Guideline for the management of knee and hip osteoarthritis

Recommendations

Cognitive behavioural therapy

Guideline for the management of knee and hip osteoarthritis
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Last revised: 01 Jul 2018

Non-pharmacological interventions 

Cognitive behavioural therapy


 

Cognitive behavioural therapy (CBT) – Knee and/or hip

Recommendation

It may be appropriate to offer CBT for some people with knee and/or hip osteoarthritis (OA). Clinicians should consider whether CBT is appropriate, taking into account psychological comorbidities and personal preference. They should be cognisant of issues related to cost and access. It is recommended that CBT is combined with exercise to improve outcomes. CBT may be offered face-to-face or via online programs.

Strength of recommendation

Conditional for recommendation

Quality of evidence

Low (knee)
Very low (hip)

What is it? 

CBT is a psychological intervention that aims to show people how their thinking affects their mood, to help them identify and challenge unhelpful thoughts, and to learn practical self-help strategies. It can be used to treat a range of problems that may be relevant for people with OA, including pain, depression, anxiety, insomnia and eating problems. The most commonly studied CBT for OA has been pain coping skills training, with or without partner support. 

Rationale

Low-quality evidence in people with knee OA shows that CBT programs can have small benefits for pain, and can also improve self-efficacy, pain coping, depression and anxiety77 (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document). CBT for knee OA is associated with a low risk of adverse events. Very low-quality evidence from a limited number of studies indicates that combining CBT with exercise is more effective than either alone (Appendix 5 of the Guideline for the management of knee and hip osteoarthritis: Technical document). 

While there is no evidence of the effects of CBT, specifically in people with hip OA, the working group felt that benefits seen in people with knee OA and mixed samples of hip/knee OA are likely to be generalisable to those with hip OA. Clinicians should consider the appropriateness of CBT for people with knee and/or hip OA; in particular, those with psychosocial comorbidities. It may be that certain people respond better to CBT than others, with some evidence showing that responders to pain coping skills training were older and more educated, had moderate-to-high expectations for treatment outcomes, and greater OA disease severity.78 Successful programs have been delivered face-to-face individually or in group settings by a range of health professionals, including psychologists, physiotherapists and nurses, as well as via online. Evidence-based online CBT programs are an alternative option for people with limited accessibility to face-to-face treatment.77,79

Harms 

Low likelihood of adverse effects.

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