Table 1.
Study, Sample, and Intervention Characteristics of the 10 Studies (k = 12) included in the Meta-Analysis
| Study | Sample | Recruitment/Location | Condition | Current Treatment | Control | Intervention Details | Sessions | Dosea | Outcomes |
|---|---|---|---|---|---|---|---|---|---|
| Appelbaum (1988); Linked: Appelbaum (1986) | N = 18 (39%); 11% F; Mage = 62; Myears DX = 15; 100% veterans | Outpatients referred through rheumatology or rehabilitation medicine services at the Albany VAMC; Albany, NY | RA (Stage II or III) | Pharma | WL | Cognitive Behavioral Pain Management. Theory-based cognitive behavioral pain management intervention delivered over 6 weeks that included PMR, thermal biofeedback, and cognitive pain management strategies (i.e., stress and coping, problem-solving skills). Problem-solving homework was required; HP of relaxation and biofeedback exercises was encouraged. | 10 | 630 | PI; PF; Dep |
| Berry (2014) | N = 14 (100%); 7% F; Mage = 45; 100% veterans | Patients at the Wm. Jennings Bryan Dorn VAMC; Columbia, SC | Chronic pain, injury-related | NR | SC | Biofeedback. Heart rate variability coherence biofeedback delivered over 4 weeks that included controlled breathing and self-regulation training. No HP was reported. | 4 | 160b | PI;PF |
| Carmody (2013) | N = 101 (67%); 3% F; Mage = 68; Myears dx = 18; 100% veterans | Physician referrals, flyers, and letters sent to veterans ≥55 years of age at the San Francisco VAMC or affiliated VA community-based outpatient clinics; San Francisco, CA | Chronic pain, multiple | Pharma | Phone-delivered pain education , TM | Cognitive-Behavioral Therapy (telephone-delivered). Manualized form of cognitive-behavioral therapy for pain management delivered over 20 weeks, adapted for low literacy rural populations with a primary goal to facilitate adjustment to chronic pain by teaching methods to manage negative emotions/thoughts, and improve social functioning and coping. Handouts were provided to guide home assignments. | 12 | 540 | PI; Dep |
| Groessl (2017); Linked: Groessl (2015); Groessl, Liu, and Schmalzl (2017); Groessl et al. (2016) | N = 152 (72%); 26% F; Mage = 53; Myears DX = 15; 100% veterans | VA San Diego Healthcare System; San Diego, CA | Chronic LBP | Pharma | WL | Yoga. Hatha yoga consisting of physical yoga postures, movement sequences, regulated breathing, and brief meditation delivered over 12 weeks. A HP manual was provided; participants were encouraged to practice 15–20 minutes on days without an instructor-led yoga session. | 24 | 1440 | PI; PF; Dep |
| Hausmann (2018)c; Linked: Hausmann, Ibrahim, et al. (2018) | N = 360 (86%); 24% F; Mage = 64; 100% veterans | VA Pittsburg Healthcare System, Pittsburg, PA; VA Medical Center, Philadelphia, PA | KneeOA | Pharma and Nonpharma | Neutral activities, TM | Positive Psychology. Home-based intervention that included a series of activities to build positive psychology skills (e.g., reflection, gratitude, kindness, mindfulness) introduced via a brief, 5 to 15-minute telephone call once a week for 6 weeks. A workbook was provided; participants were encouraged to practice the weekly skill each day. | 6 | 60 | PI;PF |
| Hausmann (2017) | N = 42 (100%); 17% F; Mage = 68; 100% veterans | VA Pittsburg Healthcare System, Pittsburg, PA | Knee or HipOA | Pharma and Nonpharma | Neutral activities, TM | Positive Psychology. Home-based intervention that included a series of activities to build positive psychology skills (e.g., reflection, gratitude, kindness, mindfulness) introduced via a brief, 10 to 15-minute telephone call once a week for 6 weeks. A workbook was provided; participants were encouraged to practice the weekly skill each day. | 6 | 75 | PI;PF |
| Highland (2018); Linked (2017) | N = 68 (91%); 63% F; Mage = 44; 28% veterans, 59% active duty | Patients at Walter Reed National Medical Unit; Bethesda, MD | Chronic LBP | Pharma | SC | Yoga. Weekly individual therapeutic yoga sessions that focused on postural alignment, breath work, and centering delivered over 8 weeks. This program allowed for modification in postures. An audio CD was provided for optional HP. | 12 | 720 | PI;PF |
