Self-Management for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Effect of Clinic-Based and Asynchronous Video-Based Exercise on Clinic and Psychosocial Outcomes in Patients With Knee Osteoarthritis: Quasi-Experimental Study

BACKGROUND

Telerehabilitation is promising for improving knee osteoarthritis, but the effect of different telerehabilitation strategies on knee osteoarthritis is unclear.

OBJECTIVE

This study aimed to examine the effect of a clinic-based strengthening exercise (CbSE) and asynchronous video-based strengthening exercise (AVbSE) on pain, range of motion, muscle strength, quality of life, and physical function among patients with knee osteoarthritis.

METHODS

A total of 52 consenting patients participated in this 8-week experimental study; they were assigned to the CbSE or AVbSE group at 2 different study sites. CbSE is a circuit exercise module comprising knee flexion and extension warm-up in sitting, quadriceps isometric setting, quadriceps strengthening exercise, hamstring clenches, wall squat, and a cooldown of knee flexion and extension. The AVbSE is an asynchronous video-based version of the CbSE.

RESULTS

This study spanned from March 31, 2021, to November 26, 2021. Eight out of 62 participants discontinued participation. Data collection and analysis have been completed. Significant differences were only observed in the mental health (t50=-3, P=.004), pain (t39.4=-3.6, P<.001), social support (t50=-2.7, P=.009), and social activities (t50=2.2, P=.03) domains of the Osteoarthritis Knee and Hip Quality of Life (OAKHQoL) questionnaire with higher scores in the AVbSE group at the end of week 4. At the end of week 8, significant differences were observed in mental health (t50=-2.1, P=.04) and pain (t37.3=-2.8, P=.008) measures with higher scores in AVbSE; however, a significantly higher score was observed in the CbSE group for the Quadruple Visual Analog Scale. No significant main effect of time was observed in this study, except in the muscle strength (F2100=1.5, P=.24), social support (F2100=2.5, P=.09), and social activity (F2100=0.7, P=.48) domains of the OAKHQoL questionnaire and activity limitation (F2100=0.1, P=.90), and performance restriction (F2100=1.3, P=.27) domains of the Ibadan Knee and Hip Osteoarthritis Outcome Measure (IKHOAM) questionnaire. There was no significant difference between groups in all OAKHQoL domains except social activities (mean 17.6, SD 1.2 vs 22.8, SD 1.2; P=.003) and average pain (2.8, SD 1.6 vs 2.3, SD 1.6; P=.03) with higher AVbSE mean scores. However, a higher score was observed for the CbSE group in the Quadruple Visual Analog Scale's least pain domain (1.2, SD 0.2 vs 0.7, SD 0.2; P=.04). Also, interaction effects showed that AVbSE scores were significantly higher for the OAKHQoL questionnaire's physical activity and mental health domains at all time points. However, the CbSE score was higher for the physical performance domain of the IKHOAM questionnaire in the eighth week.

CONCLUSIONS

CbSE circuit training and its AVbSE variant effectively improve treatment outcomes and increase the quality of life of patients. While AVbSE was associated with higher improvement in most health-related quality of life domains, CbSE led to higher improvement in average pain.

TRIAL REGISTRATION

Pan African Clinical Trial Registry PACTR202208515182119, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23943.

Psychological intervention for knee osteoarthritis: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the effectiveness of psychological interventions compared to standard rehabilitation in patients with knee osteoarthritis (OA). Given the recognized influence of psychological factors in OA management, the review assessed their impact on pain, functional disability, and self-efficacy. A comprehensive search was performed across multiple databases, including PubMed, PsycINFO, CINAHL, the Cochrane Central Register of Controlled Trials, Web of Science, OpenGrey, and ClinicalTrials.gov, covering records from inception to September 2023. Eligible studies were randomized controlled trials that examined psychological interventions such as cognitive-behavioral therapy and biofeedback in adults with knee OA diagnosed based on established clinical or radiological criteria. Studies with mixed populations were included only if at least 75% of participants had OA. Exclusion criteria included studies focused on surgical patients or individuals with systemic conditions (e.g. rheumatoid arthritis). No restrictions were placed on intervention duration, allowing for a broad range of studies to be considered. From the 3,649 records identified, 70 studies met the inclusion criteria, and 20 studies involving 3,138 participants were included in the meta-analysis. The results demonstrated that psychological interventions led to significant improvements in pain (mean difference [MD]: -1.04; 95% confidence interval [CI]: -1.61 to -0.46), disability and function (standardized mean difference [SMD]: -0.26; 95% CI: -0.38 to -0.15), and self-efficacy (SMD: 0.49; 95% CI: 0.28 to 0.70). The strongest effects were observed in self-efficacy. However, concerns regarding methodological limitations, variability in intervention approaches, and high heterogeneity led to the evidence quality being rated as low to very low. This review underscores the potential benefits of psychological interventions in knee OA management, particularly for enhancing self-efficacy. Nonetheless, further high-quality research employing standardized protocols is needed to validate these findings and facilitate their clinical application.

