Trial Outcomes & Findings for Staying Positive With Arthritis Study (NCT NCT02223858)

Last Updated: 2019-04-03

Results Overview

Pain subscale of the Western Ontario McMaster (WOMAC) Index. Pain is on a scale of 0-100; higher scores mean worse pain.

Recruitment status

COMPLETED

Study phase

Target enrollment

360 participants

Primary outcome timeframe

Baseline to 6 months post-intervention

Results posted on

2019-04-03

Participant Flow

Patients with symptomatic knee OA from Veterans Affairs (VA) medical centers in Pittsburgh and Philadelphia, Pennsylvania, were recruited by mail and telephone. Mailings were sent to patients meeting basic eligibility criteria based on their VA medical records Recruitment for the study ran from July 2015 to February 2017.

Eligible patients attended an in-person baseline visit where they provided written informed consent, completed a staff-administered baseline assessment, and were randomized to a 6-week positive psychological intervention or neutral control program.

Participant milestones

Participant milestones
Measure	Positive Activities (PA) Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.
Overall Study STARTED	180	180
Overall Study 1-month Follow-up	156	150
Overall Study 3-month Follow-up	155	154
Overall Study 6-month Follow-up	156	154
Overall Study COMPLETED	156	154
Overall Study NOT COMPLETED	24	26

Reasons for withdrawal

Reasons for withdrawal
Measure	Positive Activities (PA) Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.
Overall Study Death	1	1
Overall Study Lost to Follow-up	6	11
Overall Study Withdrawal by Subject	8	5
Overall Study Refused	9	9

Baseline Characteristics

For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).

Baseline characteristics by cohort

PRIMARY outcome

Timeframe: Baseline to 6 months post-intervention

Population: Participants had the option to skip any questions they did not wish to answer. This explains why the number analyzed in the rows below differs overall number analyzed.

Pain subscale of the Western Ontario McMaster (WOMAC) Index. Pain is on a scale of 0-100; higher scores mean worse pain.

Outcome measures

Outcome measures
Measure	Positive Activities (PA) n=180 Participants Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) n=180 Participants Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.
Self-reported Pain From Baseline to 1, 3, and 6 Months Post-intervention Baseline	50.24 units on a scale Standard Deviation 16.95	47.42 units on a scale Standard Deviation 18.07
Self-reported Pain From Baseline to 1, 3, and 6 Months Post-intervention 1 month	45.42 units on a scale Standard Deviation 18.58	43.57 units on a scale Standard Deviation 20.93
Self-reported Pain From Baseline to 1, 3, and 6 Months Post-intervention 3 month	43.87 units on a scale Standard Deviation 19.16	43.32 units on a scale Standard Deviation 19.13
Self-reported Pain From Baseline to 1, 3, and 6 Months Post-intervention 6 month	43.22 units on a scale Standard Deviation 20.97	41.59 units on a scale Standard Deviation 19.87

PRIMARY outcome

Timeframe: Baseline to 6 months post-intervention

Population: Participants had the option to skip any questions they did not wish to answer. This explains why the number analyzed in the rows below differs overall number analyzed.

Difficulty with physical functioning subscale of the Western Ontario McMaster (WOMAC) Index. Physical functioning is on a scale of 0-100; higher scores mean worse physical functioning.

Outcome measures

Outcome measures
Measure	Positive Activities (PA) n=180 Participants Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) n=180 Participants Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.
Self-reported Physical Functioning From Baseline to 1, 3, and 6 Months Post-intervention Baseline	47.94 units on a scale Standard Deviation 17.73	45.70 units on a scale Standard Deviation 18.53
Self-reported Physical Functioning From Baseline to 1, 3, and 6 Months Post-intervention 1 month	44.61 units on a scale Standard Deviation 19.81	43.08 units on a scale Standard Deviation 20.97
Self-reported Physical Functioning From Baseline to 1, 3, and 6 Months Post-intervention 3 month	43.39 units on a scale Standard Deviation 19.01	43.32 units on a scale Standard Deviation 19.80
Self-reported Physical Functioning From Baseline to 1, 3, and 6 Months Post-intervention 6 month	43.89 units on a scale Standard Deviation 20.02	41.91 units on a scale Standard Deviation 20.00

OTHER_PRE_SPECIFIED outcome

Timeframe: Baseline to 6 months post-intervention

Population: Participants had the option to skip any questions they did not wish to answer. This explains why the number analyzed in the rows below differs from the overall number analyzed.

Self-reported global assessment of pain in the last week using a numeric rating scale. Global assessment of pain is on a scale of 0-10; higher scores mean worse pain.

Outcome measures

Outcome measures
Measure	Positive Activities (PA) n=180 Participants Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) n=180 Participants Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.
Patient Global Assessment of Pain From Baseline to 1, 3, and 6 Months Post-intervention Baseline	5.13 units on a scale Standard Deviation 2.14	4.89 units on a scale Standard Deviation 1.96
Patient Global Assessment of Pain From Baseline to 1, 3, and 6 Months Post-intervention 1 month	4.77 units on a scale Standard Deviation 2.16	4.71 units on a scale Standard Deviation 2.21
Patient Global Assessment of Pain From Baseline to 1, 3, and 6 Months Post-intervention 3 month	4.83 units on a scale Standard Deviation 2.10	4.69 units on a scale Standard Deviation 2.06
Patient Global Assessment of Pain From Baseline to 1, 3, and 6 Months Post-intervention 6 month	4.82 units on a scale Standard Deviation 2.27	4.60 units on a scale Standard Deviation 2.24

