A Meta-analysis and Systematic Review of Randomised Controlled Trials Comparing Cognitive Behavioural Therapy to Conventional Treatment of Osteoarthritis
Samuel E. McMahon, Toby O. Smith, Karthickeyan Raju and Caroline B. Hing
Affiliation: Orthopaedic Department, Frere Hospital, Amalinda Drive, East London, Eastern Cape, 5201 South Africa.
Objectives: To identify whether cognitive behavioural therapy (CBT) is effective in the management of osteoarthritis
Methods: A mixed meta-analysis and narrative review of the literature was conducted. Three hundred and eighty five
studies were identified by literature search, five of which were included for review. The included studies were randomised
controlled trials (RCT) that compared CBT to conventional therapy.
Results: On analysis, meta-analysis of the primary outcome, pain, revealed a statistically significant improvement in
symptoms (p<0.05) between those who received CBT versus conventional management. Narrative review revealed varying
results from no change in pain to significant improvements. A meta-analysis was also performed to assess ‘other
symptoms’. This demonstrated no significant difference between the groups (p>0.05). Narrative review of patient function
revealed a trend of no clinical benefit (p>0.05). Anxiety and depression scores were more positive for those who received
CBT compared to conventional therapy, with significant improvement seen in the short-term (p<0.05).
Conclusions: The role of CBT in the management of OA remains equivocal. Some encouraging results were seen with regard
to pain, anxiety and depression. We believe further high quality RCTs are necessary to adequately answer the study
Keywords: CBT, cognitive behavioural therapy, osteoarthritis, pain.
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