Co esponding au ho : Nada BENABDELMALEK
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
The apeu ic educa ion in pa ien s ollowed o knee os eoa h i is a Souss Massa
Uni e si y Hospi al
Nada BENABDELMALEK 1, *, So ia KADA 1, Nou elhouda BAHI 1, Salma DRARI 1, Siham RACHIDI 1, A ika RAJA 1,
Soukaina TIDRARINE 1, Laila LAHLOU 2, La i a MOUBARIK 3, El Hassan KASSIMI 4, Amine BOURAMANE 4, Saadia
AIT MALEK 1, Imad GHOZLANI 5, 6 and Ma iam ERRAOUI 1, 6
1 Depa men o Rheuma ology, Hassan 2 Hospi al, Uni e si y Hospi al o Souss Massa, Agadi - Mo occo.
2 Communi y medicine, p e en i e medicine, public heal h and hygiene, FMPA, Ibn Zoh Uni e si y, Agadi – Mo occo.
3 Depa men o Nu i ion, ISPITS, Agadi -Mo occo.
4 Depa men o physical medicine and ehabili a ion, Hassan 2 Hospi al, Uni e si y Hospi al o Souss Massa, Agadi -
Mo occo.
5 Depa men o Rheuma ology, Oued Eddahab Mili a y Hospi al, Agadi – Mo occo.
6 CARBONE esea ch eam, LARISS Labo a o y, FMPA, Ibn Zoh Uni e si y, Agadi -Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3959-3969
Publica ion his o y: Recei ed on 07 Ma ch 2025; e ised on 17 Ap il 2025; accep ed on 19 Ap il 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.1.1331
Abs ac
Objec i e: To e alua e he impac o he apeu ic pa ien educa ion (TPE) in pa ien s wi h knee os eoa h i is, ocusing
on clinical ou comes and li es yle changes.
Me hods: Thi y- wo emale pa ien s, aged 45 o 65 yea s, p esen ing knee os eoa h i is we e included in his
p ospec i e coho and di ided in o wo g oups: 16 bene i ed om TPE ca ying on nu i ion, weigh managemen and
exe cise, while 16 did no ecei e TPE. Clinical assessmen s included he WOMAC Index, EQ-5D-3L, isual analog scale
(VAS) o pain, and le els o ac i i y be o e and a e 4 mon hs o TPE.
Resul s: A compa ison analysis be ween educa ed and non-educa ed pa ien s e eals a signi ican di e ences on he
p ac ice o physical ac i i y (p=0.004), a signi ican di e ences in die a y adop ion (p<0.001), an imp o emen in
weigh dis ibu ion (p=0.69), hus he numbe o obese pa ien s hal ed, om 12 o 6. The esul s e eal a s a is ically
signi ican educ ion in he pe cep ion o pain among educa ed pa ien s (p = 0.023).They also show signi ican changes
in ea men s ecei ed o knee os eoa h i is.
A e TPE he numbe o pa ien s wi h a no mal WOMAC algo unc ional sco e inc eased om 2 o 9 pa ien s. The
e alua ion o he EQ-5D-3L sco e shows signi ican changes in pa ien s' quali y o li e.
Conclusion: The TPE has demons a ed p omising esul s in imp o ing he quali y o li e o pa ien s wi h knee
os eoa h i is, pa icula ly by enhancing mobili y and au onomy and educing he se e i y o pain.
Keywo ds: Knee os eoa h i is; The apeu ic educa ion; WOMAC; EQ-5D-3L; Quali y o li e
1. In oduc ion
Knee os eoa h i is (OA) is a ch onic join disease cha ac e ized by he p og essi e deg ada ion o he a icula ca ilage
o he knee, leading o pain, s i ness and signi ican unc ional limi a ion. I ep esen s one o he main causes o
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disabili y among olde people a ound he wo ld. The p e alence o knee os eoa h i is is con inuously inc easing,
mainly due o he aging o he popula ion and he ise in isk ac o s such as obesi y and p e ious join auma (1).