Do self-management supportive interventions reduce healthcare utilization for people with musculoskeletal pain conditions? - A systematic review

OBJECTIVE

The aim of this systematic review was to investigate the effect of self-management supportive interventions on healthcare utilization in adult cares seekers with musculoskeletal pain conditions.

STUDY DESIGN

Systematic review.

METHODS

We included studies comparing the effect of a self-management supportive intervention against a control intervention and included measures of healthcare utilization. Studies were searched in MEDLINE, Embase, PsycINFO, CINAHL, Pedro, and the Cochrane Library. Results were extracted for the follow-up point closest to 12 months. Risk of bias was assessed using the Cochrane Risk of Bias tool 2, and quality of evidence by The Grading of Recommendations Assessment, Development and Evaluation. Results were synthesized on study level as mean differences or odds ratios with 95 % CI.

RESULTS

We included 28 studies. Eighteen studies reported on the use of primary care at follow-up, and ten, four, and 13 on specialty care, diagnostics imaging, and oral pain medication, respectively. Overall, there was very low-quality evidence for no effect of self-management interventions on healthcare utilization in all groups. All studies were classified as either having a "high risk of bias" or "some concerns".

CONCLUSION

Due to substantial heterogeneity in the types and measurement of healthcare utilization outcomes, it was not feasible to conduct a meta-analysis to estimate an overall effect size. A standardized way of reporting and measuring these outcomes could aid future research in this area. The current evidence suggests that self-management supportive interventions do not affect healthcare utilization in people with musculoskeletal pain conditions, but future high-quality studies may substantially change this conclusion.

Development and validation of a three-dimensional nomogram prediction model for knee osteoarthritis in middle-aged population

OBJECTIVES

This study aims to identify predictors of knee osteoarthritis (KOA) risk in middle-aged population, construct and validate a nomogram for KOA in this demographic.

METHODS

From June to December 2020, we conducted a cross-sectional survey on 5,527 middle-aged individuals from Changsha and Zhangjiajie cities in Hunan Province, selected using a stratified multi-stage random sampling method. Data collection involved a structured questionnaire encompassing general demographic, physical condition, and lifestyle behaviors dimensions. The dataset was randomly split into a training set (n = 3868) and a validation set (n = 1659) at a 7:3 ratio via computerized randomization. We analyzed the prevalence of self-reported KOA and identified its influencing factors using logistic regression. A nomogram was constructed based on these "three-dimensional" factors. Subsequent validation was conducted, and the nomogram's performance was further evaluated through ROC curves, C-index, Hosmer-Lemeshow test, and calibration curves.

RESULTS

The self-reported prevalence of KOA in the middle-aged population was 11.4% (632/5527). The risk factor with the greatest impact is: diagnosed with osteoporosis(95% CI 2.269-3.568, OR = 2.845), followed by age between 51 to 60 years (95% CI 2.176-3.151, OR = 2.619), diagnosed with hypertension(95% CI 1.633-2.499, OR = 2.02), diagnosed with diabetes (OR = 1.689), ethnic Han Chinese (OR = 1.673), exercise according to physical condition (OR = 1.643), pay attention to keeping the knee joint warm (OR = 1.535), eating habits are mainly light vegetables (OR = 1.374), male gender (OR = 1.343), drink occasionally in small amounts (OR = 1.286); a higher level of education (OR = 0.477) and frequently or always apply an external or plaster to relieve symptoms after knee discomfort (OR = 0.377; OR = 0.385) are protective factors. The C-index of the training set model was 0.8107 (95% CI: 0.8102-0.8111), with a statistically significant area under the ROC curve (AUC = 0.818), and the calibration curve showed a good fit. The C-index for the validation set was 0.8124 (95% CI: 0.8109-0.8140), with an AUC of 0.812. The Hosmer-Lemeshow test resulted in a P-value of 0.46 (P ≥ 0.05)indicating good calibration of the model.

CONCLUSION

The three dimensions nomogram generated in this study was a valid and easy-to-use tool for assessing the risk of KOA in middle-aged population, and helped healthcare professionals to screen the high-risk population.

