The effects of cognitive behavioural therapy delivered by physical therapists in knee osteoarthritis pain: A systematic review and meta-analysis of randomized controlled trials

Background: Recent evidence suggests that knee osteoarthritis (KOA) chronic pain can result in brain structural and organizational changes. Thus, patients' pain level, emotional status, and perception of their condition might be negatively altered. An approach to reverse such adaptations to chronic pain is cognitive behavioural therapy (CBT). Combining CBT with exercise might enhance therapy outcomes. Objectives: To identify the effect of combining exercise and CBT when delivered by a physical therapist in KOA pain. Methods: A systematic search in PubMed, Cochrane, and Medline Complete (EBSCO) databases was conducted from their inception to March 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study risk of bias and quality were assessed through the Risk-of-bias 2 (ROB2) and PEDro scales. Results: Six primary studies met eligibility criteria. All studies had a low risk of bias and were divided into two sub-groups, in-person interventions and distance interventions. Both groups of studies showed within group participant improvements. In regards of WOMAC pain subscale, our meta-analysis revealed an overall deduction of -1.42 (95% CI:-1.76,-1.09; I-2 = 58%),-1.62 (95% CI:-1.97,-1.27; I-2 = 0%) in centre-based intervention, and -1.28 (95% CI:-1.75,-0.81; I-2 = 73%) in distance delivered intervention. Conclusion: Combining exercise and CBT seems to be an effective method to reduce KOA pain, although it is based on a small number of studies. Further studies are needed to reveal any differences when each intervention is applied separately. (C) 2020 Elsevier Ltd. All rights reserved.