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Goff AJ, De Oliveira Silva D, Merolli M, et al. Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review. J Physiother. 2021 Jul;67(3):177-189. doi: 10.1016/j.jphys.2021.06.011. Epub 2021 Jun 20. (Systematic review)
Abstract

QUESTION: Is patient education effective as a standalone intervention or combined with other interventions for people with knee osteoarthritis?

DESIGN: Systematic 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.

PARTICIPANTS: People with knee osteoarthritis.

INTERVENTION: Any patient education intervention compared with any non-pharmacological comparator.

OUTCOME MEASURES: Primary outcomes were self-reported pain and function.

RESULTS: Twenty-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 -0.35, 95% CI -0.56 to -0.14) and function in the short term (-0.31, 95% CI -0.62 to 0.00), 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).

CONCLUSION: Although 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.

REGISTRATION: PROSPERO CRD42019122004.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

It's good to have a systematic review indicating the superiority of using patient education in combination with exercise therapy for knee OA.

Rehab Clinician (OT/PT) rater

Missing a lot or references related to the topic??

Rehab Clinician (OT/PT) rater

OA knee is a slippery slope with an increasingly miserable compromise of function and quality of life. This study confirms an intuitive sense that education and guidance in conjunction with [appropriately titrated] activity yield better patient short term results than merely education alone.
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