The Impact of Educational Style on Physiological and Psychosocial Markers in People With Knee Osteoarthritis: A Mixed-Methods Pilot RCT

Abstract

Knee osteoarthritis (OA) is a leading cause of disability among older adults, and education is a key in supporting self-management. However, how information is presented can significantly influence how people understand and manage their condition. This thesis employed a pilot randomized controlled trial (RCT) with a qualitative component to assess the feasibility and preliminary effects of two educational interventions, Pain Science Education (PSE) and Standard Biomedical Education (SBE), in older adults with knee OA. It explored physiological, psychological, emotional, and cognitive responses, and examined feasibility to inform the design of a future large-scale trial. Thirty-seven adults with knee OA were randomized to receive either neuroscience-informed PSE or traditional SBE via custom-built websites. Feasibility outcomes were largely met, except for assessment burden, indicating that only minor modifications are needed before conducting a full-scale trial. Preliminary findings suggest the PSE group showed more favorable trends, including improved parasympathetic regulation, greater knee OA knowledge, and better function and pain outcomes. A qualitative study was also conducted to explore participants’ emotional and cognitive responses to the educational materials through think-aloud and debriefing interviews. Thematic analysis of 18 transcripts (nine per group) revealed four key themes: motivated to move, knowledge and support, sentiments and self-recognition, and perspectives on surgery. Participants exposed to PSE expressed greater hope, reassurance, and motivation, while those in the SBE group described distress and a sense of inevitable decline. These differences highlight how the framing of OA education, empowering vs. impairment-focused, can shape beliefs, emotions, and self-management. In conclusion, this thesis shows that PSE is feasible and potentially more effective than SBE for a number of knee OA outcomes supporting the need to shift from a biomedical explanation of knee OA toward a more contemporary understanding that promotes engagement and self-management in OA care.