Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis

Lan X, Li L, Jia Q, He F, Kuang G, Zeng W, Chen M, Guo C, Wen Z, Chen Q · Aging Clinical and Experimental Research

On the visual analogue pain scale only low-level light (MD -3.32, 95% CI -3.82 to -0.75) and shockwave (MD -1.31, 95% CI -2.42 to -0.16) beat exercise; ultrasound ranked eighth of nine (SUCRA 37.5) and did not. On the WOMAC pain subscale ultrasound ranked last of nine (SUCRA 7.8) and was the one modality that did not reduce the score against exercise. No modality separated from exercise on the WOMAC function subscale or the six-minute walk. Shockwave came second for pain and first for walking distance (SUCRA 71.5). The comparisons between modalities are the network's indirect estimates, not head-to-head trials.

Population

Adults with clinically diagnosed knee osteoarthritis in 32 randomised trials, searched across nine Chinese and English databases to October 2024

Intervention

Electrical stimulation, low-level light, ultrasound, cryotherapy, thermotherapy, extracorporeal shockwave and whole-body vibration, ranked against each other in a Bayesian network

Comparator

Resistance and range-of-motion exercise, the network's reference node

Limitations

Author-reported: Chinese and English literature only, a relatively high risk of bias across the 32 trials with wide variation in frequency, duration and protocol, and sparse data behind the stiffness and function rankings. Every endpoint is symptomatic; no structural measure appears. Funded by the Hunan Provincial Natural Science Foundation of China (2024JJ9424).