title: Arthritis self-efficacy scale scores in knee osteoarthritis: a systematic review and meta-analysis comparing arthritis self-management education with or without exercise.
abstract: METHODS
  Systematic literature review and meta-analysis.
  
  
  OBJECTIVE
  To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis.
  
  
  BACKGROUND
  Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function.
  
  
  METHODS
  MEDLINE (1946-March 2013), CINAHL (1981-March 2013), and PsycINFO (1967-March 2013) databases were searched.
  
  
  RESULTS
  Twenty-four studies, including 3163 subjects (women, n = 2547 [80.5%]; mean ± SD age, 65.3 ± 6.5 years), met the inclusion criteria. A meta-analysis was performed to compare the standardized mean difference effect sizes (Cohen d) of randomized controlled studies that used the Arthritis Self-Efficacy Scale pain (13 studies, n = 1906), other symptoms (13 studies, n = 1957), and function (5 studies, n = 399) subscales. Cohen d effect sizes were also calculated for cohort studies that used the Arthritis Self-Efficacy Scale pain (10 studies, n = 1035), other symptoms (9 studies, n = 913), and function (3 studies, n = 141) subscales. Both randomized controlled studies and cohort studies were grouped by intervention type (intervention 1, arthritis self-management education alone; intervention 2, arthritis self-management education with exercise), and effect sizes were compared (Mann-Whitney U tests, P<.05). Interventions that used arthritis self-management education with exercise displayed higher methodological quality scale scores (76.8 ± 13.1 versus 61.6 ± 19.6, P = .03). Statistically significant standardized effect-size differences between intervention 1 and intervention 2 were not observed.
  
  
  CONCLUSIONS
  Small to moderate effect sizes were observed regardless of whether the intervention included exercise. Exercise interventions used in conjunction with arthritis self-management education programs need to be developed to better enhance the self-efficacy of patients with knee osteoarthritis.
  
  
  METHODS
  Therapy, level 2b-.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY.
authors.forename: Emily
authors.initials: E
authors.lastname: Brand
authors.forename: John
authors.initials: J
authors.lastname: Nyland
authors.forename: Cameron
authors.initials: C
authors.lastname: Henzman
authors.forename: Mark
authors.initials: M
authors.lastname: McGinnis
mesh_terms: D015444:Exercise; D006801:Humans; D020370:Osteoarthritis, Knee / Q000523:psychology*; D010353:Patient Education as Topic; D012648:Self Care; D020377:Self Efficacy