L. Jürgenhake Santana1, A. Ramos Álvarez1, S. Martín Pérez2, E. Sánchez Romero3, J.L. Alonso Pérez3
1Master Degree in Orthopaedic Manual Therapy, Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain, 2Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, , Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain, 3Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
Background: Knee osteoarthritis (KO) is a leading cause of chronic pain and loss of function among worldwide population. Education (Ed) alone or combined with exercise (Ex) is said to improve these symptoms but its clinical efficacy is still inconclusive.
Purpose: The aim of this study was to evaluate the effectiveness of Ed alone or combined with Ex on easing symptoms in patients with KO.
Methods: A systematic review was performed following PRISMA statement using the MeSH keywords “knee" AND "osteoarthritis” AND “chronic pain” AND “education” AND “exercise” in meta-search engines Tripdatabase and Cochrane Central Register of Controlled Trials (CENTRAL) and electronic databases PEDro, MEDLINE (PubMED) and aMED between March 3rd 2020 and March 22nd 2020. Eligibility criteria were the followings:
(1) Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs),
(2) published between January 1st 2010 and January 1st 2020,
(3) adults older than 50 years with painful KO,
(4) experimental group received Ed alone or in combination with Ex,
(5) control group consisted of usual care based on pharmacological management and rest and
(6) reported at least one outcome of pain, psychological status, functionality or adherence.
The methodological quality and the risk of bias of RCTs were assessed blindly and independently using PEDro scale and Risk of Bias-ROB 2.0 tool respectively.
(1) Randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs),
(2) published between January 1st 2010 and January 1st 2020,
(3) adults older than 50 years with painful KO,
(4) experimental group received Ed alone or in combination with Ex,
(5) control group consisted of usual care based on pharmacological management and rest and
(6) reported at least one outcome of pain, psychological status, functionality or adherence.
The methodological quality and the risk of bias of RCTs were assessed blindly and independently using PEDro scale and Risk of Bias-ROB 2.0 tool respectively.
Results: A total of 38 full-text articles were selected of which 8 RCTs (n=1289 subjects) were finally included and rated as good quality and moderate risk of bias. Ed alone (pain neurophysiology education, coping skills, setting short and long term goals and self-management) produces little improvements in pain intensity (2 studies, n=124). In short-term, Ed combined with Ex (strengthening with weights and resistance bands, aerobic with stationary bike or community-based aerobic walking, stretching or balance) result in larger adherence (1 study, n=222) and functionality (3 articles, n=681) while, in long-term, a greater reduction of pain intensity (2 studies, n=263) is observed. Neither modalities show significative changes in psychological status such as catastrophization and self-perceived health.
Conclusion(s): In patients with KO Ed with Ex promote adherence and improve functionality and pain intensity. However, their clinical efficacy on psychological status is not enough clarified. Despite the consistency of the results, because of the high heterogeneity between Ed programmes and the moderate risk of bias found, it is required more quality trials to set clinical recommendations.
Implications: Patients who suffer from symptomatic KO could benefit from the combination of Ed and Ex because it appears to improve their clinical status more than Ed alone.
Funding, acknowledgements: No funding acknowledgements
Keywords: Education, Exercise, Knee osteoarthritis
Topic: Education
Did this work require ethics approval? No
Institution: No
Committee: No
Reason: No ethics approval is required because is a systematic review
All authors, affiliations and abstracts have been published as submitted.
