A.J. Goff1,2, D. De Oliveira Silva2, M. Merolli3, E.C. Bell2, K. Crossley2, C. Barton2
1Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore, Singapore, 2La Trobe University, La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Australia, 3The University of Melbourne, Centre for Digital Transformation of Health, Centre for Health, Exercise, and Sports Medicine, Melbourne, Australia
Background: Patient education, exercise-therapy, and weight management are guideline recommended first-line treatments for people with knee osteoarthritis. Recent high-quality evidence syntheses support the effectiveness and cost-effectiveness of exercise-therapy and weight management. The most recent comprehensive high-quality published synthesis of evidence for patient education for knee osteoarthritis on pain and function was in 2012.
Purpose: The primary aim of this review was to determine the efficacy of patient education for knee osteoarthritis as a standalone intervention, and in combination with other interventions for pain and function. Secondary aims of this review were to evaluate psychological outcomes and compare modes of patient education delivery.
Methods: This systematic review of randomized-controlled trials with meta-analysis was registered in PROSPERO (CRD42019122004). MEDLINE, EMBASE, SPORTDiscus, CINAHL, and Web of Science were searched in April 2020. Two reviewers independently determined eligibility. Mean and standard deviations for primary and secondary outcomes were extracted from included trials and pooled where possible to calculate standardized mean differences (SMD). Credibility of results was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results: Thirty-three trials (4,866 participants) were included. Very-low credibility evidence indicates that education is superior to usual care for pain in the short-term ((SMD; 95% CI) = -0.29; -0.45 to -0.14) and function in the short- (-0.27; -0.43 to -0.10) and medium-term (-0.18; -0.33 to -0.03); but inferior to exercise-therapy for pain in the short- (0.53; 0.32 to 0.73) and long-term (0.21; 0.04 to 0.39), and function in the short-term (0.35; 0.08 to 0.631). Low- to very-low credibility evidence indicates that education combined with exercise-therapy is superior to exercise-therapy alone for function in the short-term (0.68; 0.36 to 0.99) and compared to education alone for pain in the short-term (0.41; 0.23 to 0.59); and function in the short- (0.81; 0.54 to 1.08), medium- (0.39; 0.15 to 0.62); and long-term (0.32; 0.09 to 0.56). Very-low credibility evidence indicates that that education is superior compared to usual care (0.51; -0.77 to -0.25) and exercise therapy (-0.90; -1.22 to -0.58) for pain coping; and a combination of education and exercise-therapy is superior to education alone for self-efficacy (0.51; 0.20 to 0.81) in the short-term. Very-low credibility indicates that therapist-facilitated education produces similar short- and long-term outcomes for pain (0.03; -0.29 to 0.22; and -0.06; -0.33 to 0.21) and function (0.09; -0.20 to 0.38; and -0.04; -0.35 to 0.26) compared to self-directed education.
Conclusion(s): Patient education for people with knee osteoarthritis is beneficial for pain and pain coping in the short-term, and function in the short- to medium-term. Patient education is inferior to exercise-therapy for pain and function, but superior for pain coping outcomes. Patient education combined with exercise-therapy produces superior pain, function and self-efficacy outcomes when compared to these interventions alone.
Implications: Findings from this review should be used to inform future guidelines and clinical practice. Patient education should be offered as a minimum intervention to all people with knee osteoarthritis, and where possible, combined with exercise-therapy. The development of self-directed education resources should be explored further due to similar outcomes compared to therapist-facilitated education.
Funding, acknowledgements: Anthony Goff holds a sponsorship from Singapore Institute of Technology for the completion of his PhD at La Trobe.
Keywords: Patient education, Osteoarthritis, Knee
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? No
Institution: Lat Trobe University
Committee: Human Research Ethics Committee
Reason: This is a systematic review and meta-analysis which does not require ethical approval
All authors, affiliations and abstracts have been published as submitted.
