The effect of education on pain and functionality on patients with musculoskeletal dysfunctions of the upper limb: a systematic review

Doval, Danielle; Martins, Maiara da Silva; Araujo, Francisco Xavier de

doi:10.1590/1809-2950/21018929032022EN

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 29 (3) • Jul-Sep 2022 • https://doi.org/10.1590/1809-2950/21018929032022EN copy

The effect of education on pain and functionality on patients with musculoskeletal dysfunctions of the upper limb: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study verifies the effects of patient education (PE) in patients with musculoskeletal disorders of the upper limb (UL) on pain and/or functionality. The PubMed, Cochrane, PEDro, SciELO, and LILACS databases were independently searched by two reviewers, from the beginning of the publications until April 2021. We included randomized clinical trials with individuals with musculoskeletal disorders of the UL with pain and/or functionality outcomes, who have undergone intervention with PE. Reviewers independently determined study eligibility, extracted data, and assessed methodological quality using the PEDro scale. We included eight studies, totaling 603 participants. Compared to the controlled group, the PE intervention showed better results in three studies for pain relief and/or functionality improvement. Apparently, PE is more effective when combined with exercise.

Keywords
Patient Education; Upper Extremity; Pain; Functionality; Physical Therapy

Author (Year)	Sample (N; NFem; average age)	Diagnosis	PE Intervention	Comparative group	Outcomes	Instrument	Follow-up	Results	PEDro score
Núñez-Cortés et al. (2019) ⁽¹³13. Núñez-Cortés R, Espinoza-Ordóñez C, Pommer PP, Horment-Lara G, Pérez-Alenda S, Cruz-Montecinos C. A single preoperative pain neuroscience education: is it an effective strategy for patients with carpal tunnel syndrome? Med Hypotheses. 2019;126:46-50. doi: 10.1016/j.mehy.2019.03.013. https://doi.org/10.1016/j.mehy.2019.03.0...	30; 30; 53.8 years	CTS	An audiovisual PNE session on neurophysiology, biopsychosocial aspects + PO exercises	Received a standard audiovisual PE session on medical and anatomical aspects + PO exercises	Pain and UL function	Pain: VAS	Weeks 4 and 12 after surgery	Week 4:	7
						UL Function: QuickDASH		Pain: EG=CG
								Function: EG=CG
								Week 12:
								Pain: EG=CG
								Function: EG=CG
Clark, Bassett and Siegert (2019) ⁽¹⁴14. Clark H, Bassett S, Siegert R. The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: a randomized controlled trial. Physiother Theory Pract. 2019;35(10):930-9. doi: 10.1080/09593985.2018.1467521. https://doi.org/10.1080/09593985.2018.14...	108; 54; 50.55 years old	Shoulder injuries	Audiovisual PE on anatomy, treatment, exercise demonstration and diary	Had access to module 1 of the intervention program and the diary	Pain and UL function	Pain: Scale P4	Week 8 after the start of the study	Pain: EG=CG	6
	108; 54; 50.55 years old	Shoulder injuries			Pain and UL function	UL Function: DASH		Function: EG=CG	6
Manning et al. (2014) ⁽¹⁵15. Manning VL, Hurley MV, Scott DL, Coker B, Choy E, Bearne LM. Education, self-management, and upper extremity exercise training in people with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(2):217-27. doi: 10.1002/acr.22102. https://doi.org/10.1002/acr.22102...	108; 82; 55.15 years old	RA	PE in groups with interactive seminars on RA and exercises + usual care	Received only usual care	UL function, hand functional capacity, and pain	UL Function: DASH Hand functional capacity: GAT	Week 12 and 36 after the start of the study	Week 12:	8
						Pain: VAS		Function, hand functional capacity, and pain: EG>CG
								Week 36:
								Function, hand functional capacity: EG=CG
								Pain: EG>CG
Hall et al. (2013) ⁽¹⁶16. Hall B, Lee HC, Fitzgerald H, Byrne B, Barton A, Lee AH. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Am J Occup Ther. 2013;67(4):448-59. doi: 10.5014/ajot.2013.006031. https://doi.org/10.5014/ajot.2013.006031...	54; 41; 54.35 years old	CTS	PE on anatomy and CTS information + didactic materials + wrist orthosis	Did not receive any intervention	Pain and UL function	Pain: VAS	Week 8 after the end of the intervention	Pain: EG=CG	5
	54; 41; 54.35 years old	CTS		Did not receive any intervention	Pain and UL function	Function: BQFSS		Function: EG=CG	5
Lin et al. (2010) ⁽¹⁷17. Lin SY, Neoh CA, Huang YT, Wang KY, Ng HF, Shi HY. Educational program for myofascial pain syndrome. J Altern Complement Med. 2010;16(6):633-40. doi: 10.1089/acm.2009.0378. https://doi.org/10.1089/acm.2009.0378...	62; 42; 49.37 years old	MPS	Audiovisual PE and didactic materials with information on MPS and stretching + DN	Received summary on general intervention + DN	Pain	Pain: BPI-T	Week 4 after the end of the intervention	Pain: EG>CG	6
Hansson et al. (2010) ⁽¹⁸18. Hansson EE, Jönsson-Lundgren M, Ronnheden AM, Sörensson E, Bjärnung A, Dahlberg LE. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial. BMC Musculoskelet Disord. 2010;11:244. doi: 10.1186/1471-2474-11-244. https://doi.org/10.1186/1471-2474-11-244...	114; not described; 49.37 years old	OA	PE on anatomy, physiology, pain, OA, exercises and treatment	Continued living normally	Pain and hand function	Hand function: GAT	6 months after the intervention	Function: EG=CG	8
	114; not described; 49.37 years old	OA		Continued living normally	Pain and hand function	Pain: EQ-5D		Pain: EG>CG	8
Hammond and Freeman (2004) ⁽¹⁹19. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004;18(5):520-8. doi: 10.1191/0269215504cr766oa. https://doi.org/10.1191/0269215504cr766o...	127; 97; 50.52 years old	RA	Standard PE on RA, pain, treatment, and exercises + information leaflets + joint protection	Received behavioral education on joint protection + didactic material with information	Pain and UL function	Pain: VAS	4 years after the end of the intervention	Pain: EG=CG	6
	127; 97; 50.52 years old	RA			Pain and UL function	UL Function: AIMS2		Function: EG=CG	6
Hammond and Freeman (2001) ⁽²⁰20. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford). 2001;40(9):1044-51. doi: 10.1093/reumatologia/40.9.1044. https://doi.org/10.1093/reumatologia/40....	127; 97; 50.52 years old	RA	Standard PE on RA, pain, treatment, and exercises + information leaflets + joint protection	Received behavioral education on joint protection + didactic material with information	Pain and UL function	Pain: VAS	6 and 12 months after the end of the intervention	6 months:	6
						UL Function: AIMS2		Pain: EG=CG
								Function: EG=CG
								12 months:
								Pain: EG<CG
								Function: EG<CG

