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Mindfulness Is Associated With Treatment Response From Nonpharmacologic Exercise Interventions in Knee Osteoarthritis

      Highlights

      • Higher baseline mindfulness was associated with treatment response in knee osteoarthritis.
      • This finding was primarily driven by the acting-with-awareness mindfulness facet.
      • Mindfulness may be a prognostic indicator of treatment response among these patients.
      • Mindfulness-cultivating interventions might be helpful as a preparatory adjunct to exercise.

      Abstract

      Objective

      To examine the association between baseline mindfulness and response from exercise interventions in knee osteoarthritis (OA).

      Design

      Cohort study; responder analysis of a clinical trial subset.

      Setting

      Urban tertiary care academic hospital.

      Participants

      Participants with symptomatic, radiographic knee OA (N=86; mean age, 60y; 74% female; 48% white).

      Interventions

      Twelve weeks (twice per week) of Tai Chi or physical therapy exercise.

      Main Outcome Measures

      Treatment response was defined using Osteoarthritis Research Society International criteria indicating meaningful improvements in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, WOMAC function, or Patient Global Assessment scores. At baseline, participants completed the Five Facet Mindfulness Questionnaire (mean total score, 142±17) and were grouped into 3 categories of total mindfulness: higher, medium, or lower. Relative risk (RR) ratios were used to compare treatment response across groups.

      Results

      Participants with higher total mindfulness were 38% (95% confidence interval [CI], 1.05–1.83) more likely to meet responder criteria than those with lower mindfulness. We found no significant difference between medium and lower mindfulness groups (RR=1.0; 95% CI, 0.69–1.44). Among the 5 mindfulness facets, medium acting-with-awareness was 46% (95% CI, 1.09–1.96) more likely to respond than lower acting-with-awareness, and higher acting-with-awareness was 34% more likely to respond, but this did not reach significance (95% CI, 0.97–1.86).

      Conclusions

      In this study, higher mindfulness, primarily driven by its acting-with-awareness facet, was significantly associated with a greater likelihood of response to nonpharmacologic exercise interventions in knee OA. This suggests that mindfulness-cultivating interventions may increase the likelihood of response from exercise.

      Keywords

      List of abbreviations:

      BMI (body mass index), CI (confidence interval), FFMQ (Five Facet Mindfulness Questionnaire), OA (osteoarthritis), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
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