The impac o knee OA on indi iduals' quali y o li e is conside able, a ec ing no only hei mobili y and abili y o
pe o m daily ac i i ies, bu also hei psychosocial well-being (2). Ch onic symp oms such as join pain can lead o
p og essi e de e io a ion o pa ien s' men al and physical heal h, inc easing hei dependence on medical ca e and hei
cos o ca e (3). In his complex con ex , pa ien TPE plays an essen ial ole in he o e all managemen o knee
os eoa h i is. TPE encompasses a ious educa ional in e en ions aimed a in o ming and empowe ing pa ien s o
unde s and hei disease, op imize hei ea men and adop heal h-p omo ing beha io s. These in e en ions o en
include ad ice on die , weigh loss and app op ia e exe cise, all o which a e essen ial o alle ia e knee OA symp oms
and imp o e pa ien s' quali y o li e (4).
Objec i e
This s udy aims o measu e he e ec i eness o TPE in educing symp oms and imp o ing join unc ion in pa ien s. I
aims also o enhance pa ien s' knowledge ega ding hei disease and he a ailable ea men op ions, which should
p omo e hei au onomy and encou age ac i e in ol emen in hei heal h.
2. Pa ien s and Me hods
This s udy is a compa a i e p ospec i e coho including 32 emale pa ien s wi h knee OA di ided in o wo g oups: 16
pa ien s educa ed on die , weigh loss and physical exe cises and 16 non-educa ed. The inclusion c i e ia include emale
pa ien s, aged 45 o 65 yea s, p esen ing adiological s ages 1, 2 and 3 o knee os eoa h i is. The exclusion c i e ia a e
: he associa ion o o he heuma ological pa hologies and adiological s age 4 knee os eoa h i is.
An ini ial assessmen was ca ied ou using a ques ionnai e de eloped a e an in-dep h bibliog aphic sea ch, alida ed
by a senio and es ed by i e pa ien s o assess unde s anding o he ques ions. A esiden o he depa men illed his
ques ionnai e du ing in e iews wi h pa ien s. A second e alua ion was ca ied ou a e ou mon hs o measu e he
changes ha occu ed.
Fo s a is ical analysis, he c i e ia include he assessmen o WOMAC and EQ-5D-3L sco es, as well as he deg ee o
adhe ence o he die , physical ac i i y and ea men , wi h a e alua ion o body mass index (BMI) and VAS o pain in
bo h g oups.
Da a en y and s a is ical analysis we e pe o med using he Jamo i so wa e e sion 2.3.28. The quan i a i e a iables
o he Gaussian dis ibu ion we e exp essed as mean and s anda d de ia ion, hen compa ed by he T-s uden es . The
quali a i e a iables we e desc ibed in e ms equencies and pe cen ages, and hen compa ed by using he Chi-squa e
es o Fishe 's exac es , depending on he condi ions o applica ion.
3. Resul s
3.1. Demog aphic and clinical p o ile o pa ien s
We obse ed ha he included pa ien s had an a e age age o 53 yea s old (+/- 6.67). A la ge majo i y we e ma ied
(78%) and housewi es (78%), mainly coming om an u ban en i onmen (87.5%). Rega ding medical his o y, 40.6%
o pa ien s had no no able his o y. The du a ion o e olu ion o he knee os eoa h i is was 5 o 10 yea s o 40.6% o
pa ien s, wi h a bila e al p e alence in 75% o hem and a adiological s age II in 53%. The as majo i y o pa ien s did
no eso o a walking aid (90.6%).
3.2. Physical ac i i y: compa ison be ween he educa ed and non-educa ed g oup
In ou s udy, a compa a i e analysis o he p ac ice o physical ac i i y be ween educa ed and non-educa ed pa ien s o
he managemen o knee os eoa h i is e eals signi ican di e ences (p=0.004). Be o e TPE, he majo i y o non-
educa ed pa ien s we e seden a y (6 pa ien s), while only 6 engaged in daily physical ac i i y and 4 pa ien s exe cised
h ee imes a week. A e TPE, hese di e ences we e accen ua ed wi h a no able inc ease in he physical ac i i y among
educa ed pa ien s ( om 6 o 11 pa ien s), while he numbe o seden a y pa ien s d opped o ze o ( igu e 1).
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Figu e 1 Assessmen o physical ac i i y be o e and a e TPE
3.3. E olu ion o adhe ence o he die be o e and a e TPE
A compa ison be ween educa ed and non-educa ed pa ien s demons a ed signi ican di e ences in die a y adop ion
(p<0.001). Be o e TPE, he majo i y o pa ien s did no ollow any speci ic die (8 pa ien s), while one pa ien op ed o
a low-sodium die alone and 4 o a low-ca bohyd a e die alone. Th ee pa ien s ollowed a die ocused exclusi ely on
weigh loss.
