Self-Management
Self-management programs are recommended to improve pain and function for patients with knee osteoarthritis.

Rationale

Self-management programs refer to formalized training and education programs that are taught by both healthcare professionals and trained layperson instructors. They typically include several sessions over several weeks. These programs train people in several elements of self-management for osteoarthritis including medication compliance, pain management and pain coping strategies, joint protection strategies during physical activity, exercise advice, problem-solving approaches and stress management techniques.

Four high quality studies (Saffari 2018, Somers 2012, Hurley 2007, Omidi 2018) and one moderate quality study (Coleman 2012) compared self-management to usual care or no treatment. These studies reported greater improvements in pain, function, or both compared to the control groups. In addition, some of these studies reported greater improvements in quality of life, pain catastrophizing, and self-efficacy in the self-management groups (Saffari 2018, Somers 2012).

One high quality (Marconcin 2018) and three moderate quality studies examined the combined use of self-management and exercise to either groups that received self-management or exercise alone (Bennell 2016) or usual care (Yip 2007, Kao 2012). Yip et al. reported greater improvements in pain, time spent in leisure activities, and self-efficacy, compared to usual care. (Yip 2007) reported greater improvements in pain and function compared to the control groups. Bennell, et al, reported improvements in pain and function in all groups. There were no differences between groups on pain measures but the combined use of self-management (i.e., pain coping skills training) and exercise had greater improvements in function compared to those receiving only self-management or exercise (Bennell 2016).

An attempt was made to examine the literature on cognitive behavioral therapy (CBT) in the management of people with knee osteoarthritis. One high quality (Helminen 2015) and 4 moderate quality (Focht 2012, Focht 2017, Smith 2015, Lerman 2017) studies were reviewed. Control groups consisted of usual care (Helminen 2015), traditional exercise approaches for knee osteoarthritis, (Focht 2012, Focht 2017) or behavioral desensitization (Smith 2015, Lerman 2017). Inconsistency in outcome results across studies made it difficult to provide a recommendation for this intervention approach at this time.

Benefits/Harms of Implementation

Patients may expect improvements in pain and function, problem-solving abilities, and self-efficacy from participating in these programs. Engagement in exercise recommendations could result in some temporary increased knee pain or muscle soreness.

Outcome Importance

Pain, function, self-efficacy in managing osteoarthritis.

Feasibility

Self-management programs are feasible for patients provided they have appropriate access. Some patients may have limited access for participation, making the programs less feasible.

Future Research

Future research should examine delivery methods designed to increase access for patients (e.g., online delivered programs). Given that some patients with severe symptoms and disability may not be able to respond to self-management programs, future research should assess whether the outcomes of self-management programs vary with disease severity. This research should determine if there is a threshold of disease or disability severity that discriminates between responders and non-responders of this treatment approach.