Arthritis Self-Efficacy Scale Scores in Knee Osteoarthritis: A Systematic Review and Meta-analysis Comparing Arthritis Self-Management Education With or Without Exercise

STUDY DESIGN: Systematic literature review and meta-analysis. OBJECTIVE: To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis. BACKGROUND: Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function. METHODS: MEDLINE (1946-March 2013), CINAHL (1981-March 2013), and PsycINFO (1967-March 2013) databases were searched. RESULTS: Twenty-four studies, including 3163 subjects (women, n = 2547 [80.5%]; mean +/- SD age, 65.3 +/- 6.5 years), met the inclusion criteria. A meta-analysis was performed to compare the standardized mean difference effect sizes (Cohen d) of randomized controlled studies that used the Arthritis Self-Efficacy Scale pain (13 studies, n = 1906), other symptoms (13 studies, n = 1957), and function (5 studies, n = 399) subscales. Cohen d effect sizes were also calculated for cohort studies that used the Arthritis Self-Efficacy Scale pain (10 studies, n = 1035), other symptoms (9 studies, n = 913), and function (3 studies, n = 141) subscales. Both randomized controlled studies and cohort studies were grouped by intervention type (intervention 1, arthritis self-management education alone: intervention 2, arthritis self-management education with exercise), and effect sizes were compared (Mann-Whitney U tests, P<.05). Interventions that used arthritis self-management education with exercise displayed higher methodological quality scale scores (76.8 +/- 13.1 versus 61.6 +/- 19.6, P = .03). Statistically significant standardized effect-size differences between intervention land intervention 2 were not observed. CONCLUSION: Small to moderate effect sizes were observed regardless of whether the intervention included exercise. Exercise interventions used in conjunction with arthritis self-management education programs need to be developed to better enhance the self-efficacy of patients with knee osteoarthritis.