A e TPE, no able changes in die a y habi s we e obse ed: no pa ien main ained he absence o die . The low-sodium
and low-ca bohyd a e die s alone we e no longe ollowed by any pa ien and 3 pa ien s main ained a die o weigh
loss alone, while he mos signi ican change was he adop ion by 13 pa ien s o a combina ion o he 3 die s (low-
sodium, low-ca bohyd a e and o weigh loss) (Figu e 2).
Figu e 2 E alua ion o adhe ence o he die be o e and a e TPE in he educa ed g oup
3.4. E alua ion o Body Mass Index (BMI)
The esul s o ou s udy e eal a change in he weigh dis ibu ion o pa ien s wi h knee os eoa h i is be o e and a e
TPE. Be o e TPE, he majo i y o pa ien s we e classi ied as obese, wi h a mean BMI o 31 (+/- 4.45), while only h ee
we e o e weigh and one had a no mal weigh . A e he TPE in e en ion, an imp o emen was obse ed in weigh
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dis ibu ion (p=0.69). The numbe o obese pa ien s hal ed, om 12 o 6, while he numbe o o e weigh pa ien s
inc eased om 3 o 9. The numbe o pa ien s main aining a no mal weigh emained s able a jus one pa ien (Table
1).
Table 1 Weigh assessmen be o e and a e TPE
Weigh assessmen be o e TPE
Weigh assessmen a e TPE
No mal weigh
1
1
O e weigh
3
9
Obesi y
12
6
3.5. E alua ion o Visual Analog Scale (VAS)
The e alua ion o he VAS o pain be o e and a e he TPE e eals a s a is ically signi ican educ ion in he pe cep ion
o pain among educa ed pa ien s (p = 0.023). Be o e TPE, no pa ien epo ed a comple e absence o pain (VAS 0), he
majo i y p esen ing mode a e o se e e pain (8 mode a e, 5 se e e), wi h only 3 pa ien s expe iencing mild pain. A e
TPE, a no able imp o emen is obse ed: he numbe o pa ien s wi hou pain (VAS 0) inc eased o 4, and hose
expe iencing mild pain inc eased conside ably ( om 3 o 8). Only one pa ien s ill epo ed mode a e pain and h ee
had se e e pain (Figu e 3).
Figu e 3 E alua ion o pain VAS be o e and a e TPE
3.6. Compa a i e analysis o ea men s ecei ed o knee os eoa h i is:
The s udy examines he e olu ion o ea men s adminis e ed o pa ien s wi h knee os eoa h i is be o e and a e hei
pa icipa ion in a TPE p og am. Ini ially, 7 pa ien s used only an ia h i ic medica ions and 6 analgesic ea men s.
Th ee pa ien s combined he wo and only one had ecei ed local s e oid injec ion. No pa ien had ecei ed
iscosupplemen a ion o o al knee a h oplas y (TKA). A e 4 mon hs o TPE, he esul s show signi ican changes: he
exclusi e use o an ia h i ic inc eased om 7 o 13 pa ien s, while he exclusi e use o analgesics was elimina ed. The
combina ion o an ia h i ics and analgesics dec eased sligh ly om 3 o 2 pa ien s, and he use o local s e oid injec ion
emained he same wi h one pa ien be o e and a e TPE. Viscosupplemen a ion emained unused (Table 2).
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Table 2 E alua ion o ea men s ecei ed be o e and a e TPE
Numbe o pa ien s be o e TPE
Numbe o pa ien s a e TPE
An i-a h i ics alone
7
13
Analgesic alone
6
0
An i-a h i ics and analgesic associa ion
3
2
S e oid injec ion
1
1
Viscosupplemen a ion
0
0
3.7. E alua ion o WOMAC algo unc ional sco e be o e and a e TPE
In his compa a i e s udy using he WOMAC Index sco e be o e and a e TPE, he esul s showed signi ican
imp o emen in pa ien s wi h knee os eoa h i is. Be o e TPE, he majo i y o pa ien s had a WOMAC sco e indica ing
an abno mal condi ion (sco e > 13), wi h 14 pa ien s a ec ed, while only 2 pa ien s had a sco e in he no mal ange
(be ween 0 and 12). A e TPE, a posi i e de elopmen was obse ed: he numbe o pa ien s wi h a no mal WOMAC
sco e inc eased o nine, demons a ing a educ ion in pain, s i ness as well as an imp o emen in physical unc ion. A
he same ime, he numbe o pa ien s wi h an abno mal WOMAC sco e dec eased o 7, indica ing an imp o emen in
symp om managemen o a po ion o pa ien s (Figu e 4).
