Evidence-Based Recommendations for Physiotherapy Management of Knee Osteoarthritis in India: A 3-Round Delphi Study

Introduction: Osteoarthritis (OA) is a prevalent form of arthritis worldwide, causing significant functional impairment and reduced quality of life due to chronic pain. Despite the availability of research literature, there is no Indian physiotherapy guideline for patients with OA knee. Methods: This study used a modified Delphi approach, involving a literature review and expert committee feedback. Eleven expert committee members, including physiotherapists and orthopaedic surgeons, participated in the study. The study consisted of three rounds of consensus, using the GRADE instrument to grade the quality of evidence and strength of recommendations. Results: The consensus process identified evidence-based component getting affected (pain, strength, endurance, proprioception, kinesiophobia, posture, gait) in OA knee and treatment propositions (isometric exercises, strengthening, proprioceptive training, postural correction, agility training). The study demonstrated a rigorous approach to developing evidence-based treatment guidelines for OA knee, incorporating expert feedback and preferences. The final list of components getting affected and evidence-based physiotherapy protocol is under consensus. Conclusion: This study developed evidence-based treatment guidelines for osteoarthritis knee management in India, emphasizing exercise therapy, patient education, and a multidisciplinary approach, while highlighting the need for tailored guidelines incorporating various exercises targeting different components, which are getting affected in OA knee.