Author (year)	Follow-up	Pain	Functionality
Núñez-Cortés et al. (2019) ⁽¹³13. Núñez-Cortés R, Espinoza-Ordóñez C, Pommer PP, Horment-Lara G, Pérez-Alenda S, Cruz-Montecinos C. A single preoperative pain neuroscience education: is it an effective strategy for patients with carpal tunnel syndrome? Med Hypotheses. 2019;126:46-50. doi: 10.1016/j.mehy.2019.03.013. https://doi.org/10.1016/j.mehy.2019.03.0...	Week 4 and 12	EG=CG	EG=CG
Clark, Bassett and Siegert (2019) ⁽¹⁴14. Clark H, Bassett S, Siegert R. The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: a randomized controlled trial. Physiother Theory Pract. 2019;35(10):930-9. doi: 10.1080/09593985.2018.1467521. https://doi.org/10.1080/09593985.2018.14...	Week 8	EG=CG	EG=CG
Manning et al. (2014) ⁽¹⁵15. Manning VL, Hurley MV, Scott DL, Coker B, Choy E, Bearne LM. Education, self-management, and upper extremity exercise training in people with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(2):217-27. doi: 10.1002/acr.22102. https://doi.org/10.1002/acr.22102...	Week 12	EG>CG	EG>CG
	Week 36	EG>CG	EG=CG
Hall et al. (2013) ⁽¹⁶16. Hall B, Lee HC, Fitzgerald H, Byrne B, Barton A, Lee AH. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Am J Occup Ther. 2013;67(4):448-59. doi: 10.5014/ajot.2013.006031. https://doi.org/10.5014/ajot.2013.006031...	Week 8	EG=CG	EG=CG
Lin et al. (2010) ⁽¹⁷17. Lin SY, Neoh CA, Huang YT, Wang KY, Ng HF, Shi HY. Educational program for myofascial pain syndrome. J Altern Complement Med. 2010;16(6):633-40. doi: 10.1089/acm.2009.0378. https://doi.org/10.1089/acm.2009.0378...	Week 4	EG>CG	NA
Hansson et al. (2010) ⁽¹⁸18. Hansson EE, Jönsson-Lundgren M, Ronnheden AM, Sörensson E, Bjärnung A, Dahlberg LE. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial. BMC Musculoskelet Disord. 2010;11:244. doi: 10.1186/1471-2474-11-244. https://doi.org/10.1186/1471-2474-11-244...	6 months	EG>CG	EG=CG
Hammond and Freeman (2004) ⁽¹⁹19. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004;18(5):520-8. doi: 10.1191/0269215504cr766oa. https://doi.org/10.1191/0269215504cr766o...	4 years	EG=CG	EG=CG
Hammond and Freeman (2001) ⁽²⁰20. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford). 2001;40(9):1044-51. doi: 10.1093/reumatologia/40.9.1044. https://doi.org/10.1093/reumatologia/40....	6 months	EG=CG	EG=CG
	12 months	EG<CG	EG<CG

