Patient Education
Patient education programs are recommended to improve pain in patients with knee osteoarthritis

Rationale

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.