# Therapeutic Patient Education in Adults with Chronic Lower Limb Musculoskeletal Pain: A Scoping Review

## TL;DR

This review maps current research on Therapeutic Patient Education for chronic lower limb musculoskeletal pain, highlighting gaps in ankle conditions and young adults.

## Contribution

The study identifies significant variability in TPE delivery and highlights a lack of research on ankle conditions and younger populations.

## Key findings

- TPE is most commonly studied in knee and hip osteoarthritis, with less focus on ankle conditions.
- TPE combined with exercise appears more effective than exercise alone or usual care.
- There is a need for more research on TPE effects in young adults and on pain interference versus pain intensity.

## Abstract

What are the main findings?
Clinical research on Therapeutic Patient Education (TPE) in patients with chronic lower limb musculoskeletal pain has focused primarily on hip and knee osteoarthritis.TPE varies significantly across studies in content, delivery mode, providers, and duration.

Clinical research on Therapeutic Patient Education (TPE) in patients with chronic lower limb musculoskeletal pain has focused primarily on hip and knee osteoarthritis.

TPE varies significantly across studies in content, delivery mode, providers, and duration.

What are the implications of the main findings?
Clinical research lacks information on TPE in chronic ankle musculoskeletal conditions and in young adults.Future studies should report providers’ training and TPE amount.

Clinical research lacks information on TPE in chronic ankle musculoskeletal conditions and in young adults.

Future studies should report providers’ training and TPE amount.

Background: Conservative treatment of chronic musculoskeletal pain includes exercise, manual therapy, medications, physical agents/modalities, and Therapeutic Patient Education (TPE). Research on TPE has predominantly focused on spinal pain, so we do not know the extent and scope of clinical research in other areas, particularly lower extremities. This review aimed to map current research on this topic. Methods: We searched PubMed, PEDro, CINAHL, PsycINFO, and Cochrane Library up to 1 April 2024. We included RCTs on adults with chronic lower limb musculoskeletal pain, written in English, French, Spanish, or Italian. Results: Fifty-two records concerning knee osteoarthritis (n.33), hip and knee osteoarthritis (n.8), hip osteoarthritis (n.3), chronic knee pain (n.3), patellofemoral pain (n.3), and gluteal tendinopathy (n.2) were included. TPE was delivered through self-management, disease-specific information, pain education, and the management of physical activity, load, diet, stress, and sleep. Interventions were both individual- and group-based; delivery methods included in-person intervention, telephone/video calls, and web tools/apps. TPE combined with exercise seemed to be more effective than exercise alone, information/little education, or usual care. The effects of TPE as a stand-alone intervention appeared uncertain. Conclusions: There is considerable variability in TPE in terms of teaching topics, providers, administration methods, and dosage of interventions. Future studies should investigate the effects of TPE in young adult populations and in ankle conditions. They should also investigate the effects of TPE on pain intensity versus pain interference with activities, by deepening TPE effects on disability and quality of life.