Pain science education and exercise interventions for people with knee or hip osteoarthritis: a systematic review,...

Physical activity can improve pain and wellbeing for people with osteoarthritis, including those awaiting joint replacement, for whom physical activity can improve post-operative recovery. However, people with osteoarthritis report pain as a barrier to exercise. Pain Science Education (PSE) can reframe this by addressing beliefs about pain that impact exercise. This systematic review aimed to map the content of PSE interventions for people with osteoarthritis, and evaluate the effectiveness of intervention components.

This review synthesised evidence on PSE and exercise interventions for people with knee or hip osteoarthritis, including those awaiting joint replacement. Databases were searched for RCTs and non-randomised studies, from inception to 1 August 2024 (MEDLINE/PsycINFO/EMBASE/PEDro). Risk of bias was assessed (RoB 2/ROBINS-I). Intervention content was analysed using content analysis. Outcomes were analysed quantitatively, including a component network meta-analysis (cNMA) of RCTs, presented parallel to non-randomised study results. Treatment effects were evaluated against PSE intervention components to understand which components impacted outcomes (pain/physical functioning/catastrophizing/kinesiophobia/self-efficacy).

Twelve reports of 10 interventions (20-103 participants per study) were included. Content analysis identified six domains: introductory topics, acute pain mechanisms, chronic pain mechanisms, factors that sustain pain, multidisciplinary education, and exercise components. cNMA: PSE had little-to-no effect on pain and physical functioning, with beneficial effects on catastrophizing, kinesiophobia and self-efficacy.

This review highlights potential effectiveness of PSE intervention components for improving psychological outcomes for people with osteoarthritis. PSE may act as a mechanism of action for exercise interventions, and is less successful delivered standalone. PSE should be delivered using relatable examples and tailored exercises to ensure accessibility. Findings should be interpreted cautiously due to the small number of heterogeneous studies.

PROSPERO CRD42023488027.