Evidence map›Paper›PMID 31047790›Full record

Trial reportThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry2019

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.

Jordan F Karp, Jun Zhang, Abdus S Wahed, Stewart Anderson, Mary Amanda Dew, G Kelley Fitzgerald, Debra K Weiner, Steve Albert, Ari Gildengers, Meryl Butters and 1 more

Open access · greenAbstract readClinical Trial, Phase IVRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 5 pooled it
3.7field-weighted citation impact, top 7% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 5 syntheses or guidelines pooled it, 34 citations in OpenAlex.

  1. Pooled it
  2. Exercise for osteoarthritis of the knee.The Cochrane database of systematic reviews · 2024
    Pooled it
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  17. Subjective Sleep Quality and Trajectories of Interleukin-6 in Older Adults.The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry · 2021
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Jordan F KarpDepartment of Psychiatry (JFK, MAD, DKW, AG, MB, CFR). Electronic address: karpjf@upmc.edu.
Jun ZhangDepartment of Biostatistics, Graduate School of Public Health (JZ, ASW, SA, MAD).
Abdus S WahedDepartment of Biostatistics, Graduate School of Public Health (JZ, ASW, SA, MAD).
Stewart AndersonDepartment of Biostatistics, Graduate School of Public Health (JZ, ASW, SA, MAD).
Mary Amanda DewDepartment of Psychiatry (JFK, MAD, DKW, AG, MB, CFR); Department of Biostatistics, Graduate School of Public Health (JZ, ASW, SA, MAD); Department of Epidemiology.
G Kelley FitzgeraldSchool of Health and Rehabilitation Sciences (GKF), University of Pittsburgh, Pittsburgh.
Debra K WeinerDepartment of Psychiatry (JFK, MAD, DKW, AG, MB, CFR); Department of Psychiatry and Department of Medicine (DKW), University of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh.
Steve AlbertBehavioral and Community Health Sciences.
Ari GildengersDepartment of Psychiatry (JFK, MAD, DKW, AG, MB, CFR).
Meryl ButtersDepartment of Psychiatry (JFK, MAD, DKW, AG, MB, CFR).
Charles F ReynoldsDepartment of Psychiatry (JFK, MAD, DKW, AG, MB, CFR).
University of Pittsburgh · US

Funding

RESEARCH METHODS COREP30MH090333 · NIMH · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI REYNOLDS, CHARLES F. · 2011 to 2015
$8.3M
NIMH NIH HHS P30 MH090333
6 · The paper itself

Abstract

objectiveOlder 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.

methodsThis 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.

resultsStage 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.

conclusionAs 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.

Indexed as

Patient Reported Outcome MeasuresAgedAnxiety DisordersCognitive Behavioral TherapyComorbidityFemaleHumansMajor Depressive DisorderMaleMiddle AgedOsteoarthritis, KneePainPsychiatric Status Rating ScalesSeverity of Illness Indexanxietycognitive behavioral therapydepressionKnee arthritisphysical therapyprevention

Identifiers

PMID31047790
PMCPMC6739151
OpenAlexW2925222795

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.