Journal of physiotherapy | 2021
Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review.
Abstract
QUESTION\nIs patient education effective as a standalone intervention or combined with other interventions for people with knee osteoarthritis?\n\n\nDESIGN\nSystematic review of randomised controlled trials. MEDLINE, EMBASE, SPORTDiscus, CINAHL and Web of Science were searched from inception to April 2020. The Cochrane Risk of Bias tool was used for included studies, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was used to interpret certainty of results.\n\n\nPARTICIPANTS\nPeople with knee osteoarthritis.\n\n\nINTERVENTION\nAny patient education intervention compared with any non-pharmacological comparator.\n\n\nOUTCOME MEASURES\nPrimary outcomes were self-reported pain and function.\n\n\nRESULTS\nTwenty-nine trials involving 4,107 participants were included, informing low to very-low certainty evidence. Nineteen of 28 (68%) pooled comparisons were not statistically significant. Patient education was superior to usual care for pain (SMD\xa0-0.35, 95% CI -0.56 to\xa0-0.14) and function in the short term (-0.31, 95% CI\xa0-0.62 to\xa00.00), but inferior to exercise therapy for pain in the short term (0.77, 95% CI 0.07 to 1.47). Combining patient education with exercise therapy produced superior outcomes compared with patient education alone for pain in the short term (0.44, 95% CI 0.19 to 0.69) and function in the short (0.81, 95% CI 0.54 to 1.08) and medium term (0.39, 95% CI 0.15 to 0.62). When using the Western Ontario and McMaster Universities Osteoarthritis Index for these comparisons, clinically important differences indicated that patient education was inferior to exercise therapy for pain in the short term (MD 1.56, 95% CI 0.14 to 2.98) and the combination of patient education and exercise therapy for function in the short term (8.94, 95% CI 6.05 to 11.82).\n\n\nCONCLUSION\nAlthough patient education produced statistically superior short-term pain and function outcomes compared with usual care, differences were small and may not be clinically important. Patient education should not be provided as a standalone treatment and should be combined with exercise therapy to provide statistically superior and clinically important short-term improvements in function compared with education alone.\n\n\nREGISTRATION\nPROSPERO CRD42019122004.