Self-Management for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background. Knee osteoarthritis (KOA) is a high incidence chronic joint disease that seriously affects patients’ quality of life, and current treatment methods have limited efficacy. Self-management may be an effective strategy for KOA, and clinicians have been showing increased interest recently. However, the effectiveness of self-management for KOA remains controversial. Purpose. This study aims to systematically evaluate the effectiveness of self-management for KOA. Methods. We screened articles published in MEDLINE, Cochrane Library, EMBASE, and Web of Science until September 17, 2021. The main outcomes included pain, knee function, stiffness, WOMAC (total), physical function, arthritis self-efficacy (ASE-pain), arthritis self-efficacy (ASE-other symptoms), mental health, and quality of life. Results. Thirteen randomized controlled trials (RCTs) were finally included (n = 1610). Meta-analysis showed differences in pain, knee function, stiffness, ASE-pain, ASE-other symptoms, mental health, and quality of life between the self-management and control groups. Of the nine outcomes evaluated, four were highly heterogeneous, and the quality of evidence ranged from very low to moderate. Conclusion. The meta-analysis results showed that self-management might help improve the pain, knee function, stiffness, ASE, mental health, and quality of life in patients with KOA. However, it has no significant effect on WOMAC (total) and physical function. Considering that this study has some limitations, we cannot draw clear conclusions based on the results of this study. Nevertheless, we offer much needed insight and encourage more rigorously designed and implemented RCTs in the future to substantiate our conclusions.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update

“…Zero to small favourable effects were found for self-management, delivered face to face or digitally, compared with routine/usual care. 21 22 Despite the limited effects reported in the literature, the TF agreed that self-management is a concept closely related both to the delivery of information and education in a clinical setting and to the uptake of other relevant treatment modalities.…”

Osteoarthritis Literacy and Equity Issues: A Post COVID-19 Analysis and Update

“…Features of osteoarthritis that may be especially important to possibly mitigate are those of joint inflammation, excess weight gain or loss, muscle and bone attrition, nerve damage and impairments of those sensory mechanisms designed to foster joint protection and avert injury, common in vulnerable older adult osteoarthritis populations [23][24][25][26][27][28][29][30][31][32]. As put forth by Hunter et al [33], the appropriate selection and use of evidence-based management options is critical in this regard, but for helping the osteoarthritis client to obtain the full benefits from their treatment recommendations, they have to understand what is needed, and be able to act on these imperatives.…”

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“…29,30 There may also be varying degrees of muscle pathology, a high rate of muscle protein degradation and muscle volume losses, related problems that stem from damage or dysfunction of the joint sensory and motor nerves, muscle inhibition and/or weakness, plus evidence of increasing postural instability in weight bearing joints. [31][32][33][34][35][36][37] In addition, an immense loss of functional independence, motivation for self-care, a loss of independence, and a declining belief in their ability to overcome their life challenges are cognitive factors that may be expected to increasingly exacerbate the older adults pain, 38 and overall multiple biomechanical disease impacts. 39 As such, if an older adult suffering from various degrees of osteoarthritis wants to remain in the community, rather than reside in a nursing home, their goals can probably only be met if concerted efforts are made to assess if this is feasible, for example if they have mild-moderate rather than severe forms of the disease, and if so to carefully and insightfully assess their past medical history, and current health and disease status, and address and plan for their immediate, short term and long term needs accordingly, bearing in mind the more recently acknowledged need to keep older adults as healthy as possible and protected against COVID infections and their oftentimes dire repercussions.…”