Comparative Efficacy and Safety of Blood Flow Restriction Training for Knee Osteoarthritis: A Network Meta-Analysis

Knee osteoarthritis (KOA) leads to pain, functional limitations, and muscle weakness. This study compared the efficacy and safety of blood flow restriction (BFR) training with high- (HI-RT) and low-intensity resistance training (LI-RT) in KOA patients. Randomized controlled trials (RCTs) comparing these interventions were identified through database searches. Primary outcomes included knee pain, function, muscle strength, safety, and quality of life. A network meta-analysis estimated treatment effects, ranked interventions, and assessed risk of bias (Cochrane tool) and network consistency. Fourteen RCTs involving 866 participants were included. BFR significantly reduced knee pain (MD: -1.72; 95% CI: [-2.44, -1.00]), improved function (MD: 7.12; 95% CI: [2.21, 12.02]), and increased muscle strength (MD: 0.89; 95% CI: [0.18, 1.20]) compared to LI-RT. Compared to HI-RT, BFR yielded comparable or slightly better outcomes in pain (MD: -0.43; 95% CI: [-2.26, 1.40]) and strength (MD: 0.54; 95% CI: [0.39, 1.48]), with fewer adverse effects. Funnel plots and rankograms showed no major publication bias or inconsistency. BFR training appears to be a safe and effective alternative to HI-RT and LI-RT for improving pain, strength, and function in KOA patients, especially those intolerant to high-intensity exercise.