Figu e 4 E alua ion o he Womac sco e be o e and a e TPE
3.8. Impac o he apeu ic educa ion on he EQ-5D-3L sco e
The e alua ion o he EQ-5D-3L sco e be o e and a e he TPE shows signi ican changes in se e al dimensions o he
pa ien s' quali y o li e (Mobili y, au onomy, cu en ac i i ies, pain/discom o , anxie y and dep ession) ( igu e 5).
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Figu e 5 E alua ion o he EQ-5D-3L sco e be o e and a e TPE
4. Discussion
4.1. Demog aphic and clinical p o ile o pa ien s
Ou s udy esul s p o ide a de ailed o e iew o he demog aphic and clinical p o ile o pa ien s wi h knee OA,
highligh ing se e al key cha ac e is ics. The mean age o he pa ien s was 53 yea s wi h a s anda d de ia ion o 6.67
yea s, indica ing a ela i ely homogeneous coho in e ms o age. The a e age body mass index (BMI) was 31 kg/m²
wi h a s anda d de ia ion o 4.45, highligh ing a signi ican p e alence o o e weigh among he pa ien s s udied.
F om a sociodemog aphic pe spec i e, a la ge majo i y o pa ien s, 78%, we e ma ied, while 78% we e housewi es.
The majo i y esided in u ban a eas (87.5%), which can in luence access o ca e and heal h p og ams. App oxima ely
40.6% o pa ien s had no signi ican medical his o y, which may indica e a ela i ely heal hy coho despi e he p esence
o knee os eoa h i is.
Rega ding he disease i sel , he du a ion o p og ession was mos equen ly be ween 5 and 10 yea s o 40.6% o
pa ien s, e lec ing a ai ly long his o y o he disease. Knee OA was bila e al in 75% o pa ien s and was classi ied as
adiological s age II in 53% o hem, which e lec s mode a e damage o he knee join s. Rega ding he apeu ic
in e en ions, he as majo i y o pa ien s (90.6%) did no use a walking aid, which could e lec he abili y o main ain
minimal unc ionali y despi e disease p og ession.
4.2. Engagemen in physical ac i i y: compa ison be ween he educa ed and non-educa ed g oup
To discuss physical ac i i y in educa ed and non-educa ed pa ien s, in he managemen o knee os eoa h i is, ou s udy
e eals signi ican esul s compa able o o he esea ch. Be o e TPE, he highe p e alence o seden a y li es yle among
non-educa ed pa ien s is consis en wi h p e ious s udies which demons a e less engagemen in physical exe cise
among indi iduals less in o med abou he managemen o hei condi ion (5). Con e sely, ou s udy shows ha
educa ed pa ien s adop ed daily physical ac i i y mo e signi ican ly a e TPE, compa ed o non-educa ed ones, which
e lec s he po en ial bene i s o TPE on engagemen in a o able heal h beha io s (6). This pe sis en di e ence
sugges s ha educa ional in e en ion may play a c ucial ole in p omo ing an ac i e li es yle, essen ial o he e ec i e
managemen o knee OA and he p ese a ion o long- e m join unc ion. Along he same lines, p e ious s udies ha e
shown ha egula exe cise can educe pain and imp o e physical unc ion in pa ien s wi h knee OA (7).
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4.3. Assessmen o adhe ence o die be o e and a e TPE
A compa a i e analysis be ween he educa ed and non-educa ed g oup e ealed s a is ically signi ican di e ences in
he adop ion o a sui able die (p<0.001). Be o e TPE, he majo i y o pa ien s did no ollow any speci ic die , while
a e he TPE, a ansi ion owa ds s uc u ed and di e si ied die a y p ac ices was obse ed, o en including a
combina ion o low-sodium, low-ca bohyd a e and weigh loss die . The esul s o ou s udy a e consis en wi h se e al
p e ious esea ches ha ha e examined he e ec o TPE on he ea ing habi s o pa ien s wi h ch onic diseases. Fo
example, a s udy obse ed a signi ican imp o emen in adhe ence o ecommended die s a e a simila educa ional
in e en ion in pa ien s wi h ype 2 diabe es (8). Simila ly, a ecen me a-analysis on TPE in ch onic disease
managemen demons a ed inc eased compliance wi h die a y ecommenda ions, leading o imp o ed o e all heal h
ou comes (9).
