Is Biopsychosocial Rehabilitation Beneficial in Relieving Pain in Osteoarthritis?

Biopsychosocial rehabilitation has a statistically significant but clinically small beneficial effect on pain outcomes, without causing harm, in patients with osteoarthritis (OA) and inflammatory arthritis, according to study findings published in Arthritis Care & Research (Hoboken).

Researchers conducted a systematic review and meta-analysis of MEDLINE, Embase, PsycInfo, CINAHL, and Cochrane CENTRAL databases from inception to March 2019. They identified 27 eligible trials with 22 meeting the criteria for inclusion in the meta-analysis. Follow-up periods ranged from 6 to 24 months.

In the meta-analysis, the researchers quantitatively analyzed data from 3750 patients diagnosed with OA or inflammatory arthritis who received biopsychosocial rehabilitation.

Biopsychosocial rehabilitation was defined any intervention that included a physical component, along with 1 or both of a psychological or social/work-related component.

Findings from the analysis showed that biopsychosocial rehabilitation had slightly superior effects on pain relief compared with control interventions in the patient population (standardized mean difference [SMD], -0.19; 95% CI, -0.31 to -0.07).

Biopsychosocial rehabilitation slightly affected patient global assessment scores (SMD, -0.13; 95% CI, -0.26 to -0.00), but had a large effect on physician global assessment scores (SMD, -0.72; 95% CI, -1.18 to -0.26).

Biopsychosocial rehabilitation did not affect patient self-reported outcome measures reflecting pain intensity reductions of at least 30%, health-related quality of life, fatigue, self-reported disability or physical function, and mental well-being.

In contrast, when analyzing clinician-reported outcome measures, the researchers observed that biopsychosocial rehabilitation had a small effect on disability and physical function (SMD, -0.34; 95% CI, -0.57 to -0.10).

While biopsychosocial rehabilitation had a small, positive effect on pain relief, it did not correlate with measures indicating patient harm, including withdrawals from treatment and adverse or serious adverse events.

Trends in the data showed that increased patient contact time with health care providers and application of biopsychosocial interventions by specialized disciplines increased efficacy on patient outcomes.

Study limitations included lack of included studies with low risk of bias, potential impact of publication bias, lack of standardization and protocols for biopsychosocial rehabilitation, lack of analysis of intervention cost-effectiveness, and heterogeneity of studies.

“This finding raises a concern for the growing body of evidence that continues to apply uniform and standardized biopsychosocial group programs in rehabilitation, potentially masking the true effect of the ideal individualized rehabilitation,” the study authors cautioned.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Pedersen MB, Thinggaard P, Geenen R, et al. Biopsychosocial rehabilitation for inflammatory arthritis and osteoarthritis patients: a systematic review and meta-analysis of randomized trials. Arthritis Care Res (Hoboken). Published online November 8, 2021. doi:10.1002/acr.24816