Six high-quality studies (Saffari 2018, Somers 2012, Cagnin 2019, Gilbert 2018, Baker 2019, Berman 2004) thirteen moderate quality study (Brosseau 2012, Allen 2010, O’Brien 2018, Allen 2010, Bennell 2017, Marra 2017, Rezende 2017, Sandeghi 2019, Rodriguez da Silva 2017, Rini 2015, Moseng 2020, Chen 2020, Ravaud 2009) and two limited quality studies compared patient education and control. These studies reported more significant improvements in pain compared to the control groups.
Patient education programs in studies overlap with self-management programs. Patient education programs vary from patient handout, 2+ hour DVD, one-day education to multiple sessions over a month (Saffari 2018, Cagnin 2019, Brosseau 2012, O’Brien 2018, Rezende 2017, Rodriguez da Silva 2017, Rini 2015). Many studies are challenging to evaluate the effects of education because they involve exercise classes and other proven interventions (Marra 2017, Ravaud 2009). Self-management programs train people in several elements of self-management for osteoarthritis (1148), including medication compliance, pain management, and pain coping strategies, joint protection strategies (1149) during physical activity, exercise advice, problem-solving approaches, and stress management techniques. Patient education programs may not be as labor-intensive, and further work is needed to identify the amount of education needed to improve patient-related outcome measures, like pain.
Programs that focused on education are two high quality (Saffari 2018, Cagnin 2019) and four moderate quality (Brosseau 2012, O’Brien 2018, Rodriguez da Silva 2017, Rini 2015). Saffari used seven (7) group sessions over one month and provided a CD-ROM and booklet describing preventive lifestyle procedures and the importance of treatment adherence (Saffari 2018). They found improvement in SF-12 and pain scores. Cagnin used an educational session with a physical therapist who demonstrated how recommended exercises should be performed and how patients can manage their pain. They demonstrated improvement in KOOS pain scores (Cagnin 2019). Brousseau looked at education (educational pamphlet) vs. walking and education vs. walking and behavioral intervention (Brouseau 2012). There was a non-clinically significant improvement in pain in the education-only group at 12 months compared to walking and behavioral intervention. O’Brien used weight loss education, where trained telephone interviewers provided brief advice and education about the benefits of weight loss and physical activity for knee osteoarthritis immediately after randomization [O’Brien 2018]. The intervention group provided an evidence-based public health non-disease-specific telephone-based coaching service funded by the local Australian state government to support adults in making sustained lifestyle improvements, including diet, physical activity, and achieving a healthy weight and, where appropriate, access smoking cessation services. They did not find an added benefit from the coaching service over the brief telephone education in pain nor WOMAC scores. Rini compared an internet-based app (PainCoach) [http://tri.ad/projects-2/] to usual care and found a non-clinically significant reduction in VAS pain scores (Rini 2015). Rodriguez da Silva used a single day (Saturday, from 8 a.m. to 5 p.m.), which included seven lectures of 30 min by each professional team, and 60-min workshops by the physical education, physical therapy, and occupational therapy professionals, approaching the importance of their area in knee OA treatment/management. The study did not report pain scores but did note an increase in mobility with improvements in the get-up and go test. The two high-quality and four moderate-quality studies showed improved pain scores from the education given during educational sessions. Most studies (15 of the 21) incorporate education with other interventions; therefore, it is impossible to isolate the effects of education in these other 15 studies.
One high quality (Gilbert 2018) and three moderate quality (Rezende 2017, Chen 202, Ravaud 2009) used the transtheoretical model (TTM) and motivational interviewing to improve osteoarthritis treatment adherence. These studies showed improvement in WOMAC pain scores. TTM has been used successfully in other conditions that benefit from lifestyle changes [PMID: 24500864].
Future Research
Further research is needed to determine the best practice of education for reducing pain and other PROM for knee OA and the delivery method. Since many studies use different components and delivery methods and multiple interventions, it is impossible to recommend one particular educational module or particular component.