In ou s udy, he inc ease in he adop ion o sui able die s a e TPE sugges s ha his educa ional app oach can play a
c ucial ole in p omo ing heal hie ea ing habi s ha a e be e adap ed o he indi idual needs o pa ien s wi h knee
OA. This could po en ially educe he disease symp oms and imp o e quali y o li e in he long e m.
4.4. Impac o TPE on he Body Mass Index (BMI)
Ou s udy showed a signi ican imp o emen in pa ien weigh dis ibu ion a e TPE, wi h a no able educ ion in he
numbe o obese pa ien s and a p opo ional inc ease in o e weigh pa ien s. This sugges s ha TPE played a c ucial
ole in p omo ing bene icial changes in weigh managemen in hese pa ien s, po en ially imp o ing hei gene al heal h
and well-being.
Ou esul s a e consis en wi h hose epo ed in he li e a u e (10), which highligh s he e ec i eness o TPE in e ms
o weigh and BMI educ ion, especially in he sho e m. Fu he mo e, imp o ing knowledge and de eloping skills in
sel -ca e, especially wi h ega d o nu i ion and physical ac i i y, a e pa icula ly impo an aspec s(10).
Simila esul s ha e been obse ed in o he s udies in es iga ing he impac o TE p og ams on weigh managemen in
popula ions wi h a ious ch onic diseases. Fo example, a sys ema ic e iew highligh ed ha educa ional in e en ions
can induce signi ican changes in ea ing habi s and con ibu e o imp o ed weigh managemen in pa ien s wi h ch onic
diseases (8).
Ano he s udies has shown ha he weigh loss was o 8.6% and he global heal h cos s we e dec eased by 15.8% (11).
Simila ly, a esea ch also con i med ha TPE can play a c ucial ole in p omo ing heal hy li es yles and weigh
managemen in he con ex o ch onic diseases (9).
Ou esul s suppo hese conclusions by demons a ing ha TPE can no only posi i ely in luence ea ing habi s and
weigh managemen , bu also ha e a di ec impac on clinical ou comes in pa ien s wi h knee OA. The educ ion in
obesi y and he s abiliza ion o no mal weigh in ou s udy indica e be e managemen o he physical condi ion o
pa ien s.
4.5. Pain in ensi y assessmen be o e and a e TPE
The esul s o ou s udy highligh he posi i e impac o TPE on pain managemen in pa ien s wi h knee os eoa h i is,
con i ming a signi ican educ ion in pe cei ed pain le els a e he in e en ion. Be o e TPE, he majo i y o pa ien s
su e ed om mode a e o se e e pain, wi h a ew epo ing no pain a all. A e TPE, a no able inc ease in he numbe
o pa ien s epo ing a comple e absence o pain was obse ed, accompanied by a dec ease in he numbe o pa ien s
expe iencing mode a e o se e e pain. Ou obse a ions a e consis en wi h p e ious s udies ha ha e also highligh ed
he bene i s o educa ional p og ams in pain managemen among pa ien s wi h simila ch onic condi ions, such as
os eoa h i is (12). These s udies ha e highligh ed ha educa ion imp o es pain pe cep ion by s eng hening coping
s a egies and p omo ing be e daily symp om managemen .
Despi e hese encou aging esul s, he pe sis ence o mode a e o se e e pain in some pa ien s a e TPE highligh s he
need o pe sonalized and ongoing app oaches o op imize long- e m pain elie . Complemen a y s a egies, such as
egula ollow-ups and indi idualized he apeu ic adjus men s, could be explo ed o mee he speci ic needs o pa ien s
and imp o e hei quali y o li e in he long e m.
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4.6. Compa a i e analysis o ea men s ecei ed o knee os eoa h i is
The compa a i e s udy o ea men s in pa ien s wi h knee os eoa h i is be o e and a e TPE highligh s signi ican
changes in he apeu ic choices and hei clinical implica ions. A e TPE, analysis e eals a no able inc ease in he
exclusi e use o an i-a h i is medica ions, a o al elimina ion o analgesic ea men s alone, and a sligh dec ease in he
combined use o an i-a h i ic medica ions and analgesics. Fu he mo e, he use o local s e oid injec ions emained he
same, while iscosupplemen a ion emained unused in his coho .
