Social cognitive or learning theory use to improve self-efficacy in musculoskeletal rehabilitation: A systematic review and meta-analysis

Objective: To review the rehabilitation research methodological quality and intervention effectiveness of studies that used social cognitive or learning theory principles to improve self-efficacy in patients with orthopedic or musculoskeletal conditions. Design: A systematic literature review and meta-analysis of peer reviewed studies published in English was performed using the OVID and SPORTDiscus databases. Initial search terms were social cognitive theory or social learning theory combined with rehabilitation. Results: From the 25 total studies that contributed to this review, 23 contributed patient outcome information and 20 contributed to effect size determination. Of 1947 total study participants, most (n=1537, 78.9%) were women. Participants were primarily late middle-age (64.8 +/- 17years). Studies included participants with hip or knee osteoarthritis (OA) or who were post-hip or knee arthroplasty (11/25, 44%), post-femur or tibia fracture (6/25, 24%), adults in assisted living or inpatient rehabilitation facilities (2/25, 8%), independent community dwelling older adults (2/25, 8%), college-age recreational athletes post-sports injury (2/25, 8%), older women with osteoporosis risk (1/25, 4%) or middle-aged adults post-traumatic hand injury (1/25, 4%). For the 20 studies that contributed to effect size determination, a large overall mean effect size (Cohen's d=0.98, 95% CI 0.42-1.86) was observed. Conclusions: Studies that used social cognitive or learning theory principles to improve self-efficacy in patients with orthopedic or musculoskeletal conditions generally displayed moderate to large effect sizes supporting this intervention. Sound research methodological quality and low risk of intervention-related injury or other adverse events were also generally observed. Findings suggest that these interventions may also benefit individuals with conditions that have not progressed to end-stage salvage surgery such as younger, more athletically active individuals for knee OA prevention.