Effectiveness of care delivery models for knee osteoarthritis in primary healthcare settings: A systematic review and meta-analysis of randomized controlled trials
In brief
Structured care models reduce knee OA pain by 0.4 standard deviations
A meta-analysis of 15 randomized trials (2,944 patients) found that organized primary-care delivery models lowered knee osteoarthritis pain and improved function modestly, but the changes fell short of clinically important thresholds. Quality of life was unchanged, and benefits appeared strongest in small subgroups using digital communication, warranting larger pragmatic studies.
- Journal
- Osteoarthritis and cartilage (Q1)
- Published
- 4 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Hugo Pak-Yiu Fong, Shuqi Wang, Chunyi Wen, David Rabago, Christian Mallen, Regina Wing-Shan Sit
- PMID
- 42697360
- DOI
- 10.1016/j.joca.2026.09.001
Why clinicians should know about it
- Picked for Rheumatology (top studies of the week, 6 September 2026): Care models for knee OA improve pain and function modestly
Abstract
OBJECTIVE: To evaluate care delivery models for knee osteoarthritis (OA) versus usual care in primary health care settings and explore effects by delivery arrangement subcategory. METHOD: Systematic review and meta-analysis of randomized controlled trials (RCTs). We searched PubMed, Embase, CENTRAL and trial registries from 1 January 2010 to 28 June 2026. Delivery differences were mapped using the Cochrane Effective Practice and Organisation of Care (EPOC) Delivery Arrangements taxonomy. Outcomes were pain, function and health-related quality of life (HRQoL). Risk of bias and certainty were assessed using RoB 2 and GRADE respectively. RESULTS: Fifteen RCTs (n=2,944) were included. Compared with usual care, care delivery models improved pain (SMD -0.40, 95% CI -0.63 to -0.16) and function (SMD -0.26, 95% CI -0.39 to -0.14), with little to no difference in HRQoL (SMD 0.00, -0.10 to 0.09). Back-translated effects did not reach prespecified minimal clinically important differences (MCIDs) for pain (0.68 vs 2 NRS points) or function (4.2 vs 12 WOMAC Function points). Certainty was moderate for pain and function, and high for HRQoL. Exploratory subgroups incorporating information and communication technology (ICT) suggested benefit, but each included only two or three trials. CONCLUSION: Care delivery models produced small improvements in pain and function, but these did not reach prespecified MCIDs. There was little to no difference in HRQoL. Only 15 trials were included, and findings from subgroups of two or three trials should be interpreted cautiously. ICT-supported delivery, particularly when combined with care coordination, warrants evaluation in larger pragmatic trials with longer follow-up.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.