Effectiveness of Health-Led Cognitive Behavioral-Based Group Therapy on Pain, Functional Disability and Psychological Outcomes among Knee Osteoarthritis Patients in Malaysia

Abstract

Background: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia. Methods: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat. Results: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI −1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p < 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing. Conclusion: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.

Effects of self-management education programmes on self-efficacy for osteoarthritis of the knee: a systematic review of randomised controlled trials

“…Study participants were recruited in US [ 39 , 40 ], Malaysia [ 41 ], France [ 42 ], Finland [ 43 ], and Hong Kong [ 37 , 38 ]. To include study participants, four studies confirmed radiographic knee OA [ 39 – 41 , 43 ], and three studies used American College of Rheumatology clinical criteria [ 37 , 38 , 42 ]. Sample sizes in the selected studies ranged between 80 [ 39 ] and 300 [ 41 ].…”

“…Provided programme for comparison arms of interventions in each of the included studies are shown in Additional file 2 . Two studies provided conventional orthopaedic intervention [ 38 , 39 ], and the other two studies provided standard care (including education booklet) [ 41 , 42 ]. Exercise programme [ 40 ], spa therapy and education booklet [ 43 ], and ordinary general practioner’s (GP) care were also provided.…”

“…Self-efficacy for pain was measured using the ASES for pain [ 44 ] in three studies [ 37 , 38 , 42 ] and Pain Self-Efficacy Questionnaire (PSEQ) [ 45 ] in two studies [ 41 , 43 ]. Self-management education programmes had significant effects on the self-efficacy for pain at 1 month in one study [ 37 ], but not in two studies [ 38 , 41 ]. Self-management education programmes had significant effects on the PSEQ at 6 months [ 41 ], but not on ASES for pain at 3 months [ 42 ] and 4 months [ 37 , 38 ].…”

“…Self-management education programmes had significant effects on the self-efficacy for pain at 1 month in one study [ 37 ], but not in two studies [ 38 , 41 ]. Self-management education programmes had significant effects on the PSEQ at 6 months [ 41 ], but not on ASES for pain at 3 months [ 42 ] and 4 months [ 37 , 38 ]. There was no significant difference between the self-management education and comparator groups at the 12-month follow-up after the intervention [ 38 , 43 ] .…”

“…We included seven articles in this systematic review. Several studies have reported the beneficial effects of self-management education programs on self-efficacy for managing pain and other arthritis symptoms [ 37 , 38 , 41 ] and for self-regulatory [ 39 ]. However, the results of the included studies were varied and inconsistent.…”