The effectiveness of self-management educational interventions for osteoarthritis of the knee

Abstract

Background: Osteoarthritis (OA) is a common cause of pain and disability, and is the most common form of arthritis in the Western world. The most common joint to be affected is the knee. Pain and functional disability are common symptoms, which can lead to reduced quality of life and increase the risk of further morbidity.Current treatment aims to educate patients about the management of OA, reduce pain, improve function, decrease disability and reduce the progression of the disease. Education with clients has been described as a set of planned educational activities designed to improve patients' health behaviours and/or health status. The purpose of self-education is to maintain or improve health, or, in some cases, to slow deterioration by increasing participant's perception of self efficacy defined as an ability to control or manage various aspects of OA. To date, there is no systematic review of the literature undertaken to identify the effectiveness of self-management educational activities for osteoarthritis of the knee.

Objective: The objective of this systematic review is to evaluate the effectiveness of self-management educational interventions on function and quality of life for adult subjects with OA of the knee.

Search strategy: A comprehensive search strategy was undertaken on databases available from University of South Australia from their inception to January 2007.

Selection criteria: Randomised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee.Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments. Data extraction was via the Joanna Briggs Institute standard data extraction form for evidence of effectiveness, and Review Manager Software was used to calculate comparative statistics.

Results: Thirteen trials were included in the review. Trials were clinically and methodologically heterogeneous. Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain (SMD -0.25, 95%CI -0.36 to -0.13, 11 trials 1379 participants). There was no effect on physical function (SMD 0.13, 95%CI -0.33 to -0.08, eight trials, 1156 subjects). No beneficial effects were found from self management interventions with improving quality of life. We also found the exercise component of self management (four trials) demonstrated a benefit with reducing pain, improving function and quality of life. Exercise also offered a benefit over no exercise. Overall methodological quality was moderate.

Discussion: Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function. Significant heterogeneity was found between trials. This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group. The exercise component of self management programmes appears to contribute a significant benefit.

Conclusion: There is encouraging evidence of a small benefit from exercise in self management programs. Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes.