BACKGROUND: Osteoarthritis (OA) is a debilitating disease that impedes activities of daily living and negatively impacts the quality of life of affected patients. With an increasing elderly population in the Philippines and across the globe, the incidence and prevalence of OA is expected to rise, and thus, will continue to pose a significant burden to patients, caregivers and the society in general. Community-based programs are practical, easily accessible and potentially sustainable and often involve educational programs aiming at lifestyle changes from which patients suffering from osteoarthritis may benefit.

OBJECTIVE: This study aimed to determine the effectiveness of community-based interventions in the management of OA, specifically in terms of improving symptoms and physical functioning among patients who are diagnosed with this condition.

METHODS: This meta-analysis only included randomized, parallel clinical trials involving patients diagnosed to have osteoarthritis. The authors searched for studies in peer reviewed journals of PubMed, clinical trials registered in Cochrane Central Register of Controlled Trials and the grey literature. Clinical trials where the intervention described involved the community or labelled as 'community-based' delivered as face-to-face or web-based, were identified. The main categories of approaches considered were: 1) community screening; 2) health education and advocacy; 3) community exercises; and 4) monitoring of treatment by community health workers. standard care. The primary outcome considered was reported improvement of pain, stiffness and physical function based on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The authors also looked at the patients' quality of life as a secondary outcome. They used the RevMan 5.4 software in the analysis of their data. Assessment of bias, subgroup analysis and sensitivity analysis were done. The overall results were evaluated using GRADE.

RESULTS: A total of 543 studies were initially identified based on the inclusion criteria, from which 12 studies were eventually included in the review. Community interventions identified in the review included 3 publications on water-based exercises, 5 on strengthening exercises, 2 on behavioral intervention and 3 on physiotherapy. Two studies included QOL as part of the outcomes. Meta-analysis was done using the Revman 5 software and revealed that the studies were heterogeneous based on p values 50%. Subgroup analyses of specific variables were done to further assess the impact of the interventions. Results revealed that while there was no statistical difference between intervention and control, a positive trend in favor of strengthening exercises versus control in improving WOMAC pain scores, stiffness scores and physical function scores were noted. There was a statistically significant difference noted in favor of community-based intervention in the impact on quality of life, specifically for mental and social aspects based on SF-36

CONCLUSION: Based on these findings, we conclude that community-based interventions, specifically strengthening exercises, physiotherapy and behavioral intervention are effective in the management of OA and may be implemented whenever feasible. These interventions will help address the burden of OA and serve as an adjunct to existing hospital or health institution-based management.