The social and organisational factors shaping acceptability of a self-management education and exercise intervention for people with hip or knee osteoarthritis in Greenland

This study aimed to explore the experiences and perspectives of people with osteoarthritis attending the "Osteoarthritis School" (OA School) in Nuuk, Greenland to generate insights and lessons that can inform the development of self-management education and exercise interventions for people with other lifestyle conditions in a Greenland context. We conducted a qualitative interpretive description (ID) study based on ten semi-structured interviews with people with hip or knee osteoarthritis. Interviews were audio-recorded, transcribed, and coded. Using ID, we identified three themes: 1) perceptions and experiences of how the OA School intervention was organised (time and place); 2) perspectives and experiences of the education and exercise components (social factors, motivation, and education); and 3) significant change stories (physical and mental improvements and increased knowledge of OA). Social and organisational factors, such as working out with peers and the time and place of the intervention, influenced the participants' acceptance of the OA School intervention. Knowledge from this study will help us gain insight into what to address when developing future self-management education and exercise interventions in the Greenlandic healthcare system.

How Does Osteoarthritis Education Influence Knowledge, Beliefs, and Behavior in People With Knee and Hip Osteoarthritis? A Systematic Review

OBJECTIVE

Our goal was to inform the design and implementation of osteoarthritis (OA) education for people with knee and hip OA. This review investigated the impact of OA education on knowledge, beliefs, and behavior and how and why these changes occur.

METHODS

Five databases-MEDLINE, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Physiotherapy Evidence Database (PEDro)-were searched in August 2023. Eligible studies were quantitative, qualitative, and mixed-methods, involving OA education interventions and assessing knowledge, beliefs, and/or behavioral outcomes. An interpretivist analytic process guided data evaluation, synthesis, and description of meta-themes.

RESULTS

Ninety-eight studies were included (80 quantitative, 12 qualitative, 6 mixed-methods). OA education was heterogeneous in content and delivery. Outcome measures varied, with poor distinction among knowledge, beliefs, and behavior constructs. Trends toward short-term knowledge improvement were observed, but there were no clear trends in beliefs or behavior change. Intrinsic factors (eg, pre-existing beliefs) and extrinsic factors (eg, socioeconomic factors) appeared to influence change. Three meta-themes described how and why changes may occur: (i) engagement: how individuals relate with education content and delivery; (ii) embodiment: the role of experiential factors in learning, and (iii) empowerment: the level of agency education generates.

CONCLUSION

Beyond the provision of information and instruction, OA education is a complex, relational process influenced by multidimensional factors. This review identifies potentially important strategies at individual, interpersonal, and community levels to support the design and delivery of engaging education that promotes holistic, embodied learning and facilitates meaningful, empowering change.

Recommendations from the French Societies of Rheumatology and Physical Medicine and Rehabilitation on the non-pharmacological management of knee osteoarthritis

BACKGROUND

Although non-pharmacological therapies for knee osteoarthritis (OA) are essential pillars of care, they are often poorly considered and inconsistently applied.

OBJECTIVES

Under the umbrella of the French Society of Rheumatology (SFR) and the French Society of Physical Medicine and Rehabilitation (SOFMER), we aimed to establish consensual recommendations for the non-pharmacological management of people with knee OA.

METHODS

A group of fellows performed a systematic literature review on the efficacy and safety of non-pharmacological modalities (up to October 2021). The fellows then took part in discussions with a multidisciplinary group of experts to draft a list of recommendations. The list was then submitted to an independent reading committee who rated their level of agreement with each recommendation. Each recommendation was assigned a strength of recommendation and a level of evidence.

RESULTS

Five general principles were unanimously accepted: (A) the need to combine non-pharmacological and pharmacological measures; (B) the need for personalized management; (C) the need to promote adherence; (D) the need for adapted physical activity; and (E) the need for person-centered education. Specific positive or negative recommendations were defined for 11 modalities: (1) unloading knee brace; (2) kinesiotaping or knee sleeves; (3) shoes and/or insoles; (4) using a cane; (5) physical exercise program; (6) joint mobilization; (7) electro- or thermo-therapy; (8) acupuncture; (9) weight loss; (10) thermal spa therapy; and (11) workplace accommodation.

CONCLUSIONS

These SFR/SOFMER recommendations provide important and consensual knowledge to assist health professionals in decision-making for non-pharmacological treatments for knee OA.

Home care program and exercise prescription for improving quality of life in geriatric population with knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Knee Osteoarthritis (OA) is a degenerative bone disease commonly affecting the elderly. Exercise has emerged as a primary treatment strategy for individuals with knee OA. Various exercise regimes are now recognized as key approaches in managing OA.

