Evaluation of a problem-solving intervention for patients with arthritis

doi:10.1016/0738-3991(88)90074-2

Patient Education and Counseling

Volume 11, Issue 1, February 1988, Pages 29-42

https://doi.org/10.1016/0738-3991(88)90074-2 Get rights and content

Abstract

A pretest-posttest control group design was used to evaluate a patient education program designed to help people with rheumatoid arthritis (RA) cope with problems posed by their disease. One hundred and one patients were randomly assigned to an intervention or control group. All patients participated in a psychosocial interview in which problems arthritis had caused in their lives were assessed and actual and potential resources patients had for dealing with those problems were identified. In addition, individuals in the intervention group received a problem-solving intervention based, in part, on information collected during the psychosocial interview. Posttest measures showed that the problem-solving intervention helped patients solve their compliance problems and their lifestyle problems, although support for the latter finding was marginal (P < 0.10). All patients who participated in the study, regardless of group assignment, improved on a number of global measures of physical and psychological functioning. This unexpected finding is attributed to unintended positive effects of the psychosocial interview, although regression to the mean can not be definitively ruled out as a competing explanation.

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A problem-solving intervention for cardiovascular disease risk reduction in veterans: Protocol for a randomized controlled trial
2017, Contemporary Clinical Trials
Citation Excerpt :
The PST approach has demonstrated the most efficacy in the treatment of depression [31,32] and other psychological disorders [33–37]. Empirical trials of PST have also found it to be effective in improving the coping capacities of patients with physical illnesses, such as cancer [38], arthritis [39], diabetes [40], and chronic pain [41]. Furthermore, a few studies have found PST to be efficacious in addressing problems related to CVD – such as comorbid CVD and depression [42], hypertension [43], and obesity [44] – though studies of PST to date have not examined it specifically for use in the prevention of CVD.
Health behaviors related to diet, tobacco usage, physical activity, medication adherence, and alcohol use are highly determinative of risk for developing cardiovascular disease. This paper describes a study protocol to evaluate a problem-solving intervention that aims to help patients at risk for developing cardiovascular disease address barriers to adopting positive health behaviors in order to reduce cardiovascular risk.
Eligible patients are adults enrolled in Veterans Affairs (VA) health care who have not experienced a cardiovascular event but are at elevated risk based on their Framingham Risk Score (FRS). Participants in this two-site study are randomized to either the intervention or care as usual, with a target of 400 participants. The study intervention, Healthy Living Problem-Solving (HELPS), consists of six group sessions conducted approximately monthly interspersed with individualized coaching calls to help participants apply problem-solving principles. The primary outcome is FRS, analyzed at the beginning and end of the study intervention (6 months). Participants also complete measures of physical activity, caloric intake, self-efficacy, group cohesion, problem-solving capacities, and demographic characteristics.
Results of this trial will inform behavioral interventions to change health behaviors in those at risk for cardiovascular disease and other health conditions.
Trial registration: ClinicalTrials.gov identifier NCT01838226
Improving function in Age-Related Macular Degeneration: Design and methods of a randomized clinical trial
2011, Contemporary Clinical Trials
Citation Excerpt :
Third, PST encourages behavioral activation, maintains social engagement, and may result in greater use of low vision devices and services, which may further reduce task difficulty. PST is a brief, psychological treatment that teaches problem-solving skills for a variety of conditions (e.g., depression, osteoarthritis, chronic pain, obesity) [15–21]. We previously demonstrated the efficacy of PST as a short-term treatment to prevent depression in patients with AMD [22].
Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in older adults and impairs the ability to read, drive, and live independently and increases the risk for depression, falls, and earlier mortality. Although new medical treatments have improved AMD's prognosis, vision-related disability remains a major public health problem. Improving Function in AMD (IF-AMD) is a two-group randomized, parallel design, controlled clinical trial that compares the efficacy of Problem-Solving Therapy (PST) with Supportive Therapy (ST) (an attention control treatment) to improve vision function in 240 patients with AMD. PST and ST therapists deliver 6 one-hour respective treatment sessions to subjects in their homes over 2 months. Outcomes are assessed masked to treatment assignment at 3 months (main trial endpoint) and 6 months (maintenance effects). The primary outcome is targeted vision function (TVF), which refers to specific vision-dependent functional goals that subjects highly value but find difficult to achieve. TVF is an innovative outcome measure in that it is targeted and tailored to individual subjects yet is measured in a standardized way. This paper describes the research methods, theoretical and clinical aspects of the study treatments, and the measures used to evaluate functional and psychiatric outcomes in this population.
Physical Activity Interventions Among Adults with Arthritis: Meta-Analysis of Outcomes
2008, Seminars in Arthritis and Rheumatism
Citation Excerpt :
Further information about the analyses is available from the senior author. A total of 35 samples from 28 reports were eligible for inclusion (40-67). Twenty reports contributed independent groups ESs calculated from 23 samples (3516 subjects).
Due to reduced physical activity, adults with arthritis experience significant disability and comorbidities including cardiovascular disease. This meta-analytic review integrates results from primary research studies testing interventions to increase physical activity in arthritis patients.
Extensive literature searching strategies were employed to locate published and unpublished empirical studies testing physical activity interventions. Results were coded for studies that had at least 5 participants. Effect sizes (ESs) were calculated for measures of physical activity, pain, and objective and subjective measures of functional ability.