| Kearney (2016); Linked: Martinez (2016); Stephenson, Simpson, Martinez, and Kearney (2016) | N = 55 (82%); 15% F; Mage = 50; 100% veterans (100% PG); 78% on service connection disability | Flyers posted in clinics and letters sent to GW veterans in the VA Puget Sound Healthcare System; Seattle, WA | Chronic pain, GWI | Pharma and Psych | SC | Mindfulness-based Stress Reduction. Mindfulness meditation, body scan meditation, breathing practices, gentle yoga, walking meditation and loving kindness meditation delivered over 8 weeks. Participants were provided an audio CD and assigned 30–45 minutes of HP per day, 6 days per week. Informal practices (e.g., walking or eating mindfully) were also encouraged. Participants received additional readings and a workbook for tracking progress. | 9 | 1620 | PI; Dep |
| Lathia (2009) | N=31 (90%); 10% F; Mage = 62 Myears DX = 4; 100% veterans | Physical therapy unit of Philadelphia VAMC; Philadelphia, PA | Chronic shoulder pain | Pharma | Placebo | Acupuncture (individualized). Individualized treatment points based on patients’ symptoms delivered over 6 weeks. Participants were taught a 10-minute home exercise program (consisting of range-of-motion movements) to be completed 3x/day. | 12 | 360 | PI;PF |
| Acupuncture (standard). Used fixed, standard protocol treatment points delivered over 6 weeks. Participants were taught a 10-minute home exercise program (consisting of range-of-motion movements) to be completed 3x/day. | |||||||||
| Moore and Chaney (1985); Linked: Moore (1983) | N=43 (79%); 2% F; Mage = 49; Myears dx = 17; 81% receiving disability compensati on; 100% veterans | Patients in the VA Puget Sound Healthcare System; Seattle, Washington | Chronic pain, multiple | Pharma | WL | Cognitive-Behavioral Therapy (individual). Group-based lecture/discussion on gate control concepts of pain; goal-setting exercises; and relaxation techniques (i.e., imagery, autogenic training, PMR, breathing exercises) delivered over 4 weeks. Participants were given audiotaped relaxation exercises and asked to practice relaxation 2x/day for 15 minutes. | 8 | 960 | PI; PF; Dep |
| Cognitive-Behavioral Therapy (couples). Group-based lecture/discussion on gate control concepts of pain; goal-setting exercises; and relaxation techniques (i.e., imagery, autogenic training, PMR, breathing exercises) delivered over 4 weeks. Participants were given audiotaped relaxation exercises and asked to practice relaxation 2x/day for 15 minutes. | |||||||||
| Nassif (2016); Linked: Nassif (2013); Nassif, Norris, Soltes, Blackman, etal. (2014); Nassif, Norris, Soltes, Sandbrink, etal. (2014) | (77%); 0% F; Mage = 47; 100% veterans (100% OIF/OEF), 78% army | War Related Illness and Injury Study Center, Washington DC VAMC; Washington, DC | Chronic musculosk eletal pain | NR | WL | Mindfulness Meditation. Included guided imagery, PMR, and body sensing techniques delivered over 8 weeks. Participants were provided with audio recordings for HP and a workbook to log self-practice. | 16 | 960 | PI; Dep |
| Otis (2017) | N = 23 (74%); 9% F; Mage = 50; 100% veterans | VA Boston and Connecticut Healthcare Systems; West Haven, CT; Boston, MA | Comorbid chronic pain and PTSD | NR | WL | Intensive Treatment. Outpatient therapy sessions for pain and PTSD, including cognitive-behavioral therapy and cognitive processing therapy components, delivered over 3 weeks. Both cognitive-behavioral therapy and cognitive processing therapy require HP. | 6 | 540 | PI |
Note: N (%), number of participants who consented to participate in the study (retention); F, female; Dx, diagnosis; OIF, Operation Iraqi Freedom; OEF, Operation Enduring Freedom; PG, Persian Gulf war; GW, gulf war; GWI, gulf war illness; VA, Veteran’s Administration; VAMC, Veteran’s Administration Medical Center; RA, rheumatoid arthritis; OA, osteoarthritis; LBP, lower back pain; PTSD, posttraumatic stress disorder; Pharma, pharmacological; Psych, psychological; AO, assessment only; WL, waitlist control; SC, standard of care; TM, time-matched; PMR, progressive muscle relaxation; HP, home practice; NR, not/none reported; PF, physical functioning; Dep, depressive symptoms; PI, pain intensity.
a
Estimated total dose (sessions × minutes) of the intervention.
b
Dose was estimated from Thurber et al. (2010).
c
Data were only reported by race (White/African American); the effect size computed for each group was treated as a separate intervention in the analyses because each effect size represented an independent subgroup.