Interventions for supporting self-management in people with musculoskeletal pain, including focus on varying levels of health literacy: A systematic overview of reviews

Abstract

Background: Musculoskeletal (MSK) pain is a major cause of disability globally, affecting one in three adults. Self-management is a core recommendation for managing MSK pain; however, most self-management programmes require a high level of patient engagement, which may be partly influenced by health literacy levels. This overview aims to summarise current evidence on supported self-management and the influence of varying levels of health literacy in people with MSK pain.  Methods: A systematic search was conducted for relevant systematic reviews in databases (Cochrane Library, Medline, EMBASE, CINAHLPlus, AMED, and PsycInfo). Data on study populations (including markers of health literacy), characteristics, and outcomes of supported self-management such as self-efficacy in pain management were extracted. Quality of systematic reviews was assessed using AMSTAR 2, and strength of evidence rated using a modified GRADE approach. Results: In total, 40 systematic reviews contributed evidence to this overview. Based on intervention components and mode of delivery, three main self-management intervention approaches were indicated: structured self-management education programmes (10 reviews), self-directed self-management (four reviews), and combined self-management activity and education programmes (26 reviews). MSK patients with low health literacy levels were found to have poorer outcomes with current self-management interventions. The strength of evidence for self-efficacy in pain management was assessed as low (across the three approaches). Only one review systematically extracted data on measures or markers of health literacy, highlighting an important gap in evidence.  Conclusions: A comprehensive summary and critical assessment of current evidence on supported self-management and the influence of health literacy levels among patients with MSK pain was presented. There is a gap in evidence regarding potential mediators of the effects of supported self-management among people with musculoskeletal conditions and low levels of health literacy, thereby limiting the opportunity to positively influence outcomes.