Introduction: Patient education is a guideline recommended first-line intervention for people with knee osteoarthritis. Yet, guidance on how to implement education interventions is poorly covered in guidelines, limiting translation to clinical practice. The primary aim of this ancillary analysis of our systematic review is to evaluate the content, development and delivery of education interventions for knee osteoarthritis in clinical trials. Methods: We performed an ancillary analysis of a previous systematic review and meta-analysis. A literature search was performed from inception to April 2020 using pre-defined search strategy in 5 databases; MEDLINE, EMBASE, SPORTDiscus, CINAHL, and Web of Science. Randomized controlled trials involving patient education for people with knee osteoarthritis were included. For data analysis, we matched education content reported in trials against 14 pre-defined evidence-based topics and categorised as; ‘accurate/clear’, ‘partially accurate/clear’, or ‘not reported’. We identified whether interventions targeted skill development or stated learning objectives, categorised as ‘yes’ or ‘not reported’. Information about whether interventions were developed based on learning theories, previous research and co-design principles was extracted and reported as ‘yes’ or ‘not reported’. Delivery methods (number of sessions, group, one-to-one, mixed, self-directed), and mode(s) (face-to-face, telephone, written materials, etc.) of patient education interventions were identified. All data were summarised descriptively. Results: Thirty-eight education interventions across 30 trials involving 4,107 participants were included. Median number of content topics reported amongst all interventions was 3/14 (range 0-11). When content was reported, only 10% (n=13/136) were accurate and clear, with the remaining 90% (n=126/136) partially accurate/clear. Most interventions (61%, n=23/38) targeted skill development but only 34% (n=13/38) identified learning objectives. Less than half of the education interventions were based on theory (42%, n-16/38), or previous research for chronic conditions (45%, n=17/38) including 32% (n=12/38) based on research for osteoarthritis; and just 11% (n=4/38) were co-designed. Education was often facilitated face-to-face over multiple sessions (median, range; 9, 0-55), supplemented with telephone calls and/or written materials. Discussion: Education interventions in knee osteoarthritis studies lack comprehensiveness and lack clear accurate descriptions of content, impeding clinical translation. Very few are co-designed, and most do not identify learning outcomes, or use theory and previous research in development. These limitations may lead to underestimation of the value of quality patient education to improve outcomes for people with knee osteoarthritis. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.
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