Medical rehabilitation for osteoarthritis: a multimodal framework integrating contemporary evidence and Georgian rehabilitation practice

Background Osteoarthritis (OA) is the most common form of arthritis worldwide and a leading cause of disability among older adults. Its rising prevalence, driven by population ageing and the obesity epidemic, demands integrated rehabilitation strategies that move beyond symptomatic relief towards structural, functional, and quality-of-life outcomes. Objective To synthesise contemporary international evidence and accumulated Georgian rehabilitation practice into a multimodal framework for the medical rehabilitation of OA, with explicit attention to severity-stratified treatment escalation, the role of physiotherapy, balneotherapy, and joint traction, and integration with current Q1-evidence guidelines (OARSI 2019, ACR 2019, EULAR 2018). Methods Narrative synthesis of (i) the three principal contemporary OA management guidelines, (ii) Cochrane systematic reviews of exercise, aquatic therapy, and balneotherapy in OA published 2007–2025, (iii) recent reviews of physiotherapy modalities indexed in PubMed and Scopus, and (iv) the dry and underwater traction methodology developed in Georgian rehabilitation practice. Evidence was organised around the four-tier integrated rehabilitation model presented in Figure 1 and the severity-stratified algorithm in Figure 2. Findings Effective OA rehabilitation requires early initiation, individualisation, and combination of modalities matched to disease stage. Land-based exercise is a core Level 1A treatment (Cochrane SMD for pain –0.49). Aquatic exercise, balneotherapy, mud and paraffin–ozokerite applications, and joint traction provide complementary mechanical, thermal, and circulatory benefit. When integrated, traction with balneotherapy and instrumental physiotherapy yields immediate effectiveness rates of 93–97% and sustained benefit at 6–12 months in published Georgian series. Conclusion Multimodal, severity-stratified, and individualised rehabilitation can prevent functional decline, restore working capacity, and improve quality of life in most patients with OA. Annual spa-and-resort treatment serves as an important stabilising factor for degenerative joint disease in temperate-climate populations. Keywords osteoarthritis; medical rehabilitation; physiotherapy; balneotherapy; mud therapy; joint traction; kinesitherapy; OARSI guidelines; Cochrane evidence; spa therapy