Diagnosis	Author (year)	Follow-up	Pain	Functionality
RA	Manning et al. (2014) ⁽¹⁵15. Manning VL, Hurley MV, Scott DL, Coker B, Choy E, Bearne LM. Education, self-management, and upper extremity exercise training in people with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(2):217-27. doi: 10.1002/acr.22102. https://doi.org/10.1002/acr.22102...	Week 12	EG>CG	EG>CG
		Week 36	EG>CG	EG=CG
	Hammond e Freeman (2004) ⁽¹⁹19. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004;18(5):520-8. doi: 10.1191/0269215504cr766oa. https://doi.org/10.1191/0269215504cr766o...	4 years	EG=CG	EG=CG
	Hammond e Freeman (2001) ⁽²⁰20. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford). 2001;40(9):1044-51. doi: 10.1093/reumatologia/40.9.1044. https://doi.org/10.1093/reumatologia/40....	6 months	EG=CG	EG=CG
		12 months	EG<CG	EG<CG
CTS	Núñez-Cortés (2019) ⁽¹³13. Núñez-Cortés R, Espinoza-Ordóñez C, Pommer PP, Horment-Lara G, Pérez-Alenda S, Cruz-Montecinos C. A single preoperative pain neuroscience education: is it an effective strategy for patients with carpal tunnel syndrome? Med Hypotheses. 2019;126:46-50. doi: 10.1016/j.mehy.2019.03.013. https://doi.org/10.1016/j.mehy.2019.03.0...	Week 4 and 12	EG=CG	EG=CG
CTS	Hall et al. (2013) ⁽¹⁶16. Hall B, Lee HC, Fitzgerald H, Byrne B, Barton A, Lee AH. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Am J Occup Ther. 2013;67(4):448-59. doi: 10.5014/ajot.2013.006031. https://doi.org/10.5014/ajot.2013.006031...	Week 8	EG=CG	EG=CG
OA	Hansson et al. (2010) ⁽¹⁸18. Hansson EE, Jönsson-Lundgren M, Ronnheden AM, Sörensson E, Bjärnung A, Dahlberg LE. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial. BMC Musculoskelet Disord. 2010;11:244. doi: 10.1186/1471-2474-11-244. https://doi.org/10.1186/1471-2474-11-244...	6 months	EG>CG	EG=CG
MPS	Lin et al. (2010) ⁽¹⁷17. Lin SY, Neoh CA, Huang YT, Wang KY, Ng HF, Shi HY. Educational program for myofascial pain syndrome. J Altern Complement Med. 2010;16(6):633-40. doi: 10.1089/acm.2009.0378. https://doi.org/10.1089/acm.2009.0378...	Week 4	EG>CG	NA
Shoulder injuries	Clark, Bassett and Siegert (2019) ⁽¹⁴14. Clark H, Bassett S, Siegert R. The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: a randomized controlled trial. Physiother Theory Pract. 2019;35(10):930-9. doi: 10.1080/09593985.2018.1467521. https://doi.org/10.1080/09593985.2018.14...	Week 8	EG=CG	EG=CG

