Self-regulation (Mindfulness Meditation and Brainwave) Training for People with Knee Osteoarthritis: A Feasibility and Safety Randomized Control Trial.

Group-1 will receive Electroencephalography-Neurofeedback (Brainwave) training + usual care. Electroencephalography- Neurofeedback (EEG-NF) training is a form of biofeedback training designed to self-regulate activities of targeted neural areas to improve health outcomes. EEG-NF works under the principles of operant conditioning learning. Real-time feedback (reward) is provided to the participant on reaching a threshold level of the cortical electrical activity at the targeted brain regions linked to the pain experience, thereby supporting self-regulation of pain and health. In this trial, Electroencephalography (EEG) neurofeedback will be administered four times a week (30 minutes/ session) for a total of 3 consecutive weeks, by trained research personnel. During each session, participants will be asked to close their eyes and sit relaxed on a chair with back support. The Comby EEG lead cap with sensors will be placed on the individual’s scalp. The targeted brain region will include the pregenual anterior cingulate cortex (pgACC). The Brainmaster Inc. system delivers sound feedback (reward) each time the participant’s real-time brain activity at the targeted region meets the desired infraslow threshold (0.0–0.1 Hz) at the targeted cortical area(s). The reward threshold will be adjusted in real-time between 60-80%, i.e., for 60-80% of the time. Group-2 will receive Mindfulness Meditation Training (MMT) + usual care. Mindfulness Meditation Training (MMT): The MMT regimen will consist of twelve 20 minutes sessions which will be administered for three successive weeks with four sessions each week. A trained research assistant will administer the training. During each session, participants will be instructed to focus on the sensation of each breath occurring at the tip of the nose. On progression, participants will be instructed to broaden their focus to the "full flow of the breath", including bodily sensations. We will instruct participants to acknowledge thoughts, feelings, and emotions as they arise without judgment and "simply return their attention back to the breath sensations". Participants in groups 1 and 2 will continue to receive the usual, normal routine care offered by their healthcare providers and carry out self-management strategies. Adherence to training will be recorded through attendance at each training session. Monitoring usual care: Participants (in groups 1 & 2) will record healthcare interventions received and self-management strategies carried out on a weekly basis during the training period. This would be recorded using a self-report questionnaire (digital or paper format).