- Rodrigues da Silva, J. M., de Rezende, M. U., Spada, T. C., da Silva Francisco, L., Sabine de Farias, F. E., Clemente da Silva, C. A., Cernigoy, C. H. A., Greve, J. M. D., Ciolac, E. G. Educational program promoting regular physical exercise improves functional capacity and daily living physical activity in subjects with knee osteoarthritis. BMC Musculoskeletal Disorders 2017; 1: 546
- Sadeghi, A., Rad, Z. A., Sajedi, B., Heydari, A. H., Akbarieh, S., Jafari, B. Effect of weight losing on the clinical status improvement of patients with knee osteoarthritis. Reumatologia Clinica 2019; 2: 73-76
- Saffari, M., Emami Meybodi, M. K., Sanaeinasab, H., Karami, A., Pakpour, A. H., Koenig, H. G. A theory of planned behavior-based intervention to improve quality of life in patients with knee/hip osteoarthritis: a randomized controlled trial. Clinical Rheumatology 2018; 0: 10
- Somers, T. J., Blumenthal, J. A., Guilak, F., Kraus, V. B., Schmitt, D. O., Babyak, M. A., Craighead, L. W., Caldwell, D. S., Rice, J. R., McKee, D. C., Shelby, R. A., Campbell, L. C., Pells, J. J., Sims, E. L., Queen, R., Carson, J. W., Connelly, M., Dixon, K. E., Lacaille, L. J., Huebner, J. L., Rejeski, W. J., Keefe, F. J. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain 2012; 6: 1199-209
- O'Brien, K. M., Wiggers, J., Williams, A., Campbell, E., Hodder, R. K., Wolfenden, L., Yoong, S. L., Robson, E. K., Haskins, R., Kamper, S. J., Rissel, C., Williams, C. M. Telephone-based weight loss support for patients with knee osteoarthritis: a pragmatic randomised controlled trial. Osteoarthritis & Cartilage 2018; 4: 485-494
- Marra, C. A., Cibere, J., Grubisic, M., Grindrod, K. A., Gastonguay, L., Thomas, J. M., Embley, P., Colley, L., Tsuyuki, R. T., Khan, K. M., Esdaile, J. M. Pharmacist-initiated intervention trial in osteoarthritis: a multidisciplinary intervention for knee osteoarthritis. Arthritis care & research 2012; 12: 1837-45
- Allen, K. D., Oddone, E. Z., Coffman, C. J., Datta, S. K., Juntilla, K. A., Lindquist, J. H., Walker, T. A., Weinberger, M., Bosworth, H. B. Telephone-based self-management of osteoarthritis: A randomized trial. Annals of Internal Medicine 2010; 9: 570-9
- Baker, K., LaValley, M. P., Brown, C., Felson, D. T., Ledingham, A., Keysor, J. J. Efficacy of Computer-based Telephone Counseling on Long-term Adherence to Strength Training in Elders with Knee Osteoarthritis: A Randomized Trial. Arthritis care & research 2019; 0:
- Bennell, K. L., Campbell, P. K., Egerton, T., Metcalf, B., Kasza, J., Forbes, A., Bills, C., Gale, J., Harris, A., Kolt, G. S., Bunker, S. J., Hunter, D. J., Brand, C. A., Hinman, R. S. Telephone Coaching to Enhance a Home-Based Physical Activity Program for Knee Osteoarthritis: A Randomized Clinical Trial. Arthritis care & research 2017; 1: 84-94
- Berman, B. M., Lao, L., Langenberg, P., Lee, W. L., Gilpin, A. M., Hochberg, M. C. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine 2004; 12: 901-10
- Brosseau, L., Wells, G. A., Kenny, G. P., Reid, R., Maetzel, A., Tugwell, P., Huijbregts, M., McCullough, C., De Angelis, G., Chen, L. The implementation of a community-based aerobic walking program for mild to moderate knee osteoarthritis: a knowledge translation randomized controlled trial: part II: clinical outcomes. BMC Public Health 2012; 0: 1073
- Cagnin, A., Choiniere, M., Bureau, N. J., Durand, M., Mezghani, N., Gaudreault, N., Hagemeister, N. A multi-arm cluster randomized clinical trial of the use of knee kinesiography in the management of osteoarthritis patients in a primary care setting. Postgraduate Medicine; 1: 91-101
- Chen, H., Wang, Y., Liu, C., Lu, H., Liu, N., Yu, F., Wan, Q., Chen, J., Shang, S. Benefits of a transtheoretical model-based program on exercise adherence in older adults with knee osteoarthritis: a cluster randomized controlled trial. Journal of advanced nursing 2020; 0:
- Gilbert, A. L., Lee, J., Ehrlich-Jones, L., Semanik, P. A., Song, J., Pellegrini, C. A., Pinto Pt, D., Dunlop, D. D., Chang, R. W. A randomized trial of a motivational interviewing intervention to increase lifestyle physical activity and improve self-reported function in adults with arthritis. Seminars in Arthritis & Rheumatism 2018; 5: 732-740
- Moseng, T., Dagfinrud, H., van Bodegom-Vos, L., Dziedzic, K., Hagen, K. B., Natvig, B., Rotterud, J. H., Vlieland, T. V., Osteras, N. Low adherence to exercise may have influenced the proportion of OMERACT-OARSI responders in an integrated osteoarthritis care model: secondary analyses from a cluster-randomised stepped-wedge trial. BMC Musculoskeletal Disorders ; 1: 236
- Ravaud, P., Flipo, R. M., Boutron, I., Roy, C., Mahmoudi, A., Giraudeau, B., Pham, T. ARTIST (osteoarthritis intervention standardized) study of standardised consultation versus usual care for patients with osteoarthritis of the knee in primary care in France: pragmatic randomised controlled trial. BMJ 2009; 0: b421
- Rezende, M. U., Frucchi, R., Pailo, A. F., Campos, G. C., Pasqualin, T., Hissadomi, M. I. Parqve: Project Arthritis Recovering Quality of Life through Education: Two-Year Results. Acta Ortopedica Brasileira 2017; 1: 18-24
- Rini, C., Porter, L. S., Somers, T. J., McKee, D. C., DeVellis, R. F., Smith, M., Winkel, G., Ahern, D. K., Goldman, R., Stiller, J. L., Mariani, C., Patterson, C., Jordan, J. M., Caldwell, D. S., Keefe, F. J. Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial. Pain 2015; 5: 837-48