OBJECTIVE

To evaluate the impact of a Home Care program combined with Exercise prescriptions on the quality of life in the geriatric population with knee OA.

METHODS AND MATERIALS

This review was conducted following a systematic approach to search for relevant articles in electronic databases. Studies published between 2011 and 2021 were included, following the PRISMA Guidelines. The databases screened included PubMed, Scopus, Cochrane, PEDro, MEDLINE, and EMBASE, using medical subject headings (MeSH) and Health Science Description (DeSC) terms.

RESULTS

A total of 12 studies involving participants undergoing home care programs and exercise prescriptions for OA were identified. The review findings indicated significant improvements in pain management and quality of life for individuals adhering to a structured home care program and therapist-guided exercise prescription.

CONCLUSION

The review suggests that implementing a home care program alongside an appropriate exercise regimen can enhance the quality of life in geriatric patients with knee OA, improving adherence to physical activity and overall patient outcomes.

A bibliometric analysis of the application of physical therapy in knee osteoarthritis from 2013 to 2022

Background

Knee osteoarthritis (KOA) is one of the most common chronic joint diseases. Physical therapy, a non-invasive approach, is extensively used in its treatment. Although bibliometrics is a reliable method to evaluate the significance and impact of research fields, systematic bibliometric analyses in this area are lacking. This study aims to perform a bibliometric analysis covering 2013 to 2022, to highlight the current state, key focuses, and trends in physical therapy for KOA.

Methods

This study utilizes the Web of Science Core Collection to gather relevant literature on physical therapy and KOA from 2013 to 2022. CiteSpace and VOSviewer software facilitated the visual analysis of the annual publications, geographic and institutional distributions, journals, authors, references, and keywords in this field.

Results

The study analyzed 1,357 articles, showing an overall increase in publications over time from 71 countries and 2,302 institutions. The United States and Australia emerged as leaders in this field. The analysis identified 6,046 authors, with Kim L. Bennell as the most prolific and Bellamy N. receiving the most citations. BMC Musculoskeletal Disorders published the most articles, while Osteoarthritis and Cartilage received the most citations. High-impact articles were authored notably by McAlindon TE, Bannuru RR, Fernandes L, and Bennell KL. Keyword analysis highlighted a strong focus on patient self-management, exercise therapy, physical factor therapy, and remote rehabilitation.

Conclusion

The bibliometric analysis confirms significant interest and ongoing research in physical therapy for KOA treatment from 2013 to 2022, indicating a growing field. Journals and authors in this area show influential and collaborative dynamics. Future research should focus on enhancing international and institutional collaboration and explore emerging trends like internet-guided treatments.

The Effectiveness of a Single Hyaluronic Acid Injection in Improving Symptoms and Muscular Strength in Patients with Knee Osteoarthritis: A Multicenter, Retrospective Study

Knee osteoarthritis (KOA) is a progressive and multifactorial disease that leads to joint pain, muscle weakness, physical disability, and decreased quality of life. In KOA, the quantity of hyaluronic acid (HA) and the molecular weight (MW) are decreased, leading to joint pain due to increased wear of the knee articular cartilage. Arthrogenic muscle inhibition, which is usually found in patients with KOA, is associated with joint inflammation, pain, and swelling, also causing muscle atrophy, primarily of the anterior thigh muscles, and hindering the rehabilitation process. The aim of our work was to determine if a single HA infiltration could minimize the effects of arthrogenic muscle inhibition in patients with KOA in the short term, using isokinetic dynamometry to evaluate the strength of the knee extensor and flexor muscles of the thigh. Thirty patients with KOA who underwent both clinical and isokinetic assessment, and that received a single injection of HA, were retrospectively included. Our results showed that a single intra-articular injection of HA significantly reduces pain and improves joint function at four weeks, while non-statistically significant improvements were observed for the reference isokinetic parameter (maximum torque) at both 90°/s and 180°/s. Further high-quality studies are necessary to confirm the results of our study.

Investigating the effect of an Orem-based self-care educative supportive nursing system on the joint function of patients with knee osteoarthritis

BACKGROUND

Osteoarthritis is the most common form of arthritis. It is a common progressive joint disease characterized by chronic pain and functional disability, which disturbs functional movements, body balance, and quality of life in patients with knee osteoarthritis. This study investigates the effect of an Orem-based self-care educative supportive nursing system on the joint function of patients with knee osteoarthritis.

