The Efficacy of Education as an Intervention for Improving Core Outcome Domains in People With Tendinopathy: A Systematic Review With Meta-Analysis

OBJECTIVE: To evaluate the efficacy of standalone education for people with tendinopathy. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, CINHAL, SPORTDiscus, and EMBASE (inception to June 2024). STUDY SECTION CRITERIA: Randomised controlled trials (RCTs) comparing standalone education to another intervention for adults with tendinopathy. DATA SYNTHESIS: Outcome (success/no success), pain, and function data were extracted in the short- (≤3 months), medium- (3-6 months) and long-term (≥12 months). Homogeneous data were pooled using random effects and sub-grouped by tendinopathy. Continuous and dichotomous data were used to calculate standardised mean differences and odds ratios (OR) with 95% confidence intervals (CI), respectively. RESULTS: 11 RCTs involving 2,094 people with tendinopathy were included. Education delivery mode and content varied substantially. There was very low to low certainty evidence that education was equivalent to physiotherapy management for short- (OR 0.56, 95% CI 0.31, 1.01), medium- (OR 0.42, 95% CI 0.12, 1.53), and long-term (OR 0.56, 95% CI 0.21, 1.51) treatment success. There was very low to low certainty evidence that education was equivalent to corticosteroid injection for short- (OR 0.32, 95% CI 0.14, 2.31), medium- (OR 1.76, 95% CI 0.18, 17.54), and long-term (OR 1.86, 95% CI 0.71, 4.84) treatment success. There was very low certainty evidence that education combined with physiotherapy management offered no additional benefit for short- (OR 0.54, 95% CI 0.07, 4.16), medium- (OR 0.47, 95% CI 0.12, 1.81), and long-term (OR 0.56, 95% CI 0.21, 1.46) treatment success. CONCLUSION: The short-term benefits of additional treatment to standalone education were not carried through into the medium- and long-term. Education as a standalone treatment could be considered as part of shared decision-making for adults with tendinopathy.