The primary objective of this project is to examine effectiveness of a tailored pacing intervention on fatigue, pain, and physical function compared to general pacing intervention and usual care groups. A secondary objective is to evaluate the natural history of symptoms and physical disability over time among people with knee and hip osteoarthritis.

In the United States, osteoarthritis is a growing public health issue and a leading cause of disability among older adults. Almost 50% of users of the Veterans Affairs (VA) system present with osteoarthritis. Veterans are a particularly important group to target for symptom management interventions as they are twice as likely as non-veterans to report chronic joint symptoms and activity limitations. There are few evidence-based symptom management interventions offered by health care professionals, such as occupational and physical therapists, at the time when people are seeking treatment for their symptoms. The proposed activity pacing intervention is individually-tailored to a person's symptom and activity patterns. This tailoring provides a personally-relevant and focused intervention that may help people adopt this strategy into their daily lives.

Inclusion Criteria:

• Age of 50 years and older
• Reported pain for at least 3 months
• Mild-moderate pain severity according to the WOMAC pain scale
• Radiographic evidence of knee or hip osteoarthritis (Kellgren-Lawrence score of 2 in at least one joint)
• Community-dwelling (i.e. own home, apartment, senior residence)
• Ambulatory with or without a cane or walker
• Adequate cognition to complete study activities (score of 5 on the 6-Item Screener)
• Ability to use the Actiwatch-S (Phillips-Respironics, Mini-Mitter, Bend OR)accelerometer to record symptoms and activity patterns (ascertained by completion of a learning module specific to the use of the device in this study)
• English-speaking

Exclusion Criteria:

• Self-reported medical history of conditions with pain and/or fatigue as a known and marked symptom (e.g multiple sclerosis, rheumatoid arthritis)
• Medically unstable (e.g. acute conditions or acute presentations of chronic conditions)
• Anemia (hemoglobin of <10 for men and <11 for women)
• Unmanaged thyroid dysfunction (Thyroid stimulating hormone <.035>5.5 mg/dl)
• 2 or more days of complete bed rest within the last month
• Limb hemiplegia or amputation
• Arthroscopic procedure within the previous 2 months
• Joint injection within the previous 3 months
• Total or partial joint replacement within the previous 6 months
• Self-reported illness or conditions that impair cooperation with the study team or ability to complete study procedures
• Current enrollee in physical or occupational therapy for symptoms associated with osteoarthritis
• Current attendance or attendance within the previous year in a cognitive behavioral therapy program or other self-management program that includes activity pacing instruction
• Any other unforeseen exclusion criteria that, by the opinion of the study personnel, would make the participant unable to safely or effectively complete the study.

Data were collected from baseline through completion of Time 3 outcome measures at 6 months

Although overall effects were not found by group over time, additional data analyses will be conducted to determine if there were positive effects for specific subgroups of people.