Knee bracing outperformed exercise and 10 other physical therapies for treating knee osteoarthritis pain and stiffness in a network meta-analysis of 139 randomized clinical trials involving 9,644 patients, with some treatments performing no better than placebo and ultrasound ranking lowest across all outcomes. Hydrotherapy and exercise followed closely in comparative rankings.
Knee bracing consistently ranked highest for reducing pain, improving function, and relieving stiffness on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). For pain relief specifically, knee bracing ranked first, followed by exercise and high-intensity laser therapy. Hydrotherapy achieved the best ranking for total scores and visual analog scale pain at rest. Exercise performed well across several outcomes, particularly pain and total scores.
Ultrasound ranked the lowest across outcomes, and placebo often performed similarly or better than some active therapies. For stiffness, knee bracing outperformed all other interventions, while placebo was least effective. Pairwise comparisons supported these results: knee bracing reduced pain more than lateral wedged insoles, and exercise performed better than ultrasound and placebo for pain and function.
Researchers analyzed studies from PubMed, Embase, Ovid, Cochrane Library, Web of Science, and Scopus through December 2023. Eligible trials enrolled adult patients with mild-to-moderate knee osteoarthritis confirmed by clinical or radiographic criteria. The analysis used a frequentist random-effects model and combined direct and indirect evidence. Surface Under the Cumulative Ranking probabilities were calculated to estimate the likelihood of each intervention being most effective.
The study compared low-level laser therapy, high-intensity laser therapy, transcutaneous electrical nerve stimulation, interferential current, short-wave diathermy, ultrasound, lateral wedged insoles, knee braces, exercise, hydrotherapy, kinesio taping, and extracorporeal shock wave therapy.
"The findings suggest that knee brace may be the most recommended therapeutic option for the knee osteoarthritis, followed by hydrotherapy and exercise," wrote lead study author Xiao Chen, PhD, of the First People's Hospital of Neijiang, China, and colleagues
The researchers reported several limitations. Treatment durations varied across trials, and many included studies had small sample sizes. Variability in randomization and blinding introduced potential bias. Only English-language publications were included. Inconsistencies in assessment tools other than WOMAC were noted.
The authors reported no conflicts of interest.
Source: PloS One
