participants randomized to intervention, 64% completed ≥50% of the scheduled group sessions. Follow-up data was complete for 84% participants at two months and 68% at four months. Outcome analysis demonstrated important differences between the Rasch-transformed and standard scales. There were significant differences between the groups in pain. Qualitative interviews with seven participants suggested the intervention was acceptable. CONCLUSIONS: ACT for osteoarthritis is likely to be an acceptable treatment option for people with osteoarthritis. Progress to a definitive trial is warranted. Rasch-transformed outcome scales are preferable in clinical trials where possible. Implications for Rehabilitation Acceptance commitment therapy (ACT) is an effective treatment for many pain conditions andcould be a useful intervention for people with osteoarthritis who have high levels of pain. Rasch analysis is a measurement technique that may enable greater precision in detectingmeaningful treatment effects in routine clinical outcomes. The ACT intervention was successful in reducing pain and sleep difficulties and there werenotable differences in effects between standard and Rasch-transformed scales. In a relatively small trial, ACT may to be an acceptable intervention for people with osteoarthritisand progress to a definitive trial is warranted.

Rasch analysis of the Chronic Pain Acceptance Questionnaire Revised in people with knee osteoarthritis.

OBJECTIVE: To examine the measurement properties of the Chronic Pain Acceptance Questionnaire Revised (CPAQ-R) and its subscales with people with knee osteoarthritis using Rasch analysis. DESIGN: Cross-sectional questionnaire study. PATIENTS: A total of 176 participants with radiographic evidence of osteoarthritis of the knee, as identified by a Kellgren-Lawrence grade ≥ 2, and pain on most days for at least the past month. METHODS: Participants completed the CPAQ-R at home within a set of measures covering different aspects of osteoarthritis pain. The questionnaires were returned by pre-paid envelope. Rasch analysis was conducted on the Activity Engagement and Pain Willingness subscales and the Total scale using Rasch Unidimensional Measurement Models (RUMM2020). RESULTS: The Activity Engagement and Pain Willingness subscales fit the Rasch model following minimal changes, including re-scoring and removal of item 14 due to misfit. Both subscales passed tests of unidimensionality. Although the Total scale could be adjusted to yield adequate fit statistics, it demonstrated multidimensionality. CONCLUSION: The Activity Engagement and Pain Willingness subscales have good measurement properties for 2 distinct factors relevant to pain acceptance. CPAQ-R is a valid measurement tool that may help target and evaluate response to treatments that address low activity engagement and pain willingness in people with osteoarthritis.

Pain phenotype in patients with knee osteoarthritis: classification and measurement properties of painDETECT and self-report Leeds assessment of neuropathic symptoms and signs scale in a cross-sectional study.

OBJECTIVE: Multiple mechanisms are involved in pain associated with osteoarthritis (OA). The painDETECT and Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaires screen for neuropathic pain and may also identify individuals with musculoskeletal pain who exhibit abnormal central pain processing. The aim of this cross-sectional study was to evaluate painDETECT and S-LANSS for classification agreement and fit to the Rasch model, and to explore their relationship to pain severity and pain mechanisms in OA. METHODS: A total of 192 patients with knee OA completed questionnaires covering different aspects of pain. Another group of 77 patients with knee OA completed questionnaires and underwent quantitative sensory testing for pressure-pain thresholds (PPTs). Agreement between painDETECT and S-LANSS was evaluated using kappa coefficients and receiver operator characteristic (ROC) curves. Rasch analysis of both questionnaires was conducted. Relationships between screening questionnaires and measures of pain severity or PPTs were calculated using correlations. RESULTS: PainDETECT and S-LANSS shared a stronger correlation with each other than with measures of pain severity. ROC curves identified optimal cutoff scores for painDETECT and S-LANSS to maximize agreement, but the kappa coefficient was low (κ = 0.33-0.46). Rasch analysis supported the measurement properties of painDETECT but not those of S-LANSS. Higher painDETECT scores were associated with widespread reductions in PPTs. CONCLUSION: The data suggest that painDETECT assesses pain quality associated with augmented central pain processing in patients with OA. Although developed as a screening questionnaire, painDETECT may also function as a measure of characteristics that indicate augmented central pain processing. Agreement between painDETECT and S-LANSS for pain classification was low, and it is currently unknown which tool may best predict treatment outcome.

Personal experience of osteoarthritis and pain questionnaires: mapping items to themes.

PURPOSE: The aim of this study was to examine the correspondence between qualitative and quantitative methods of coding experience of pain reported by participants with osteoarthritis (OA) of the knee. METHODS: A mapping grid was produced to record the correspondence between subthemes that emerged from thematic analysis of interviews with 24 participants with knee OA, and from questionnaire items which were used in a study of 192 knee OA participants. Items were rated according to their degree of correspondence between subthemes and questionnaire items, and an overall correspondence score was produced for each subtheme and questionnaire measure. RESULTS: The subthemes that corresponded well with the questionnaire items were those that related to socio-emotional functioning, the overall experience of pain and the impact of pain on physical functioning. The questionnaire items did not relate to participants' knowledge about their condition and their experience of the medical system. CONCLUSIONS: The study indicated that many aspects of pain experience reported by patients in qualitative interviews are also assessed by commonly used questionnaire outcome measures for people with pain. However, although participants reported that knowledge about their condition and their experience of the medical system were important aspects of the overall pain experience, these are rarely used as outcome measures. Questionnaires that address these additional aspects of the pain experience could be useful to further evaluate the experience of pain and may help to address important concerns raised by patients with OA of the knee.

Rasch analysis of the Nottingham extended activities of daily living scale.

BACKGROUND AND PURPOSE: The Nottingham Extended Activities of Daily Living (EADL) Scale is frequently used in clinical practice and research in rehabilitation to assess patients' independence in activities of daily living. Summative scores are used for this purpose, but this is problematic because the EADL is an ordinal level measurement scale. OBJECTIVES: To examine the fit of data to the Rasch model and to determine how the fit could be improved by making changes to the scale. The appropriateness of using total and subscale (Mobility, Kitchen, Domestic and Leisure) scores in determining change over time was evaluated. METHODS: EADL data (n = 210 stroke patients, 55% male, age range 27­93 years) from a randomized trial of a Stroke family support organiser service were analysed using the Partial Credit model. RESULTS: Rasch analysis did not support the total scale as a unidimensional measure of activities of daily living. However,the subscales exhibited reasonable fit to the Rasch model following re-scoring and removal of items. Item 16 exhibited differential item functioning for age and item 22 differential item functioning for gender. CONCLUSION: The results endorse the use and psychometric properties of the 4 EADL subscales, but not the total scale.Further work to corroborate these findings would be useful.

Time scale similarity and long-term memory for autobiographical events.

We examine the extent to which retrieval from very long-term autobiographical memory is similar when participants are asked to retrieve from widely differing periods of time. Three groups of 20 participants were given 4 min to recall autobiographical events from the last 5 weeks, 5 months, or 5 years. Following recall, the participants dated their events. Similar retrieval rates, relative recency effects, and relative lag-recency effects were found, despite the fact that the considered time scales varied by a factor of 52. These data are broadly consistent with the principle of recency, the principle of contiguity (Howard & Kahana, 2002), and scale similarity in the rates of recall (Brown, Neath, & Chater, 2007; Maylor, Chater, & Brown, 2001). These findings are taken as support for models of memory that predict time scale similarity in retrieval, such as SIMPLE (Brown et al., 2007) and TCM (Howard & Kahana, 2002).