Elastic Band Resistance Training Versus Isokinetic Machine-Based Rehabilitation for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis

Knee osteoarthritis (KOA) is a common musculoskeletal disorder for which resistance exercise is recommended, although the relative effectiveness of different modalities remains uncertain. This systematic review and network meta-analysis compared elastic band resistance training (EBRT) and isokinetic machine-based rehabilitation (IMBR) for pain, physical function, and stiffness in adults with KOA. PubMed, Scopus, CENTRAL, and Google Scholar were searched from inception to 31 May 2026 for randomized controlled trials comparing EBRT or IMBR with a common control. Nineteen trials (7 EBRT and 12 IMBR) were included in the systematic review. Of these, total of 8 unique trials contributing to the quantitative synthesis. Both EBRT (MD −1.52, 95% CI −2.63 to −0.41) and IMBR (MD −2.38, 95% CI −4.35 to −0.42) reduced Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain compared with control. IMBR was associated with improved physical function compared with control (MD −9.78, 95% CI −17.04 to −2.51), whereas the EBRT estimate was not statistically significant. Both EBRT and IMBR were associated with improvements in selected WOMAC outcomes compared with control, although heterogeneity was substantial and the certainty of evidence was low to very low. Indirect comparisons did not demonstrate statistically significant differences between the two modalities for pain, physical function, or stiffness. Although the numerical findings suggest a potential advantage for IMBR in some outcomes, they do not establish its superiority over EBRT. A stepped-care approach, in which accessible EBRT is considered initially and IMBR is explored for patients with persistent functional limitations, represents a hypothesis for future evaluation rather than a recommendation supported by the current comparative evidence. Direct head-to-head trials are needed to establish comparative effectiveness and clinical relevance.