What type of study is this?

This is a Meta-Analysis study (also classified as: Systematic Review).

December 8, 2025Open Access

Effectiveness of physical therapies for patients with knee osteoarthritis: a systematic review and network meta-analysis of randomized controlled trials

ZBZhaodong BiShanghai Sixth People's Hospital CBChunmei BaiChinese Academy of Medical Sciences & Peking Union Medical College XLXiuting LiHebei Medical University

Key Points

TENS reduced NRS pain by 2.73 in 3,707 participants with knee osteoarthritis, indicating strong pain relief.
Moderate to low-level evidence identifies laser therapy as most effective for pain during walking at less than 1 month and 1–3 months.
Randomized controlled trials assessed multiple physical therapy interventions compared to placebo or general nursing for KOA pain management.
Findings highlight the need for further studies to confirm varying efficacy of physical therapies in managing knee osteoarthritis.

Abstract

Background Physical therapy offers a useful option for management of knee osteoarthritis (KOA) and this study aims to summarize the latest evidence on the effectiveness of variable physical therapies. Methods We considered randomized trials of patients with KOA that compared any of the following interventions for treatment of osteoarthritis pain: physical therapies, general nursing, placebo. We performed frequentist random-effect network meta-analyses to summarize the evidence and applied the Confidence in Network Meta-Analysis frameworks to rate the certainty of evidence, calculate the treatment effects, categorize interventions, and present the findings. Results The search identified 74 eligible RCTs, enrolling 3,707 participants. TENS demonstrated the largest reduction of NRS (MD, −2.73; 95% CI, −5.20 to −0.26) and VAS pain at rest (MD, −2.87; 95% CI, −4.87 to −0.87). Moderate to low-level evidence established laser as most effective for improving VAS for pain during walking at 1 month (MD, −2.50; 95% CI, −3.88 to −1.11) and 1–3 months (MD, −2.49; 95% CI, −4.51 to −0.48), and neuromuscular exercise (MD, −1.77; 95% CI, −3.14 to −0.39) at 3 months. For WOMAC total scores at 1 month, 1–3 months, and 3 months, shockwave (MD, −9.56; 95% CI, −16.71 to −2.41; low-level confidence), aquatic sports (MD, −16.53; 95% CI, −30.74 to −2.31; low-level confidence), and shockwave (MD, −30.02; 95% CI, −40.39 to −19.65, moderate-level confidence) respectively, demonstrated the greatest improvements. Conclusion Physical therapies exhibited varying efficacy profiles in management of KOA with most being supported by moderate-to-low levels evidence, warranting further studies to better establish their effectiveness. Systematic review registration Identifier PROSPERO CRD42023458296.

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