Complex Lifestyle and Psychological Intervention in Knee Osteoarthritis: Scoping Review of Randomized Controlled Trials.

Bryan Yijia Tan,Tivona Thach,Lorainne Tudor Car,Julian Thumboo,Josip Car,Soren Thorgaard Skou,Yasmin Lynda Munro

doi:10.3390/ijerph182312757

Abstract

Knee osteoarthritis (OA) causes pain, disability and poor quality of life in the elderly. The primary aim was to identify and map out the current evidence for randomised controlled trials (RCTs) on complex lifestyle and psychosocial interventions for knee OA. The secondary aim was to outline different components of complex lifestyle and psychosocial interventions. Our scoping review searched five databases from 2000 to 2021 where complex lifestyle or psychosocial interventions for patients with knee OA were compared to other interventions. Screening and data extraction were performed by two review authors independently and discrepancies resolved through consensus and in parallel with a third reviewer. A total of 38 articles were selected: 9 studied the effectiveness of psychological interventions; 11 were on self-management and lifestyle interventions; 18 looked at multifaceted interventions. This review highlights the substantial variation in knee OA interventions and the overall lack of quality in the current literature. Potential areas of future research, including identifying prognostic social factors, stratified care models, transdisciplinary care delivery and technology augmented interventions, have been identified. Further high-quality RCTs utilizing process evaluations and economic evaluation in accordance with the MRC guidelines are critical for the development of evidence-based knee OA programs globally.

Highlights

Osteoarthritis (OA) is among the largest and fastest growing cause of pain, disability and poor quality of life in the elderly around the world [1]
International guidelines are all consistent in their recommendations of lifestyle changes, with exercise and weight loss programs recommended as the first-line treatments of knee OA with a stepwise approach, where surgery is considered only when non-surgical treatment fails [2,3]
We limited our searches to randomised controlled trials (RCTs) only using pre-defined RCT filters, with the publication date from the year 2000 to 15 February 2021, to ensure the latest evidence would be appraised as part of this scoping review, as knee OA interventions and delivery models have changed substantially over time

Summary

Introduction

Osteoarthritis (OA) is among the largest and fastest growing cause of pain, disability and poor quality of life in the elderly around the world [1]. International guidelines are all consistent in their recommendations of lifestyle changes, with exercise and weight loss programs recommended as the first-line treatments of knee OA with a stepwise approach, where surgery is considered only when non-surgical treatment fails [2,3]. International studies report that at least 60% of patients from established healthcare systems around the world such as Australia, Canada and the US are not receiving optimal conservative treatment [4,5]. In order to tackle the growing OA epidemic, many complex multidisciplinary programs have been developed around the world aiming to enhance care coordination and improve outcomes [6,7].

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Discussion

Conclusion