Twenty-eight research studies with 4111 subjects were synthesized. The mean ES for 2-group comparisons (treatment versus control) was 0.69 for physical activity, 0.21 for pain, 0.49 for objectively measured function, and 0.14 for subjectively measured function. This average effect on subjective function is consistent with a Health Assessment Questionnaire mean of 0.64 for treatment subjects as compared with 0.70 for control subjects. For pain assessed using the 0 to 10 visual analog scale, the average effect amounts to a mean of 3.78 for treatment subjects versus 4.33 for control subjects. Control group subjects experienced statistically significant improvements in pain and, to a lesser extent, objectively measured functional ability during study participation.
Physical activity interventions resulted in moderate positive effects on physical activity behavior and small positive effects on pain and physical function outcomes. Future research should examine specific intervention characteristics that result in optimal results, such as frequency, type, and intensity of exercise.
Meta-analysis of patient education interventions to increase physical activity among chronically ill adults
2008, Patient Education and Counseling
This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses.
Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses.
Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples.
These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect.
Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.
An underrated psychotherapic approach: The problem solving therapy
2007, Annales Medico-Psychologiques
La Thérapie de résolution de problèmes sociaux (TRP) est une approche thérapeutique originale intégrant des éléments du modèle du stress de Lazarus et des thérapies comportementales et cognitives dans une orientation psychosociale de la psychopathologie. L’article présente les principaux concepts et paramètres du modèle de résolution de problèmes et ses liens avec le modèle interactionnel du stress. Une description particulière des variables d’orientation au problème et de résolution de problème propre est effectuée. Enfin, l’intérêt pratique de la TRP est souligné par différents exemples d’application clinique et de résultats dans le champ de la psychopathologie.
The capacity to solve problems can be considered as a factor reducing the impact of negative life experiences, thereby contributing to making the adaptation of the individual easier. The Problem Solving Therapy (PST) is an original therapeutic approach integrating elements of the Lazarus stress model and of the cognitive and behaviour therapies emphasizing the social context of psychopathology. In this approach, the resolution of problems plays a mediator role as a coping strategy for an individual in interaction with his environment, with stressing life events, with his emotional arousal and with his physical and psychological wellbeing. The article indicates the main characteristics of the Problem Solving Therapy model and of its link to an interaction stress model in which: “problem solving” is defined as a cognitive and behavioural self-focused process with which a person seeks identification or discovery of adaptive solutions to specific problems to which he is confronted in everyday life; the “problem”, defined as a situation in which an adaptive response or behaviour is needed to maintain an optimal functioning, and the patient does not have this response immediately; the “solution”, defined as the response given to cope with the situation and which corresponds to the solving problem process. A detailed description of the two underlying solving problem processes is also made. The problem orientation, the set of immediate cognitive and emotional responses of an individual when confronted to a problem and the solving itself, that is to say the application of four techniques, each of them having a specific objective in the process. These techniques can be perceived as a behavioural chain in which the “definition and formulation of the problem”, the “generating of alternative solutions”, the “decision making” and finally, the “implementation and the verification of the selected solution” take part. The last part of this article deals with the practical interest of PST with several examples of clinical applications and results in the field of psychopathology. Anxiety disorders (panic disorder, agoraphobia, post-traumatic stress disorder and social phobia), mood disorders (major depressive episodes, suicidal ideation), psychotic disorders, addiction disorders (alcohol dependence) and somatic disorders (handicap, chronic pain, cancer) are put forward. This literature review finally brings to the fore the diversity of the populations who could benefit from the PST (adolescents, students, adults, elderly persons, mentally disordered offenders, nurses, caregivers) and encourages an extension of its application.
The efficacy of problem solving therapy in reducing mental and physical health problems: A meta-analysis
2007, Clinical Psychology Review
This paper describes a meta-analysis of 31 studies that examined the efficacy of problem solving therapy (PST). The meta-analysis, encompassing 2895 participants, showed that PST is significantly more effective than no treatment (d = 1.37), treatment as usual (d = 0.54), and attention placebo (d = 0.54), but not significantly more effective than other bona fide treatments offered as part of a study (d = 0.22). Significant moderators included whether the PST included problem-orientation training, whether homework was assigned, and whether a developer of PST helped conduct the study.

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^☆: The work described in this paper was supported in part by Multipurpose Arthritis Center Grant No. AM 30701 from the National Institutes of Health.

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Original articleEvaluation of a problem-solving intervention for patients with arthritis☆

Abstract

Patient Couns Health Educ

Patient Couns Health Educ

Clin Psychol Rev

Rheumatoid arthritis: Review of psychosocial factors related to etiology, effects and treatment

Psychol Bull

A critical review of compliance studies in rheumatoid arthritis

Arthritis Rheum

Primer on the Rheumatic Diseases

Statistical Power Analysis for the Behavioral Sciences

Resolving Social Conflict

Force-field analysis for psychosocial diagnosis

Patient Educ Newsl

Original article
Evaluation of a problem-solving intervention for patients with arthritis☆