To investigate the effectiveness of SMIs on pain, disability and quality of life in individuals with musculoskeletal pain in the upper and lower extremities.
This systematic review involved a literature search in PUBMED, CINAHL, EMBASE, and PsycINFO from inception to April 2024 and was registered in PROSPERO (CRD42024569340). Randomised controlled trials (RCTs) testing SMIs for musculoskeletal pain of any duration (acute, subacute, chronic) in the extremities were included. Primary outcomes were pain, disability and quality of life at any timepoint. Two independent researchers screened studies and completed data extraction. Methodological quality was assessed using the Cochrane Risk Of Bias 2 (ROB2) tool. Due to significant heterogeneity across the included studies, a meta-analysis was not feasible. Therefore, quantitative findings were summarized descriptively.
Thirty-one RCTs (4878 participants: 4204 lower limb, 560 upper limb and 114 with upper/lower limb conditions) with a follow-up period ranging from 6weeks to 30months were included. The SMIs across the studies encompassed a diverse array of approaches, including educational interventions (both written and verbal) focused on self-management, pain coping strategies, exercise, diet, and medication. Control interventions were equally varied, comprising usual care, waitlist control, supervised or group-based exercises, telerehabilitation, management by general practitioners, orthopaedic treatment, or physiotherapy. Given the heterogeneity of both the intervention and control types, as well as the outcomes measured, the results were correspondingly varied. Sixteen RCTs favoured self-management for some or all outcomes.Among those that supported self-management, two favoured the control condition for certain outcomes. Thirteen RCTs found no significant difference between the self-management group and the control condition, while 2 studies favoured the control condition over self-management. Risk of bias was found to range from low to high for the included studies.
Overall, while SMIs showed promise in many trials, the results were mixed, with some trials favouring control conditions or showing no significant differences. The diversity in interventions, control conditions, and outcomes measured highlights the complexity of evaluating SMIs. In addition, the risk of bias across studies ranged from low to high, suggesting that the strength of the evidence may vary.
The variability in results suggests the need for more clear definitions of SMIs and what this should entail, as well as increased clarity regarding how this is reported in the literature. Clinicians should carefully consider the type of SMI when recommending interventions, as effectiveness may vary based on context and patient characteristics. Future research should focus on reducing heterogeneity and improving methodological rigor to provide clearer guidance on the implementation of SMIs in clinical practice.
Extremity Pain
Self-management
