Improving Patient Reported Outcomes and Preventing Depression and Anxiety in Older Adults With Knee Osteoarthritis: Results of a Sequenced Multiple Assignment Randomized Trial (SMART) Study.
Aged
Anxiety Disorders
/ prevention & control
Cognitive Behavioral Therapy
/ methods
Comorbidity
Depressive Disorder, Major
/ prevention & control
Female
Humans
Male
Middle Aged
Osteoarthritis, Knee
/ psychology
Pain
/ psychology
Patient Reported Outcome Measures
Psychiatric Status Rating Scales
Severity of Illness Index
Knee arthritis
anxiety
cognitive behavioral therapy
depression
physical therapy
prevention
Journal
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
ISSN: 1545-7214
Titre abrégé: Am J Geriatr Psychiatry
Pays: England
ID NLM: 9309609
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
23
08
2018
revised:
27
02
2019
accepted:
18
03
2019
pubmed:
3
5
2019
medline:
4
9
2020
entrez:
4
5
2019
Statut:
ppublish
Résumé
Older adults with knee osteoarthritis (OA) and comorbid subsyndromal depressive symptoms are at elevated risk for incidental major depression or anxiety disorders. Using an indicated prevention paradigm, the authors conducted a sequenced multiple assignment randomized trial (SMART) to: 1) evaluate the effect of cognitive behavioral therapy (CBT) and physical therapy (PT), together with the temporal ordering of these interventions, on patient-reported global impression of change (P-GIC), mood, anxiety, and pain; and 2) compare the strategies' impact on incidence of common psychiatric disorders over 12-months. This intervention development trial compared four adaptive strategies delivered in two stages (each up to 8 weeks), contrasted with enhanced usual care (EUC). The strategies were CBT followed by an increased dose of CBT (CBT-CBT), CBT followed by PT (CBT-PT), PT followed by an increased dose of PT (PT-PT), and PT followed by CBT (PT-CBT). Participants (n = 99) were aged 60 years and older and met clinical criteria for knee OA and subthreshold depression. Response was defined as at least "much better" on the P-GIC. Participants were assessed quarterly for 12 months for incidence of psychiatric disorders. Stage 1 response was higher for PT (47.5%) compared to CBT (20.5%). Non-responders receiving an additional dose of the same intervention experienced a response rate of 73%, higher than for switching to a different intervention. All strategies were superior to EUC (5%). Although not powered to detect effects on disorders, neither intervention strategy nor response status affected 12-month incidence of depression and anxiety disorders. As response rates were similar for PT-PT and CBT-CBT, it may be dose and not type of these interventions that are necessary for clinical benefit. For non-responders, this finding may guide providers to stay the clinical course for up to 12 weeks before switching. These results support future trials of SMART designs in late-life depression prevention.
Identifiants
pubmed: 31047790
pii: S1064-7481(19)30303-3
doi: 10.1016/j.jagp.2019.03.011
pmc: PMC6739151
mid: NIHMS1528175
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT01530204']
Types de publication
Clinical Trial, Phase IV
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1035-1045Subventions
Organisme : NIMH NIH HHS
ID : P30 MH090333
Pays : United States
Informations de copyright
Copyright © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
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