Monitoring	Author (year)	Follow-up	Pain	Functionality
Short-term	Núñez-Cortés (2019) ⁽¹³13. Núñez-Cortés R, Espinoza-Ordóñez C, Pommer PP, Horment-Lara G, Pérez-Alenda S, Cruz-Montecinos C. A single preoperative pain neuroscience education: is it an effective strategy for patients with carpal tunnel syndrome? Med Hypotheses. 2019;126:46-50. doi: 10.1016/j.mehy.2019.03.013. https://doi.org/10.1016/j.mehy.2019.03.0...	4 weeks	EG=CG	EG=CG
Short-term	Lin et al. (2010) ⁽¹⁷17. Lin SY, Neoh CA, Huang YT, Wang KY, Ng HF, Shi HY. Educational program for myofascial pain syndrome. J Altern Complement Med. 2010;16(6):633-40. doi: 10.1089/acm.2009.0378. https://doi.org/10.1089/acm.2009.0378...	4 weeks	EG>CG	NA
Medium-term	Núñez-Cortés (2019) ⁽¹³13. Núñez-Cortés R, Espinoza-Ordóñez C, Pommer PP, Horment-Lara G, Pérez-Alenda S, Cruz-Montecinos C. A single preoperative pain neuroscience education: is it an effective strategy for patients with carpal tunnel syndrome? Med Hypotheses. 2019;126:46-50. doi: 10.1016/j.mehy.2019.03.013. https://doi.org/10.1016/j.mehy.2019.03.0...	12 weeks	EG=CG	EG=CG
	Clark, Bassett and Siegert (2019) ⁽¹⁴14. Clark H, Bassett S, Siegert R. The effectiveness of web-based patient education and action and coping plans as an adjunct to patient treatment in physiotherapy: a randomized controlled trial. Physiother Theory Pract. 2019;35(10):930-9. doi: 10.1080/09593985.2018.1467521. https://doi.org/10.1080/09593985.2018.14...	8 weeks	EG=CG	EG=CG
	Manning et al. (2014) ⁽¹⁵15. Manning VL, Hurley MV, Scott DL, Coker B, Choy E, Bearne LM. Education, self-management, and upper extremity exercise training in people with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(2):217-27. doi: 10.1002/acr.22102. https://doi.org/10.1002/acr.22102...	12 weeks	EG>CG	EG>CG
	Hall et al. (2013) ⁽¹⁶16. Hall B, Lee HC, Fitzgerald H, Byrne B, Barton A, Lee AH. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. Am J Occup Ther. 2013;67(4):448-59. doi: 10.5014/ajot.2013.006031. https://doi.org/10.5014/ajot.2013.006031...	8 weeks	EG=CG	EG=CG
Long-term	Manning et al. (2014) ⁽¹⁵15. Manning VL, Hurley MV, Scott DL, Coker B, Choy E, Bearne LM. Education, self-management, and upper extremity exercise training in people with rheumatoid arthritis: a randomized controlled trial. Arthritis Care Res (Hoboken). 2014;66(2):217-27. doi: 10.1002/acr.22102. https://doi.org/10.1002/acr.22102...	36 weeks	EG>CG	EG=CG
	Hansson et al. (2010) ⁽¹⁸18. Hansson EE, Jönsson-Lundgren M, Ronnheden AM, Sörensson E, Bjärnung A, Dahlberg LE. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial. BMC Musculoskelet Disord. 2010;11:244. doi: 10.1186/1471-2474-11-244. https://doi.org/10.1186/1471-2474-11-244...	6 months	EG>CG	EG=CG
	Hammond e Freeman (2004) ⁽¹⁹19. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004;18(5):520-8. doi: 10.1191/0269215504cr766oa. https://doi.org/10.1191/0269215504cr766o...	4 years	EG=CG	EG=CG
	Hammond e Freeman (2001) ⁽²⁰20. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford). 2001;40(9):1044-51. doi: 10.1093/reumatologia/40.9.1044. https://doi.org/10.1093/reumatologia/40....	6 months	EG=CG	EG=CG
		12 months	EG<CG	EG<CG

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[1] Corresponding address: Francisco Xavier de Araujo - Rua Santos Dumont, 888 - Canoas (RS), Brazil - ZIP Code: 92120-110 - E-mail: franciscoxaraujo@gmail.com