Biopsychosocial rehabilitation for inflammatory arthritis and osteoarthritis: Protocol for a systematic review and meta-analysis of randomised trials

Morten Lynggaard Pedersen, Peter Thinggard, Rinie Geenen, Marianne Uggen Rasmussen, Maarten de Wit, Lyn March, Philip Mease, Ernest Choy, Phillip Conaghan, Simon S.K. Lee, Anne Faber Hansen, Simon Tarp, Carsten Bogh Juhl, Sabrina Mai Nielsen, Kirstine Amris, Robin Christensen*

*Corresponding author for this work

Research output: Other contributionNet publication - Internet publicationResearchpeer-review

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Inflammatory arthritis (IA) and osteoarthritis (OA) have a detrimental effect on function and quality of life, primarily due to pain and physical limitations, resulting in a large global socioeconomic burden. International guidelines and the European League Against Rheumatism (EULAR) recommend the use of biopsychosocial approaches for nonpharmacological rehabilitation. The ability to weigh benefits and harms will support decisions for treatment in clinical practice.

To assess the benefits and harms of biopsychosocial rehabilitation for patients with IA or OA.

Methods and analysis
Eligible studies will be located through a systematic search of MEDLINE (via Pubmed), EMBASE (via Ovid), CENTRAL (via Cochrane Library), PsycINFO (via Ovid) and CINAHL (via Ebsco),, Web of Science, the abstract archives of American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR). Hand searching of trials and relevant reviews will be performed. Randomised and quasi-randomised controlled trials examining the benefits and/or harms of biopsychosocial rehabilitation compared to any other control therapy for IA or OA will be included. Trials will be restricted to English, German and Scandinavian languages. No restrictions will be imposed regarding age, gender, trial duration, setting, publication date or publication status. Risk of bias will be assessed using the Cochrane Risk of Bias tool. There is currently no consensus on a generic core outcome measurement set that would apply across all rheumatic and musculoskeletal diseases and for all types of biopsychosocial rehabilitation. However, pain, physical function and mental wellbeing remains constructs of major importance to all (rheumatology) stakeholders. Metaanalyses of outcome measures will be performed using a restricted maximum likelihood (REML) based model (i.e. random-effects). Subgroup analyses will be conducted by stratifying for type of musculoskeletal condition, treatment modality/component, approach in care (i.e. multidisciplinary rehabilitation, interdisciplinary rehabilitation or others), supervision of intervention (e.g. group or individual), extent of intervention (measured in hours per week), length of intervention, trial duration and comparator/control group. GRADE (Grading of Recommendations Assessment, Development and Evaluation) will be used to rate the overall certainty of the evidence for risk of bias, publication bias, imprecision, inconsistency, indirectness, and magnitude of effect. This results in ratings of high-, moderate-, low-, or very low–, quality of evidence reflecting the extent to which we are confident that the effect estimates are correct.

Perspectives and dissemination
We anticipate that the findings of this study will be useful in clinical recommendations for the management of IA and OA. The results will be disseminated as at least one scientific article in at least one peer-reviewed research journal. Also, we expect that our systematic review will facilitate evidence-based research; i.e. identifying key areas for future trial research and provide a framework for conducting the trials urgently needed.

PROSPERO Registration number: CRD42019127670
Original languageEnglish
Publication dateApr 2019
Number of pages27
Publication statusPublished - Apr 2019


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