Biopsychosocial Rehabilitation for Inflammatory Arthritis and Osteoarthritis Patients: A Systematic Review and Meta‐Analysis of Randomized Trials

Abstract

To assess the benefits and harms associated with biopsychosocial rehabilitation in patients with inflammatory arthritis (IA) and osteoarthritis (OA). METHODS:We performed a systematic review and meta-analysis. Data were collected through electronic searches of Cochrane CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to March 2019. Trials examining the effect of biopsychosocial rehabilitation in adults with IA and/or OA were considered eligible, excluding rehabilitation adjunct to surgery. The primary outcome for benefit was pain, and total withdrawals for harm. RESULTS:Of the 27 trials meeting the eligibility criteria, 22 trials (3,750 participants) reported sufficient data to be included in the quantitative synthesis. For patient reported outcome measures, biopsychosocial rehabilitation was slightly superior to control for pain relief (SMD -0.19 [95%CI, -0.31 to -0.07]), had a small effect on patient global (SMD -0.13 [95%CI, -0.26 to -0.00]), with no apparent effect on health-related quality of life, fatigue, self-reported disability/physical function, mental well-being, and reduction in pain intensity ≥30%. Clinician measured outcomes displayed a small effect on observed disability/physical function (SMD -0.34 [95%CI, -0.57 to -0.10]), a large effect on physician global score (SMD -0.72 [95%CI, -1.18 to -0.26]), and no effect on inflammation. No difference in harms for number of withdrawals, adverse events, or serious adverse events.

Understanding the psychosocial determinants of effective disease management in rheumatoid arthritis to prevent persistently active disease: a qualitative study

“…So, I am going around and around in a cycle looking for ways to improve my [mental and physical] health, but it is harder to [engage in] healthy [RA management] as you have less energy and less ability to stick [to your treatment] because you are focusing on the pain and sadness more. (white woman, [25][26][27][28][29][30][31][32][33][34] Mental and physical well-being practices Practising daily 'positive thinking' was used by participants to cope with their RA symptoms and prognosis, and helps them stay focused on managing their RA. They described using humour, practising positive selftalk, surrounding themselves with positive people and engaging in mindfulness.…”

“…You can overcome the pain by feeling better about yourself and your life. (Black woman, [25][26][27][28][29][30][31][32][33][34] Several used complementary medicine and other pain relief alongside their prescribed RA medical treatment. Regular use of RA medication was perceived to 'have a traumatising effect on the body' and using non-medical treatments was explained as to allow participants to feel in control of their care.…”

Clinical prediction model for interdisciplinary biopsychosocial rehabilitation in osteoarthritis patients

“… 5 In recent years, various studies have indicated positive effects of a conservative biopsychosocial oriented approach in OA treatment. 6 , 7 Despite the recommendation of this treatment in OA, effect sizes of conservative treatment remain only small or at best moderate. 7 A possible explanation for this relative lack of treatment success could be related to suboptimal patient selection.…”

“… 11 , 12 Individualized interdisciplinary multimodal pain treatments (IMPT) have resulted in positive improvement of several patient-reported and clinician measured outcomes regarding pain, disability and psychological factors in patients experiencing different chronic primary musculoskeletal pain disorders, 13 but also for self-reported pain, health and clinically observed disability in OA patients specifically. 6 This sort of treatment usually targets different components of the biopsychosocial model that contribute to the maintenance of chronic pain and/ or disability, requires active participation of the patients, and is given by a team of different health professionals ( e.g . physiotherapist, psychologist, physiatrist, social worker, etc.)…”

“…who work interdisciplinary. 6 , 14 Moreover, predictive factors for IMPT treatment success in different musculoskeletal pain populations (baseline lower levels of negative psychological factors and disability, and higher levels of physical functioning), and some specific in OA populations (younger age, baseline lower BMI and having knee OA) are reported. 15 - 17 However, a clinical prediction model which informs whether an OA patient is expected to benefit or not from IMPT is currently lacking.…”