AUTHOR=Feng Tianxiao , Wang Xu , Jin Zikai , Qin Xiaokuan , Sun Chuanrui , Qi Baoyu , Zhang Yili , Zhu Liguo , Wei Xu 

TITLE=Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1081238

DOI=10.3389/fpubh.2023.1081238

ISSN=2296-2565

ABSTRACT=Background: Manual therapy has been used as an alternative approach to treat knee osteoarthritis (KOA). Numerous systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its effectiveness and safety. Nevertheless, the conclusions of SRs/MAs are inconsistent, and the uneven quality needs to be critically appraised. 
Objectives: To conduct a comprehensive overview of the effectiveness and safety of manual therapy for KOA and the quality of relevant SRs/MAs, thus providing critical evidence and valuable direction for future researchers to promote the generation of advanced evidence.
Methods: The pre-defined search strategies were applied to eight electronic databases. The methodological quality, risk of bias, reporting quality, and evidence quality were assessed by two independent reviewers who used respectively the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Version (PRISMA 2020), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) based on the method of narrative synthesis. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the total effective rate.
Results: A total of eleven relevant SRs/MAs were included: nine SRs/MAs were rated critically low quality, and two were rated low quality by AMSTAR-2. According to ROBIS, three SRs/MAs were rated low risk in Domain 2. Ten SRs/MAs were rated low risk in Domain 3. Five SRs/MAs were rated low risk in Domain 4 and Phase 3. By PRISMA 2020, there were some reporting deficiencies in the aspects of abstract, search strategy, heterogeneity exploration, sensitivity analysis, publication bias, evidence quality, funding, and conflict of interest. The evidence quality was defined as moderate quality (21.05%), low quality (42.11%), and critically low quality (36.84%). A re-meta-analysis revealed that manual therapy can increase the total effective rate in KOA patients (RR=1.15, 95% CI [1.12, 1.18], p<0.00001). No severe adverse reactions occurred in the manual therapy group.
Conclusions: Manual therapy may be clinically effective and safe for patients with KOA. However, this conclusion must be interpreted with caution because of the generally unsatisfactory study quality and inconsistent conclusions of the included SRs/MAs.