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Meta-Analysis
. 2025 Mar 19:27:e56227.
doi: 10.2196/56227.

Behavioral Therapy-Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis

Beiyao Zhu #  1 , Dian Zhu #  2 , Xiao'ao Xue  3 , Hongyi Yang  2 , Shurong Zhang  3
Affiliations
Meta-Analysis

Behavioral Therapy-Based Digital Interventions for Treating Osteoarthritis: Systematic Review and Meta-Analysis

Beiyao Zhu et al. J Med Internet Res. .

Abstract

Background: Osteoarthritis (OA) is characterized by pain, functional impairments, muscle weakness, and joint stiffness. Since OA heightens reliance on heath care resources and exacerbates socioeconomic burden, remote OA rehabilitation using digital technologies is rapidly evolving.

Objective: The aim of this study was to analyze the efficacy of behavioral therapy-based digital interventions for patients with OA.

Methods: This study is a systematic review of randomized controlled trials (RCTs) that assessed the effects of behavioral therapy-based digital intervention tools for OA. These RCTs were searched from inception to June 2023 in the Web of Science, Embase, Cochrane Library, Ovid, and PubMed databases.

Results: Ten eligible RCTs comprising 1895 patients with OA were included. Digital tools based on either cognitive behavioral therapy (CBT) or behavior change technique (BCT) were investigated. All studies demonstrated low-to-moderate effects on pain reduction in the short term (standardized mean difference [SMD] -0.20, 95% CI -0.35 to -0.05). Six studies reported improvement in physical function (SMD -0.20, 95% CI -0.41 to 0.00), and 5 confirmed increased pain self-efficacy (SMD 0.22, 95% CI 0.02-0.42). In subgroup analysis, compared with CBT, BCT-based digital interventions demonstrated their effects on pain reduction (SMD -0.25, 95% CI -0.49 to 0.00) and physical function (SMD -0.26, 95% CI -0.54 to -0.01) in the short term. In addition, physiotherapist involvement in treatment had a positive effect on pain control (SMD -0.14, 95% CI -0.27 to -0.02). Furthermore, web-based digital tools improved physical function in the short term (SMD -0.28, 95% CI -0.54 to -0.01).

Conclusions: Moderate- and low-quality evidence supported that behavioral therapy-based digital tools improved pain intensity, physical function, and self-efficacy in the short term. However, affective interactions between patients and professionals may affect the clinical outcomes.

Trial registration: PROSPERO CRD42023430716; https://tinyurl.com/yc49vzyy.

Keywords: behavioral therapy; digital intervention; impairment; meta-analysis; osteoarthritis; pain; pain reduction; patient; psychotherapy-based digital intervention; quality of life; socioeconomic burden; systematic review; treatment.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the studies selected in this review. OA: osteoarthritis; RCT: randomized controlled trial.
Figure 2
Figure 2
Risk of bias. Red indicates high risk, green indicates low risk, and yellow indicates unclear risk.
Figure 3
Figure 3
Main results of this study. HQoL: health-related quality of life.
Figure 4
Figure 4
Pain outcomes in different behavioral therapy models.
Figure 5
Figure 5
Physical function outcomes in different behavioral therapy models.
Figure 6
Figure 6
Pain outcomes related to therapist involvement.
Figure 7
Figure 7
Physical function outcomes related to therapist involvement.
Figure 8
Figure 8
Pain outcomes with different digital tools.
Figure 9
Figure 9
Physical function outcomes with different digital tools.
See this image and copyright information in PMC

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