Are rehabilitation interventions effective for kinesiophobia and pain in osteoarthritis? A systematic review and meta-analysis of randomized controlled trials

Background: Kinesiophobia is an excessive and misunderstood feeling in the osteoarthritis (OA) population, processing acute to subacute diseases and delaying functional recovery. The purpose of this study was to synthesize evidence from randomized controlled trials (RCTs) to evaluate the effectiveness of rehabilitation interventions to reduce kinesiophobia and pain intensity in individuals with OA. Methods A systematic search in 5 electronic databases (PubMed, Web of Science, Cochrane Library, Embase, and CNKI) was performed to identify RCTs comparing rehabilitation interventions with control interventions in OA. It was reported that changes in kinesiophobia and pain intensity were assessed as standardized mean difference (SMD) if outcomes were on the distinct scales with 95% confidence intervals (95% CI). If heterogeneity (I 2  > 50%) of the pooled effect is detected, subgroup analysis and sensitivity analysis would be necessary to evaluate the source of heterogeneity and eliminate it. Two independent reviewers assessed methodological quality using the Cochrane Collaboration Risk of Bias Tool. The GRADEpro GDT was used to illustrate the quality of evidence. Results Twelve trials with 830 participants met eligibility criteria and were included in this review. The results demonstrate statistical significant difference favored kinesiophobia concerning the rehabilitation interventions [SMD difference: -0.55 (95% CI, -0.86 to -0.24)], physiotherapy [SMD difference: -0.36 (95% CI, -0.65 to -0.08)], psychotherapy [SMD difference: -1.42 (95% CI, -2.05 to -0.79)]. Also display difference for pain intensity was observed in rehabilitation interventions [SMD difference: -0.22 (95% CI, -0.37 to -0.07)], physiotherapy [SMD difference: -0.29 (95% CI: -0.45 to -0.13)], psychotherapy [SMD difference: -2.45 (95% CI, -3.61 to -1.30)]. Five studies reported adverse effects (n = 57), and only one participant suffered a severe adverse event. Conclusion Concerning OA, rehabilitation interventions were statistically effective for reducing kinesiophobia and pain intensity compared to control interventions. Overall, the degree of evidence was low to moderate.