Psychological Interventions Added to Standard Care Improve Pain and Function Outcomes in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Abstract

Objective: Knee osteoarthritis is a primary cause of disability across the world and current standard care fails to address all biopsychosocial contributions to pain. The current review aims to evaluate randomised controlled trials examining the effect of adding cognitive behavioural therapy or pain coping skills training to standard care on pain and function outcomes for individuals with knee osteoarthritis.

Data sources: Systematic searches were conducted of CINAHL, EMBASE (OVID), Medline (EBSCO) and PsycINFO databases until July 2024 with no date restrictions.

Methods: This systematic review followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Risk of bias was assessed using the Risk of bias 2 tool. Meta-analysis using a random-effects model was carried out using the ​Statistical Package for the Social Sciences, and effect sizes from standardised mean differences were calculated using Cohen's d statistic. Heterogeneity was assessed using I-squared and Tau-squared tests.

Results: Four randomised controlled trials met eligibility criteria (n = 628, mean age 62.91), demonstrating a low risk of bias. The addition of cognitive behavioural therapy or pain coping skills training to standard care for knee osteoarthritis produced statistically significant changes in standardised mean differences (p < 0.001), showing small to medium effect sizes in pain (0.488) and function (0.340) between 3- and 6-month time points. Heterogeneity measured by I^-squared and Tau-squared was low for pain and function.

Conclusion: Adding psychological interventions to standard care for knee osteoarthritis improves outcomes in both pain and function. These findings support the integration of psychological interventions into clinical practice.