STUDY DESIGN: 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 to March 2013), CINAHL (1981 to March 2013), and PsycINFO (1967 to March 2013) databases were searched. RESULTS: Twenty-four studies, including 3,163 subjects (women, n = 2,547 (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 = 1,906), other symptoms (13 studies, n = 1,957), 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 = 1,035), 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 < 0.05). 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 = 0.03). Statistically significant standardized effect-size differences between intervention 1 and intervention 2 were not observed. CONCLUSION: 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. LEVEL OF EVIDENCE: Therapy, level 2b-.

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