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

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.