The Journal of Rheumatology 2001; 28:5 1068 From the Netherlands Institute of Health Services Research (Nivel); and the Department of Rheumatology and Clinical Immunology, University Medical Centre, Utrecht, The Netherlands. M.P.M. Steultjens, PhD, Research Associate; J. Dekker, PhD, Professor of Allied Health Care, Netherlands Institute of Health Services Research (Nivel), Utrecht, Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam; J.W.J. Bijlsma, MD, Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, University Medical Centre, Utrecht, The Netherlands. Address reprint requests to M.P.M. Steultjens, NIVEL, PO Box 1568, 3500 BN Utrecht, The Netherlands. E-mail: m.steultjens@nivel.nl Submitted July 31, 2000 revision accepted November 17, 2000. Pain and physical disability are major symptoms in osteoarthritis (OA), profoundly affecting everyday life of patients. However, the level of articular degeneration, central to the syndrome of OA, is only weakly related to the level of pain and disability experienced by patients 1-3 . One factor that may influence the level of pain and disability is the way in which patients cope with their chronic condition. Studies in patients with various chronic disorders have shown that patients who use passive coping styles such as catastrophizing, worrying, and resting report higher levels of pain and disability 3-10 . In a longitudinal study in patients with rheumatoid arthritis (RA), Evers, et al 11 found that frequent use of passive coping styles predicted a higher level of disability one year later. Similar findings were reported by van Lankveld, et al 12 in patients with RA and Vlaeyen, et al in patients with chronic low back pain (LBP) 13 . The relationship between passive coping styles and pain and disability may be explained through the effect of avoidance of activity on the physical condition of the patient. Patients tend to avoid activity, fearing that activity will result in more pain. However, because of their inactivity, their physical condition deteriorates, resulting in muscle weakness and instability of joints. This, in turn, will lead to more pain and disability 14 . With pain and disability increasing, the patient will avoid activity even more, thus entering a downward spiral towards increasing pain and disability. Less attention has been given to the influence of active coping styles on the level of pain and disability. Positive associations have been reported between the active coping style of transformation of pain (diverting attention from pain) and low levels of pain and disability in patients with RA 15 . However, in general, studies have focused on the importance of the use of passive coping styles rather than the use of active coping styles. We investigated the role of coping styles as prospective determinants of pain and disability in patients with OA of the knee or hip. It was expected that resting (passivity) would determine pain and disability: frequent use of resting as a means to cope with OA was expected to result in higher levels of pain and disability. MATERIALS AND METHODS Subjects. We used data from a randomized clinical trial into the effective- ness of exercise therapy in patients with OA 16 . Patients were admissible for the trial if they were diagnosed with OA of the knee or hip according to the classification criteria of the American College of Rheumatology 17,18 . There were 200 patients participating in the trial. Of those patients, 10 were diag- nosed with both knee OA and hip OA. These 10 patients were excluded from the analyses presented here. Data of all 190 remaining patients were used. This included patients from both the intervention and control group of the trial. Data used in the present study were obtained at the onset of the trial (baseline) and at the end of the followup period, 36 weeks later. Coping, Pain, and Disability in Osteoarthritis: A Longitudinal Study MARTIJN P.M. STEULTJENS, JOOSTDEKKER, and JOHANNES W.J. BIJLSMA ABSTRACT. Objective. To establish the role of coping styles as prospective determinants of pain and disability in patients with osteoarthritis (OA) of the knee or hip. Methods. Data from 71 patients with OA of the hip and 119 patients with OA of the knee were used. Using regression analysis, relationships were established between the use of active and passive coping styles and the level of pain and disability 36 weeks later. Results. In patients with knee OA, the passive coping style of resting was found to predict a higher level of disability 36 weeks later after controlling for the baseline level of disability. In the same manner in patients with knee OA, the active coping style of transforming pain was found to predict higher levels of pain 36 weeks later. In patients with hip OA, no significant relationship between coping styles and pain and disability was found. Conclusion. The role of resting as a prospective determinant of disability, as reported in patients with other chronic disorders, could also be established for knee OA, but not hip OA. Transforming pain was found to be a risk factor for pain in knee OA. (J Rheumatol 2001;28:1068–72) Key Indexing Terms: COPING PAIN DISABILITY OSTEOARTHRITIS Personal non-commercial use only. The Journal of Rheumatology Copyright © 2001. All rights reserved. www.jrheum.org Downloaded on January 22, 2022 from