Cognitive behavioural therapy and pain coping skills training for osteoarthritis knee pain management: a systematic review.
Ayah Ismail, Catherine Moore, Natasha Alshishani and 2 others
PMID 29643612WHAT IT FOUND
For adults with knee osteoarthritis, CBT or PCST alone did not reduce pain more than the comparison groups.
Some programmes combining PCST with behavioural weight management or exercise reported greater pain reduction, but the effect of any single part cannot be separated.
Key findings
01The review included 665 adult participants across four trials.
02CBT or PCST alone did not show a statistically significant difference in WOMAC pain.
03PCST combined with behavioural weight management, and PCST combined with exercise, showed significant between-group pain differences (p=0.002; p=0.01; p=0.0002; p<0.01; p<0.05).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The review included only four trials, and their protocols differed enough that the authors did not combine them statistically. Blinding of participants and therapists was often not achieved. Self-reported pain ratings may be less reliable without blinding. The search was limited to English-language published studies, so relevant work in other languages or unpublished sources may be missing. The primary database search was not independently duplicated, so selection risk may be higher. The review focused on WOMAC pain and did not synthesize coping, depression or function outcomes. Attrition and follow-up completion varied across trials.
The easy way to misread this
Do not read the combined results as proof that CBT or PCST alone reduces knee pain. When CBT or PCST was given alone, pain differences were not significant, and when PCST was combined with behavioural weight management or exercise, the separate contribution of PCST cannot be separated.