Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: Long-term followup results

Objective, To evaluate the long-term effects of a spouse-assisted coping sk ills intervention in patients with osteoarthritis (OA)of the knees, and to evaluate how pre- to posttreatment changes in marital adjustment and self-e fficacy relate to long-term improvements in pain, psychological disability: physical disability, pain coping, and pain behavior. Methods. A followup study was conducted with 88 OA patients who had been ra ndomly assigned to 1 of 3 treatment conditions: 1) spouse-assisted coping s kills training (spouse-assisted CST), 2) a conventional CST intervention wi th no spouse involvement, and 3) an arthritis education-spousal support (AE -SS) control. condition. To evaluate long-term outcome, comprehensive measu res of self-efficacy, marital adjustment, pain, psychological disability, p hysical disability pain coping, and pain behavior were collected from these individuals at 6 and 12 months posttreatment. Results. Data analysis revealed that, at 6-month followup, patients in the spouse-assisted CST condition scored higher on measures of coping and self- efficacy than those in the AE-SS control group. At 6-month followup, patien ts who received CST without spouse involvement showed a significantly highe r frequency of coping attempts and reported higher levels of marital adjust ment than those in the AE-SS control group. At 12-month followup, patients in the spouse-assisted CST condition had significantly higher overall self- efficacy than those in the AE-SS control condition. In addition, patients i n both the spouse-assisted CST and CST only conditions tended to show impro vements in physical disability at the 12-month followup. Individual differe nces in outcome were noted at the 12-month followup. Patients in the spouse -assisted CST condition who reported initial (pre- to posttreatment) increa ses in marital adjustment had lower levels of psychological disability, phy sical disability: and pain behavior at 12-month followup. However, for pati ents in the conventional CST and AE-SS control conditions, increases in mar ital adjustment occurring over the initial phase of treatment were related to increases in pain and decreases in scores on the Pain Control in Rationa l Thinking factor of the Coping Strategies Questionnaire. Finally, patients in the spouse-assisted CST condition who showed pre- to posttreatment incr eases in self-efficacy were more likely to show decreases in pain, psycholo gical disability, and physical disability at 12-month followup. Conclusions. These findings suggest that spouse-assisted CST can enhance se lf-efficacy and improve the coping abilities of OA patients in the long ter m. Individual differences in the long-term outcome of spouse-assisted CST w ere noted, with some patients (those showing increases in marital satisfact ion and self-efficacy) shorting much better outcomes than others.