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:10.1590/1809-2950/21018929032022PT

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

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) ⁽¹³	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) ⁽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
Clark, Bassett and Siegert (2019) ⁽¹⁴	108; 54; 50.55 years old	Shoulder injuries			Pain and UL function	UL Function: DASH		Function: EG=CG	6
Manning et al. (2014) ⁽¹⁵	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) ⁽¹⁶	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
Hall et al. (2013) ⁽¹⁶	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) ⁽¹⁷	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) ⁽¹⁸	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
Hansson et al. (2010) ⁽¹⁸	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) ⁽¹⁹	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
Hammond and Freeman (2004) ⁽¹⁹	127; 97; 50.52 years old	RA			Pain and UL function	UL Function: AIMS2		Function: EG=CG	6
Hammond and Freeman (2001) ⁽²⁰	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) ⁽¹³	Week 4 and 12	EG=CG	EG=CG
Clark, Bassett and Siegert (2019) ⁽¹⁴	Week 8	EG=CG	EG=CG
Manning et al. (2014) ⁽¹⁵	Week 12	EG>CG	EG>CG
Manning et al. (2014) ⁽¹⁵	Week 36	EG>CG	EG=CG
Hall et al. (2013) ⁽¹⁶	Week 8	EG=CG	EG=CG
Lin et al. (2010) ⁽¹⁷	Week 4	EG>CG	NA
Hansson et al. (2010) ⁽¹⁸	6 months	EG>CG	EG=CG
Hammond and Freeman (2004) ⁽¹⁹	4 years	EG=CG	EG=CG
Hammond and Freeman (2001) ⁽²⁰	6 months	EG=CG	EG=CG
Hammond and Freeman (2001) ⁽²⁰	12 months	EG<CG	EG<CG

Diagnosis	Author (year)	Follow-up	Pain	Functionality
RA	Manning et al. (2014) ⁽¹⁵	Week 12	EG>CG	EG>CG
	Manning et al. (2014) ⁽¹⁵	Week 36	EG>CG	EG=CG
	Hammond e Freeman (2004) ⁽¹⁹	4 years	EG=CG	EG=CG
	Hammond e Freeman (2001) ⁽²⁰	6 months	EG=CG	EG=CG
	Hammond e Freeman (2001) ⁽²⁰	12 months	EG<CG	EG<CG
CTS	Núñez-Cortés (2019) ⁽¹³	Week 4 and 12	EG=CG	EG=CG
CTS	Hall et al. (2013) ⁽¹⁶	Week 8	EG=CG	EG=CG
OA	Hansson et al. (2010) ⁽¹⁸	6 months	EG>CG	EG=CG
MPS	Lin et al. (2010) ⁽¹⁷	Week 4	EG>CG	NA
Shoulder injuries	Clark, Bassett and Siegert (2019) ⁽¹⁴	Week 8	EG=CG	EG=CG

Monitoring	Author (year)	Follow-up	Pain	Functionality
Short-term	Núñez-Cortés (2019) ⁽¹³	4 weeks	EG=CG	EG=CG
Short-term	Lin et al. (2010) ⁽¹⁷	4 weeks	EG>CG	NA
Medium-term	Núñez-Cortés (2019) ⁽¹³	12 weeks	EG=CG	EG=CG
	Clark, Bassett and Siegert (2019) ⁽¹⁴	8 weeks	EG=CG	EG=CG
	Manning et al. (2014) ⁽¹⁵	12 weeks	EG>CG	EG>CG
	Hall et al. (2013) ⁽¹⁶	8 weeks	EG=CG	EG=CG
Long-term	Manning et al. (2014) ⁽¹⁵	36 weeks	EG>CG	EG=CG
	Hansson et al. (2010) ⁽¹⁸	6 months	EG>CG	EG=CG
	Hammond e Freeman (2004) ⁽¹⁹	4 years	EG=CG	EG=CG
	Hammond e Freeman (2001) ⁽²⁰	6 months	EG=CG	EG=CG
	Hammond e Freeman (2001) ⁽²⁰	12 months	EG<CG	EG<CG

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[TFN5] CTS: carpal tunnel syndrome; PNE: pain neuroscience education; PO: postoperative; VAS: visual analog scale; QuickDASH: abbreviated form of the Arm, Shoulder and Hand Disabilities Questionnaire; EG: experimental group; CG: comparative group; DASH: disabilities of the arm, shoulder and hand; RA: rheumatoid arthritis; GAT: grip ability test; BQFSS: Boston Carpal Tunnel Syndrome Questionnaire Functional Status Scale; MPS: myofascial pain syndrome; DN: dry needling; BPI-T: brief pain inventory (Taiwanese version); OA: osteoarthritis; EQ-5D: generic EuroQol instrument - 5 Dimensions; AIMS2: arthritis impact measurement scales 2; =: no significant difference between groups; >: significant difference in favor of EP; <: significant difference in favor of the comparative group.