Patient and healthcare professional perceptions of weight reduction in the treatment of knee osteoarthritis: A systematic literature review

Abstract

Objective Weight reduction confers significant clinical benefits in knee osteoarthritis (OA) management. This systematic review examined patients' and healthcare professionals' (HCPs) perceptions of weight reduction for surgical, pharmacological and non-pharmacological interventions, with emphasis on barriers to implementation. Method The review was conducted across Embase, MEDLINE, Cochrane, and PsycInfo for eligible studies using the Population, Intervention, Comparator, Outcome, Timeframe, and Study type framework. Results The search identified 2134 publications; of these, 203 had full-text screening, with 46 studies included: 23 qualitative studies, 15 cross-sectional studies, 6 randomized-controlled trials, one quasi-experimental and one observational cohort study. Four main themes of barriers to weight reduction were identified, including limited knowledge, lack of access to interventions, OA-specific barriers to exercise, and non-OA-specific barriers to dieting and exercise. The patient-reported barriers included intrapersonal barriers (i.e., difficulty achieving weight reduction, lack of motivation), physical barriers (i.e., age, challenges with general movement), and social barriers (i.e., lack of social support). The HCP-reported barriers included knowledge barriers, communication barriers, and systemic barriers (i.e., time constraints and resource limitations). Both patients and HCPs had varying expectations and satisfaction levels regarding the impact and delivery of weight reduction interventions. Conclusions Despite broad recognition of weight reduction's benefits in knee OA, substantial barriers hinder adherence and implementation. Targeted strategies addressing patient-HCP communication, alongside enhanced education and training for both groups, are critical to improving weight reduction outcomes in this population. There is currently a gap in evidence around barriers to gastric surgery and pharmacological treatment specific to patients with knee OA.