Education Tools Lead to Improved Knee Osteoarthritis Management

Maria E. Suarez-Almazor, MD, PhD

A recent study showed self-administered patient educational tools in the management of knee osteoarthritis improved patient knowledge over the span of 6 months.

Study participants who received combined video and booklet education were more effective in changing self-care behaviors. The education tools additionally provided greater advantages for Spanish-speaking and less-educated patients. 

“Generally, educational interventions show positive impacts on knowledge and decisional conflict but varying impacts on self-efficacy and health behaviors,” investigators wrote. “Self-efficacy and behavior may not easily change with educational interventions because these changes require not only knowledge but also experiences.”

Investigators, led by Maria E. Suarez-Almazor, MD, PhD, and Heather Lin, PhD of The University of Texas MD Anderson Cancer Center, conducted a randomized clinical trial with 219 participants randomly receiving an educational video in combination with 2 booklets (n = 109), or the booklets alone (n = 110).

According to the data, participants had a mean age of 64.6 years and were 76% women. Another 82% had adequate health literacy and 89% selected English as their preferred language. The mean duration of knee osteoarthritis among patients was 10.2 years. 

The trial evaluated changes in scores with a patient knowledge questionnaire, the Decisional Conflict Scale (DCS), Arthritis Self-Efficacy Scale and the Effective Consumer Scale (ECS) between baseline and same day, 3 months and 6 months post intervention. 

The DCS used the response categories Informed and Values Clarity, while self-efficacy used the eight-item short form, with answers ranging from scores of 0 – 100. The ECS used the 17-item Likert-type questionnaire, with answers ranging from “never” to “always.”

Each group’s knowledge increased from baseline to the evaluation time point, at 3 months and 6 months. Comparisons of the mean increase in knowledge from the baseline showed the video and booklets group performed better than the booklets-only group post-intervention: 9.4 vs 9.0 (mean difference, 0.39; 95% CI, 0.02 – 0.76).

No significant differences were observed at 3 months and 6 months follow-up, and the increase in knowledge was maintained at 6 months. 

The DCS scores in both patient groups (video + booklets vs booklets) decreased at the follow-up compared with the baseline, on both the combined DCS and the individual Informed and Values Clarity subscales. Changes from baseline to post intervention in DCS were not a significant difference, but there was lower conflict observed in the video and booklets group for the combined DCS and informed subscale (95% CI, −18.9 to 0.68).

At the six-month mark, similar trends were observed for the combined DCS and Values Clarity subscale, but there was no statistical significance.

Self-efficacy was not assessed immediately post-intervention and there was no significant change from baseline in either group at the three- and six-month marks. 

The ECS outcome was also not assessed immediately following intervention and investigators found no statistically significant improvements in scores at 3 months in both groups. At the six-month follow-up, there was a significant change observed in the video and booklets group but not in the lone booklets group. However, there was no significant differences between the groups at each of the follow-ups, according to the data. 

Data determined that Spanish-speaking participants in the video and booklets group experienced a larger decrease in outcome scores on the total DCS (−43.76 vs −4.24; P = .009), as well as the Informed and Values Clarity subscales.

Study participants in the lowest educational group who received the video and booklets gained more in self-efficacy than those receiving the books only (12.45 vs −7.84; P = .02).

Suarez-Almazor and Lin concluded that osteoarthritis education material needs to consider the various patient subpopulations it would be serving in use.

“This is supported by our observation of various beneficial effects of different formats in certain specific participant subgroups,” they wrote. “Factors such as the patient preference for presentation format and their motivation to learn about their condition may be as important as the format itself.”

The study, “A Randomized Controlled Trial Comparing Two Self-Administered Educational Strategies for Patients with Knee Osteoarthritis,” was published online in ACR Open Rheumatology.