The pain in your knees has been there for years. Your doctor says it's osteoarthritis—you're just getting older, and there's not much to do about it. They recommend exercise, but it's never been your thing. It's boring, tiring, and now that you're in pain and feeling stiff, won't it just make things worse? It feels like surgery is the only option.
This frustrating story of hopelessness is far too common for individuals diagnosed with osteoarthritis.
In fact, physical activity offers numerous benefits for osteoarthritis, from improved pain [1] and functioning to increased quality of life [2]. Yet, those with osteoarthritis tend to be less active than those without it [3]. While traditional psychological interventions like cognitive behavioral therapy can help, they're often time- and resource-intensive [4].
Enter a new digital intervention—one that offers individuals a fresh perspective on osteoarthritis and exercise by cultivating more adaptive mindsets. The improvements in physical activity are promising, coupled with psychological benefits that current educational approaches often miss.
Beyond Biomechanics: Discovering the Mind-Body Connection in Osteoarthritis
Our journey began in the Neuromuscular Biomechanics Laboratory at Stanford, led by Professor Scott Delp. We were running a large clinical trial training individuals with knee osteoarthritis to make subtle changes to their walking patterns, aiming to reduce knee loading5. While effective at improving pain, it didn't increase physical activity levels6. This puzzling outcome led us to dig deeper.
As I engaged with study participants, I realized the barriers to physical activity were far more complex than pain alone. The narratives individuals held about osteoarthritis and exercise seemed to profoundly impact their behavior and overall experience.
Intrigued by this observation, our team connected with Professor Alia Crum's Mind and Body Lab through the Stanford Catalyst for Collaborative Solutions. We learned about mindsets – core assumptions that shape our expectations and actions7. Inspired by recent work on adaptive mindsets in cancer patients8, we assembled a multidisciplinary dream team.
Our mission crystallized: to improve the lives of those with osteoarthritis through an accessible intervention that could reshape these influential narratives.
Developing Rethinking Osteoarthritis: Blending Science and Patient Insight
Our journey to create Rethinking Osteoarthritis began with a crucial question: How do some individuals maintain an active lifestyle despite knee osteoarthritis? Through semi-structured interviews, we uncovered that while many held common misconceptions about osteoarthritis, their positive beliefs about exercise seemed to override these, enabling continued physical activity.
These insights, combined with existing research, helped us formulate a theory of mindsets in the context of osteoarthritis. We realized that mindsets about osteoarthritis and exercise are shaped by various factors and, in turn, influence behavior, attention, feelings, and even physiology.
We took a meta-mindset approach, explicitly teaching individuals about the power of mindsets and how to harness them. This approach was designed to empower individuals to adopt beneficial mindsets even when faced with challenges like pain.
The development of Rethinking Osteoarthritis was truly multidisciplinary. We brought together experts in bioengineering, biomechanics, psychology, narratology, and orthopedic surgery. Crucially, we involved patients throughout the process, ensuring our content resonated with its intended audience.
A pilot study with 21 participants showed promising results, with significant improvements in osteoarthritis knowledge and positive shifts in all mindset measures.
By blending scientific rigor with human-centered design, we created an intervention that not only educates but also empowers individuals to rethink their relationship with osteoarthritis and physical activity.
Key Findings: Promising Outcomes from Our Clinical Trial
Our decentralized, randomized clinical trial involving 408 participants with knee osteoarthritis tested the effectiveness of our digital mindset intervention, Rethinking Osteoarthritis. We compared it to a digital education intervention and a no-intervention group. The results were promising: the mindset intervention significantly improved mindsets about osteoarthritis and exercise compared to both other groups (P < 0.001). It also increased physical activity levels more than the no-intervention group (mean = 28.6 points, P = 0.001). While pain reduction wasn't statistically significant, we observed other important benefits. The mindset group showed greater improvements in perceived need for surgery, self-imposed physical limitations, fear of movement, and self-efficacy compared to both the no-intervention and education groups. These findings highlight the potential of brief digital interventions in educating about osteoarthritis and underscore the additional benefits of improving mindsets to transform patients' approach to disease management.
The Power of Digital Mindset Intervention
It's crucial to note that we're not suggesting osteoarthritis is a positive condition, nor is changing one's mindset a cure-all solution. Instead, our intervention provides individuals with the tools to recognize their current mindsets and offers strategies for adopting more empowering perspectives. It's about opening doors to new possibilities in managing one's health and well-being.
Before, I thought that surgery was my only option. Now, instead of feeling fearful and limited, I am educated and empower to improve my situation.-Elizabeth, 59
The promising results of our study underscore the potential of digital mindset interventions in transforming osteoarthritis care. Our next challenge is to disseminate this tool broadly, making it accessible to those who could benefit from it most. We invite healthcare providers, researchers, and individuals with osteoarthritis to join us in this effort. By sharing Rethinking Osteoarthritis within your communities, participating in further research, or simply spreading awareness about the power of mindsets, you can help us make a significant impact on the lives of those living with osteoarthritis.
Together, we can reshape the narrative around osteoarthritis, empowering individuals to take control of their health journey with renewed optimism and resilience.
I want to express my gratitude to my co-authors and the 408 participants who made this research possible.
References
1. Marks, R. Knee osteoarthritis and exercise adherence: A review. Curr. Aging Sci. 5, 72–83 (2012).
2. Fransen, M. et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br. J. Sports Med. 49, 1554–1557 (2015).
3. Gay, C., Guiguet-Auclair, C., Mourgues, C., Gerbaud, L. & Coudeyre, E. Physical activity level and association with behavioral factors in knee osteoarthritis. Ann. Phys. Rehabil. Med. 62, 14–20 (2019).
4. Dixon, K. E., Keefe, F. J., Scipio, C. D., Perri, L. M. & Abernethy, A. P. Psychological interventions for arthritis pain management in adults: a meta-analysis. Health Psychol. 26, 241–250 (2007).
5. Uhlrich, S. D. et al. Personalization improves the biomechanical efficacy of foot progression angle modifications in individuals with medial knee osteoarthritis. J. Biomech. 144, 111312 (2022).
6. Uhlrich, S. Gait Modifications for Knee Osteoarthritis: Design, Evaluation, and Clinical Translation. (Stanford University, 2020).
7. Crum, A. J., Salovey, P. & Achor, S. Rethinking stress: the role of mindsets in determining the stress response. J. Pers. Soc. Psychol. 104, 716–733 (2013).
8. Zion, S. R. et al. Changing cancer mindsets: A randomized controlled feasibility and efficacy trial. Psychooncology 32, 1433–1442 (2023).
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