Biopsychosocial rehabilitation for inflammatory arthritis and osteoarthritis: A systematic review and meta‐analysis of randomized trials

OBJECTIVE

To assess the benefits and harms associated with biopsychosocial rehabilitation in patients with inflammatory arthritis (IA) and osteoarthritis (OA).

METHODS

We performed a systematic review and meta-analysis. Data were collected through electronic searches of Cochrane CENTRAL, Medline, Embase, PsycINFO, and CINAHL databases up to March 2019. Trials examining the effect of biopsychosocial rehabilitation in adults with IA and/or OA were considered eligible, excluding rehabilitation adjunct to surgery. The primary outcome for benefit was pain, and total withdrawals for harm.

RESULTS

Of the 27 trials meeting the eligibility criteria, 22 trials (3,750 participants) reported sufficient data to be included in the quantitative synthesis. For patient reported outcome measures, biopsychosocial rehabilitation was slightly superior to control for pain relief (SMD -0.19 [95%CI, -0.31 to -0.07]), had a small effect on patient global (SMD -0.13 [95%CI, -0.26 to -0.00]), with no apparent effect on health-related quality of life, fatigue, self-reported disability/physical function, mental well-being, and reduction in pain intensity ≥30%. Clinician measured outcomes displayed a small effect on observed disability/physical function (SMD -0.34 [95%CI, -0.57 to -0.10]), a large effect on physician global score (SMD -0.72 [95%CI, -1.18 to -0.26]), and no effect on inflammation. No difference in harms for number of withdrawals, adverse events, or serious adverse events.

CONCLUSIONS

Biopsychosocial rehabilitation produces a significant but clinically small beneficial effect on patient-reported pain among patients with IA and OA, with no difference in harm. Methodological weaknesses were observed in the included trials, suggesting low to moderate confidence in the estimates of effect.