SYSTEMATIC REVIEW article
Front. Med.
Sec. Rheumatology
This article is part of the Research TopicTherapeutic Strategies: Rehabilitation, Complementary and Alternative Therapies for Musculoskeletal DiseasesView all 5 articles
Effectiveness of physical therapies for patients with knee osteoarthritis: a systematic review and network meta-analysis of randomized controlled trials
Provisionally accepted
Shanshan Zhang1
yihao Ge1zhaodong Bi2yuqing Li1cici Bai1
Feng Zhang1miao Tian1yunxu Tian1kexin Zhang1
Xiuting Li1
yanbin Zhu1*- 1Third Hospital of Hebei Medical University, Shijiazhuang, China
- 2Shanghai 6th Peoples Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
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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 3707 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. Conclusions: 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. Registration of systematic reviews: The study was registered with PROSPERO CRD42023458296.
Keywords: physical therapies, knee osteoarthritis, Pain, Network meta-analysis, systematic review
Received: 04 Oct 2025; Accepted: 10 Nov 2025.
Copyright: © 2025 Zhang, Ge, Bi, Li, Bai, Zhang, Tian, Tian, Zhang, Li and Zhu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: yanbin Zhu, 38600312@hebmu.edu.cn
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