A Meta-analysis and Systematic Review of Randomised Controlled Trials Comparing Cognitive Behavioural Therapy to Conventional Treatment of Osteoarthritis

Objectives: To identify whether cognitive behavioural therapy (CBT) is effective in the management of osteoarthritis (OA). Methods: A mixed meta-analysis and narrative review of the literature was conducted. Three hundred and eighty five studies were identified by literature search, five of which were included for review. The included studies were randomised controlled trials (RCT) that compared CBT to conventional therapy. Results: On analysis, meta-analysis of the primary outcome, pain, revealed a statistically significant improvement in symptoms (p<0.05) between those who received CBT versus conventional management. Narrative review revealed varying results from no change in pain to significant improvements. A meta-analysis was also performed to assess 'other symptoms'. This demonstrated no significant difference between the groups (p>0.05). Narrative review of patient function revealed a trend of no clinical benefit (p>0.05). Anxiety and depression scores were more positive for those who received CBT compared to conventional therapy, with significant improvement seen in the short-term (p<0.05). Conclusions: The role of CBT in the management of OA remains equivocal. Some encouraging results were seen with regard to pain, anxiety and depression. We believe further high quality RCTs are necessary to adequately answer the study question.