These esul s sugges ha TPE plays a c ucial ole in op imizing he apeu ic choices o knee OA. I seems o p omo e
be e managemen o knee os eoa h i is symp oms and a educ ion in dependence on isola ed analgesics. This
e olu ion owa ds mo e a ge ed and adap ed ea men s could po en ially imp o e clinical ou comes and pa ien s’
quali y o li e in he long e m.
P e ious esea ch has shown ha educa ional p og ams on pain managemen and ea men op imiza ion can
signi ican ly imp o e unc ional ou comes and educe he need o in asi e pha macological in e en ions (13). In
addi ion, o he wo k has highligh ed he e ec i eness o educa ional in e en ions in educing pain and imp o ing
adhe ence o non-pha macological ea men s, hus con ibu ing o be e managemen o he disease (14).
4.7. Assessmen o WOMAC algo unc ional sco e be o e and a e TPE
Ou s udy used he WOMAC sco e o assess he impac o TPE on emale pa ien s wi h knee os eoa h i is, e ealing
encou aging esul s ega ding he imp o emen o symp oms and pa icipan s' quali y o li e. A e he educa ional
in e en ion, a subs an ial educ ion in he numbe o pa ien s wi h an abno mal WOMAC sco e was obse ed, wi h an
inc ease in pa ien s wi h no mal sco e.
These esul s a e consis en wi h o he s udies which ha e also shown he bene i s o TPE in he managemen o
os eoa h i is. Fo example, a s udy epo ed signi ican imp o emen in WOMAC sco es a e a TPE p og am ocused
on pain sel -managemen and imp o ed physical unc ion (15). Simila ly, a me a-analysis concluded ha educa ional
in e en ions a e e ec i e in educing pain and imp o ing unc ionali y in pa ien s wi h os eoa h i is (16).
The obse a ion ha TPE can con ibu e o be e symp om managemen in pa ien s wi h os eoa h i is is pa icula ly
ele an o clinical p ac ices. By p o iding in o ma ion on sel -ca e, app op ia e exe cise s a egies, and coping
echniques, TPE may help educe he need o agg essi e and po en ially in asi e pha macological ea men s. A
andomized con olled ial demons a ed ha educa ion o pa ien s wi h os eoa h i is is easible in a p ima y ca e
se ing and can imp o e heal h pe cep ion as well as unc ion o some ex en . The p og am included educa ion a he
han ins uc ion on exe cise (17). Ano he sys ema ic e iew and me a-analysis o andomized con olled ials
in es iga ing he e ec i eness o pa ien TPE in e en ions o ch onic diseases ound ha hese TPE in e en ions
we e e ec i e in imp o ing biological ou comes, ea men adhe ence, knowledge, sel -e icacy and psychological
heal h. This e iciency was consis en ega dless o TPE o ma (indi idual, g oup and elec onic) and heal hca e
p o ide s (non-specialis s s specialis s) (18).
4.8. Impac o TPE on he EQ-5D-3L sco e
The cu en s udy on TPE in pa ien s wi h knee os eoa h i is shows p omising esul s e alua ed by he EQ-5D-3L sco e.
Be o e TPE, he majo i y o pa ien s had signi ican limi a ions in mobili y, independence, daily ac i i ies and
expe ienced mode a e o se e e le els o pain o discom o . A e he TPE in e en ion, no able imp o emen s we e
obse ed in hese a eas, including an imp o emen in mobili y and in independence, as well as a dec ease in se e e
le els o pain o discom o . These esul s a e consis en wi h p e ious s udies which ha e also shown ha TPE
imp o es symp om managemen and quali y o li e in os eoa h i is pa ien s. Fo example, esea ch has shown ha TPE
p og ams educe pain and imp o e physical unc ion in pa ien s wi h os eoa h i is (9). Addi ionally, a ecen me a-
analysis con i med he bene i s o educa ional in e en ions in he managemen o ch onic diseases, including
os eoa h i is (16). O he s udies sugges ha educa ional in e en ions can imp o e physical limi a ions, educe pain,
and po en ially dec ease heal h ca e cos s o pa ien s wi h os eoa h i is. Howe e , e ec i eness a ies depending on
he ype o in e en ion and he sus ainabili y o he e ec s emains a ques ion o be explo ed (12).
