This umbrella review aimed to: (1) synthesize evidence from existing SRs and meta-analyses on the effectiveness of patient education and self-management programs on pain and function in OA patients, and (2) assess the methodological quality of included SRs and meta-analyses to determine their findings' robustness.
A comprehensive search of Medline (PubMed), Cochrane Library, EMBASE, Epistemonikos, CINAHL, Web of Science, Scopus, and PEDro was conducted from inception to June 26, 2024. Search terms will combine keywords and MeSH terms related to "osteoarthritis," "patient education," "self-management," and "systematic review." This umbrella review included SRs of randomized controlled trials (RCTs) or quasi-RCTs investigating patient education/ self-management interventions for adult patients with OA of any type or severity. No language restrictions were applied. Outcomes of interest were pain and physical function, encompassing all relevant outcome measures. Two reviewers independently assessed methodological quality using the Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) and reporting quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
The initial search yielded 13,410 references; after deduplication and screening, 35 full-text articles were reviewed, resulting in the inclusion of 18 SRs analyzing 156 experimental studies. Twelve SRs focused on education, and six on self-management. Sixteen SRs reported that education/self-management interventions, alone or combined with other treatments, effectively reduced pain. Nine SRs reported positive effects on physical function, while six reported no significant improvement. Methodological assessments classified 9 SRs as ‘critically low’ quality and 9 as ‘low’ quality based on AMSTAR 2 criteria. The PRISMA evaluations revealed poor reporting standards among included SRs. Specifically, only 50% of them met the standard criteria for items related to risk of bias assessment, synthesis methods, risk of bias in studies, results of syntheses, and syntheses of results. Additionally, only 44% of them met the criteria for certainty assessment, 33.3% for reporting biases, 27.8% for reporting bias assessment, and a mere 16.7% for study selection.
Current SRs on patient education and self-management show a trend towards pain reduction but inconsistent effects on physical function, largely due to low-quality primary RCTs, small sample sizes, and short follow-up. However, education remains vital in OA management. Future research should focus on robust methodologies to identify the most effective strategies for outcome optimization.
The effectiveness of education and self-management interventions underscores the need for physiotherapists to prioritize these approaches, fostering patient active engagement. Additionally, the low quality of many SRs calls for improved methodological rigor, with researchers adopting standardized guidelines such as AMSTAR 2 for reliable findings. Better adherence to PRISMA reporting guidelines is essential for thorough documentation.
patient education
osteoarthritis
