Data Sheet 3_Effectiveness of physical therapies for patients with knee osteoarthritis: a systematic review and network meta-analysis of randomized controlled trials.docx

BackgroundPhysical 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.
MethodsWe 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.
ResultsThe 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.
ConclusionPhysical 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 registrationIdentifier PROSPERO CRD42023458296.