4.9. Limi a ions o he s udy
This s udy has limi a ions ha should be conside ed when in e p e ing he esul s. Fi s o all, he sample size is
ela i ely small wi h only 32 pa ien s di ided in o wo g oups. A smalle sample size may limi he abili y o gene alize
indings o a b oade popula ion and may also a ec he s a is ical powe o he s udy, making i di icul o de ec
signi ican di e ences be ween educa ed and non-educa ed g oups.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(01), 3959-3969
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Addi ionally, he ela i ely sho ollow-up du a ion o ou mon hs may no be su icien o ully cap u e he long- e m
e ec s o TPE on clinical ou comes and ecommenda ion adhe ence. Pa ien s wi h knee OA may ha e ch onic disease
ajec o ies ha equi e assessmen o e a mo e p olonged pe iod o assess he ue long- e m e ec s o educa ional
in e en ions.
Rega ding po en ial bias, i emains possible ha ecall o memo y bias in luenced pa ien s' esponses a baseline and
ollow-up assessmen s. Fu he mo e, he ac ha he assessmen was ca ied ou by a esiden o he depa men could
in oduce assessmen bias, pa icula ly in e ms o subjec i i y in he in e p e a ion o pa ien s' esponses.
4.10. Clinical implica ions o TPE in heuma ology
The clinical implica ions o in eg a ing TPE in o daily heuma ology p ac ice a e b oad and p omising, as sugges ed by
his compa a i e p ospec i e s udy on knee os eoa h i is (19). Indeed, TPE o e s se e al angible ad an ages which
can en ich he ca e o pa ien s su e ing om ch onic heuma ological diseases, such as knee os eoa h i is.
Fi s , TPE helps imp o e pa ien s' unde s anding o hei illness, including cla i ying isk ac o s, sel -ca e s a egies,
and a ailable ea men op ions. This p omo es ac i e pa icipa ion o pa ien s in he daily managemen o hei
condi ion, making hem pa ne s in he medical decision-making p ocess (20). By in eg a ing ad ice on die , weigh loss
and app op ia e exe cise, as he s udy shows, TPE can no only educe dependence on analgesic medica ions, bu also
imp o e join unc ion and educe disease p og ession (21). This can lead o a signi ican imp o emen in pa ien s'
quali y o li e, allowing hem o main ain inc eased mobili y and independence in he long e m.
Fu he mo e, by s eng hening pa ien sel -managemen skills, TPE can po en ially educe unplanned medical
consul a ions and hospi aliza ions ela ed o knee OA, he eby dec easing heal hca e cos s and op imizing he use o
a ailable esou ces (22).
In p ac ical e ms, heuma ologis s and o he heal hca e p o essionals can in eg a e s uc u ed TPE p og ams in o hei
egula consul a ions, p o iding pa ien s wi h p ac ical in o ma ion and ools o be e manage hei heal h condi ions
on a daily basis. This equi es a long- e m commi men o he aining and con inuous educa ion o heal hca e
p o essionals o ensu e e ec i e and consis en implemen a ion o hese p og ams (23).
The lis o abb e ia ions
BMI
Body Mass Index
EQ-5D-3L
Eu oQol-5 Dimensions-3 Le els
RHC
Regional Hospi al Cen e
UHC
Uni e si y Hospi al Cen e
TPE
The apeu ic pa ien educa ion
VAS
Visual Analog Scale
WOMAC
Wes e n On a io and McMas e Uni e si ies Os eoa h i is Index
5. Conclusion
This s udy o TPE in pa ien s wi h knee OA e ealed signi ican imp o emen s in heal h and quali y o li e. A e he
in e en ion, no able imp o emen s we e obse ed, wi h a educ ion in se e e limi a ions and be e pain managemen .
Addi ionally, TPE p omo ed bene icial changes in pa ien s' li es yle habi s, such as inc eased egula physical ac i i y
and adop ion o heal hie die s, he eby con ibu ing o be e weigh managemen and o e all imp o emen o heal h.
These esul s highligh he c ucial impo ance o TPE in he managemen o os eoa h i is, no only o i s immedia e
e ec s on symp oms and physical unc ion, bu also o encou aging a heal hy li es yle in he long e m.
Recommenda ions o u u e esea ch o clinical applica ions
To guide u u e esea ch and clinical applica ions based on he conclusions o his s udy on TPE in pa ien s wi h knee
os eoa h i is, se e al ecommenda ions can be conside ed:
