To measure the efficacy of education for adults with MSKDs.
A systematic review with meta-analysis was conducted (Prospero CRD42024506410). Five databases were searched for eligible studies published between 2005 and 2023. Randomized clinical trials (RCTs) evaluating the efficacy of education in adults with MSKDs compared with any rehabilitation interventions, such as exercise programs and multimodal physiotherapy interventions, were included. Outcomes measures extracted and pooled for meta-analyses included pain, disability, quality of life, kinesiophobia, and catastrophization. Standardized mean differences (SMDs) were calculated using inverse variance random-effect models to estimate treatment effects. Risk of bias of included trial was evaluated using the Cochrane Risk of Bias tool (V2). The GRADE approach was used to assess the certainty of the findings.
Fifty-two RCTs contributed to the meta-analysis, involving 6,101 participants (mean age 45.1±8.47 years, 60% female). Most participants suffered from chronic spinal pain. Thirty-two RCTs were considered to have a low to moderate risk of bias. Education alone compared to no intervention resulted in a significant reduction of pain in the medium term (SMD: -0.44; 95%CI: -0.80 to -0.07; n=142; 2 RCTs), but not in the short or long term, and in a significant reduction of disabilities in the short (SMD: -0.24; 95%CI: -0.46 to -0.02; n=348; 2 RCTs) and long term (SMD: -0.24; 95%CI: -0.44 to -0.04; n=416; 3 RCTs). The addition of education to another rehabilitation interventions significantly reduced pain in the short (SMD: -0.54; 95%CI: -0.75 to -0.33; n=717; 17 RCTs) and medium term (SMD: -0.54; 95%CI: -0.79 to -0.29; n=829; 16 RCTs), but not in the long term, and significantly reduced disability in the short (SMD: -0.55; 95%CI: -0.79 to -0.31; n=648; 15 RCTs) and medium term (SMD: -0.53; 95%CI: -0.87 to -0.19; n=778; 16 RCTs), but not in the long term when compared to rehabilitation interventions. Similarly, the addition of education to rehabilitation intervention significantly reduced kinesiophobia and catastrophization in the short and medium term. However, education alone or in addition to another intervention did not result in any significant improvements in terms of quality of life when compared to no intervention or another rehabilitation intervention.
Based on moderate to high certainty evidence, education interventions can help reduce pain and disability in the short term. Moderate certainty evidence also indicates that the addition of education to rehabilitation intervention results in reductions of pain, disability, kinesiophobia and catastrophization in the short term. These effects can generally be considered clinically important. Further research is needed to identify the specific components of an effective education intervention.
Education should be regarded as a core intervention in the management of MSKDs, and healthcare providers should recognize its clinical importance to reduce pain, disability, kinesiophobia and catastrophization.
Musculoskeletal disorder
Efficacy