Adverse Events

Positive Activities (PA)

Serious events: 12 serious events

Other events: 0 other events

Deaths: 1 deaths

Attention Control (AC)

Serious events: 8 serious events

Other events: 0 other events

Deaths: 1 deaths

Serious adverse events

Serious adverse events
Measure	Positive Activities (PA) n=180 participants at risk Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) n=180 participants at risk Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.
General disorders Hospitalizations unrelated to the study	2.2% 4/180 • Number of events 4 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Neoplasms benign, malignant and unspecified (incl cysts and polyps) Hospitalizations unrelated to the study	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Cardiac disorders Hospitalizations unrelated to the study	1.7% 3/180 • Number of events 3 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	1.1% 2/180 • Number of events 2 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Gastrointestinal disorders Hospitalizations unrelated to the study	1.7% 3/180 • Number of events 3 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Psychiatric disorders Hospitalizations unrelated to the study	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Renal and urinary disorders Hospitalizations unrelated to the study	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Vascular disorders Hospitalizations unrelated to the study	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Endocrine disorders Hospitalizations unrelated to the study	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Injury, poisoning and procedural complications Hospitalizations unrelated to the study	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.
Surgical and medical procedures Hospitalizations unrelated to the study	0.00% 0/180 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.	0.56% 1/180 • Number of events 1 • From baseline through 6-months post intervention. All adverse events that occurred with the participants fell under the definition of "serious adverse events" as they were all hospitalizations. There are no "other (not including serious) adverse events" to report.

Other adverse events

Adverse event data not reported

Additional Information

Dr. Leslie R.M. Hausmann

Veterans Affairs Pittsburgh Healthcare System

Phone: 412-360-2112

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place

Measure	Positive Activities (PA) n=180 Participants Positive Activities (PA) Program: PA activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The intervention was an individually-based program in which participants completed one new positive psychological activity for the first 5 weeks and repeated their favorite in week 6. Activities, which were adapted for the target population, included recalling and reflecting on positive events; writing a letter of gratitude; cultivating mindfulness; practicing kindness; and increasing engagement in activities that they enjoy, give them a sense of achievement, or bring them closer to others (a variant of behavioral activation).	Attention Control (AC) n=180 Participants Attention Control (AC) Program: AC activities were delivered using a combination of activity booklets and oral instructions provided during weekly telephone calls from trained interventionists. The booklet contains all instructions patients need to complete the full program. The 6-week program consisting of at-home activities (1 completed per week) are based on affectively neutral activities from control conditions in prior studies of positive activities interventions. The control program was identical to the intervention in terms of framing, reading level, format, duration, and delivery, but contained neutral control activities adapted from previous positive psychological intervention studies. Control activities asked participants to recall events that affected them each day, identify ways they could change their life circumstances, recall early memories, record things they did in the past week, plan their day, and repeat their favorite activity in week 6.	Total n=360 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Age, Categorical Between 18 and 65 years	95 Participants n=180 Participants	100 Participants n=180 Participants	195 Participants n=360 Participants
Age, Categorical >=65 years	85 Participants n=180 Participants	80 Participants n=180 Participants	165 Participants n=360 Participants
Sex: Female, Male Female	44 Participants n=180 Participants	41 Participants n=180 Participants	85 Participants n=360 Participants
Sex: Female, Male Male	136 Participants n=180 Participants	139 Participants n=180 Participants	275 Participants n=360 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	180 Participants n=180 Participants	180 Participants n=180 Participants	360 Participants n=360 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Race (NIH/OMB) Asian	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Race (NIH/OMB) Black or African American	90 Participants n=180 Participants	90 Participants n=180 Participants	180 Participants n=360 Participants
Race (NIH/OMB) White	90 Participants n=180 Participants	90 Participants n=180 Participants	180 Participants n=360 Participants
Race (NIH/OMB) More than one race	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants n=180 Participants	0 Participants n=180 Participants	0 Participants n=360 Participants
Region of Enrollment United States	180 Participants n=180 Participants	180 Participants n=180 Participants	360 Participants n=360 Participants
Self-reported pain, physical functioning, and global assessment of pain at baseline Pain (Western Ontario McMaster Index;100=worst)*	50.24 units on a scale STANDARD_DEVIATION 16.95 • n=179 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).	47.42 units on a scale STANDARD_DEVIATION 18.07 • n=178 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).	48.83 units on a scale STANDARD_DEVIATION 17.55 • n=357 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).
Self-reported pain, physical functioning, and global assessment of pain at baseline Physical functioning (WOMAC; 100=worst)*	47.94 units on a scale STANDARD_DEVIATION 17.73 • n=177 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).	45.70 units on a scale STANDARD_DEVIATION 18.53 • n=174 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).	46.82 units on a scale STANDARD_DEVIATION 18.14 • n=351 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).
Self-reported pain, physical functioning, and global assessment of pain at baseline Global assessment (0-10; higher=worse)*	5.13 units on a scale STANDARD_DEVIATION 2.14 • n=180 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).	4.89 units on a scale STANDARD_DEVIATION 1.96 • n=180 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).	5.01 units on a scale STANDARD_DEVIATION 2.06 • n=360 Participants • For Pain and Physical Functioning, those who skipped \>20% of items within a scale (\>1 or \>3 items, respectively) were excluded. \*WOMAC score range: 0-100; higher=worse symptoms. Global assessment was measured by participants considering their knee arthritis pain condition over the past week (0-10; higher=worse pain).