Effectiveness of care delivery models for knee osteoarthritis in primary healthcare settings: A systematic review and meta-analysis of randomized controlled trials.

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.