MATERIALS AND METHODS

This semi-experimental paper studies 130 patients with knee osteoarthritis. The patients are selected using convenience sampling and randomly assigned to intervention and control groups equally. The K00S questionnaire was used to collect patients' demographic information and other information relating to their knees' function. We carried out interventions for six weeks, with a session of 45 to 60 minutes each week. Data were collected before the intervention and three months after the intervention. SPSS 21.0 and descriptive and inferential statistics were used to analyze the collected data at the significance level of 0.05.

RESULTS

The results show significant differences between the two groups in terms of joint symptoms (P = 0.001), pain (P = 0.001), daily activities (P = 0.001), sports and recreational activities (P = 0.001), and quality of life (P = 0.02). In other words, there was a significant difference in the average subscale scores of activities in all five dimensions between the intervention and control groups (P < 0.05).

CONCLUSION

Orem's self-care model has a positive and significant effect on the functional movement of patients with knee osteoarthritis and improves their joint function.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update

INTRODUCTION

Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed.

METHODS

The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed.

RESULTS

The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work.

CONCLUSIONS

The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.

How can clinicians enhance self-efficacy beliefs in osteoarthritis? An overview of systematic reviews with meta-analysis

This overview of reviews aimed to synthesize the effectiveness of non-pharmacological approaches to enhance self-efficacy in people with osteoarthritis. The CINAHL, Embase, PsycINFO, PubMed, SPORTDiscus, and the Cochrane Library databases were searched from inception to December 2023. We considered systematic reviews with meta-analysis of randomized clinical trials evaluating any non-pharmacological intervention. We used AMSTAR 2 to assess the methodological quality of reviews. The overlap between reviews was calculated. We included eight systematic reviews with meta-analysis evaluating 30 different clinical trials. Overall, mind-body exercises, psychological interventions, and self-management strategies may improve arthritis self-efficacy. Specifically, the meta-analyses showed tai chi exercises, coping skills training, and the arthritis self-management program are more effective than controls to enhance arthritis self-efficacy in people with hip and/or knee osteoarthritis. In addition, inconsistent results were detected across meta-analyses regarding the effectiveness of multidisciplinary interventions. Finally, the degree of overlap between all reviews was moderate (CCA = 6%) and many included reviews reported most of the items of AMSTAR 2. Tai chi exercises, coping skills training, and the arthritis self-management program may be beneficial for enhancing arthritis self-efficacy. Open Science Framework Registration: https://doi.org/10.17605/OSF.IO/VX2T6 .

Effectiveness of a Web-Guided Self-Managed Telerehabilitation Program Enhanced with Outdoor Physical Activity on Physical Function, Physical Activity Levels and Pain in Patients with Knee Osteoarthritis: A Randomized Controlled Trial

Background: Telerehabilitation to guide self-management has been shown to be a feasible care strategy for knee osteoarthritis (KOA). The aim of this study was to explore the effectiveness of a blended web-based rehabilitation program enhanced with outdoor physical activity (BWR-OPA) and consultation versus an OPA (usual care) program in KOA patients. Methods: Forty-four KOA participants were prescribed to follow the programs five times/week for 6 weeks. The primary outcome was self-reported physical function, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were pain, PA, function (timed up-and-go (TUG) test, 30 s chair rise test (30 s CRT)), psychological functioning and QoL. Results: There was a significant difference between the groups' KOOSs for pain and symptom subscales at the 6- and 12-week post-intervention assessments compared to baseline (p < 0.005) favoring the BWR-OPA group. There was a superior improvement in PA in the BWR-OPA training group (p < 0.05). Statistical and clinical improvements were found (p < 0.001) with effect sizes over 2.0 for objective measures of function. Similar improvements were recorded over time (p < 0.005) at 12 weeks for QoL, KOOS subscales for ADL, QoL and sports/recreation and psychological functioning for both groups. Conclusions: A blended web-based self-managed care program with outdoor PA was superior in many respects to usual care in KOA participants.

Rehabilitation interventions in osteoarthritis

The goals of the management of osteoarthritis (OA) are to relieve joint pain and stiffness, maintain or increase joint mobility and stability, improve activities and participation, and enhance quality of life. The first step in the management is to make a comprehensive holistic assessment to understand the impact of the disease on the individual. Then, an individualized management plan can be set via a shared-decision making process between the patient and the clinician taking into account all components of functioning affected by the disease. Rehabilitation interventions serve as the basis of OA management whereas pharmacological modalities are usually administered for additional symptom control. This study aimed to overview the rehabilitation interventions used for people with OA with an update of the recent evidence. First, core management approaches that include patient education, physical activity and exercises, and weight loss were addressed; then adjunctive treatments including biomechanical interventions (e.g. orthoses, assistive devices) and physical modalities were overviewed.