DEVELOPING A REHABILITATION PROGRAM FOR KNEE OSTEOARTHRITIS: PATIENT STRATIFICATION AND OPTIMAL INTERVENTION SELECTION
Main Article Content
Abstract
Knee osteoarthritis (knee OA) is a leading cause of pain and disability in adults; evidencebased rehabilitation can significantly improve clinical outcomes. There are several clinical guidelines for knee OA rehabilitation with varying recommendations for intervention methods. Furthermore, there is a lack of guidance on the multimodal combination of rehabilitation methods based on individual patient characteristics. This review aims to update the latest evidence on rehabilitation methods for knee OA. In addition, an evidence-based, multimodal approach to rehabilitation planning for patients is emphasized.
Keywords
knee osteoarthritis, rehabilitation, physiotherapy, multimodal approach, evidence-based
Article Details
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References
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10. Dantas LO, Osani MC, Bannuru RR. Therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis with grade quality assessment. Brazilian journal of physical therapy. 2021. 25(6), 688-97, doi: 10.1016/j.bjpt.2021.07.003.
11. Liu Y, Wang Y, Wang Y, Jia X. A meta‐analysis of analgesic effect of ultrasound therapy for patients with knee osteoarthritis. Journal of Ultrasound in Medicine. 2022. 41(8), 1861-72, doi: 10.1002/jum.15866.
12. Rodríguez-Grande E-I, Osma-Rueda J-L, Serrano-Villar Y, Ramírez C. Effects of pulsed therapeutic ultrasound on the treatment of people with knee osteoarthritis. Journal of Physical Therapy Science. 2017. 29(9), 1637-43, doi: 10.1589/jpts.29.1637.
13. Chen H, Wang Z, Zhang X, Sun M. Effects of low-intensity pulsed ultrasound on knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation. 2022. 36(9), 1153-69, doi: 10.1177/02692155221097035.
14. Wu Y, Zhu F, Chen W, Zhang M. Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: a systematic review and meta-analysis. Clinical rehabilitation. 2022. 36(4), 472-85, doi: 10.1177/02692155211065636.
15. Reichenbach S, Jüni P, Hincapié C, Schneider C, Meli D, Schürch R, et al. Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis and cartilage. 2022. 30(3), 426-35, doi: 10.1016/j.joca.2021.10.015.
16. Chen H-L, Yang F-A, Lee T-H, Liou T-H, Escorpizo R, Chen H-C. Effectiveness of interferential current therapy in patients with knee osteoarthritis: a systematic review and metaanalysis of randomized controlled trials. Scientific reports. 2022. 12(1), 9694, doi: 10.1038/s41598-022-13478-6.
17. de Almeida CC, da Silva VZM, Júnior GC, Liebano RE, Durigan JLQ. Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis. Brazilian journal of physical therapy. 2018. 22(5), 347-54, doi: 10.1016/j.bjpt.2017.12.005.
18. Tong J, Chen Z, Sun G, Zhou J, Zeng Y, Zhong P, et al. The Efficacy of Pulsed Electromagnetic Fields on Pain, Stiffness, and Physical Function in Osteoarthritis: A Systematic Review and Meta‐Analysis. Pain Research and Management. 2022. 2022(1), 9939891, doi: 10.1155/2022/9939891.
19. Wang Q-w, Ong MT-y, Man GC-w, Franco-Obregón A, Choi BC-y, Lui PP-y, et al. The effects of pulsed electromagnetic field therapy on muscle strength and pain in patients with end-stage knee osteoarthritis: A randomized controlled trial. Frontiers in Medicine. 2024. 111435277, doi: 10.3389/fmed.2024.1435277.
20. Zhou X, Yu Y, Guo J, Cao L, Zhang X, Deng Z. The effects of various physical modalities on pain in patients with knee osteoarthritis: A network meta-analysis. Journal of Orthopaedics. 2025. doi: 10.1016/j.jor.2025.03.045.
21. Li L-L, Hu X-J, Di Y-H, Jiao W. Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: A systematic review and meta-analysis. World journal of clinical cases. 2022. 10(3), 954, doi: 10.12998/wjcc.v10.i3.954.
22. Runge N, Aina A, May S. The benefits of adding manual therapy to exercise therapy for improving pain and function in patients with knee or hip osteoarthritis: a systematic review with meta-analysis. journal of orthopaedic & sports physical therapy. 2022. 52(10), 675-A13, doi: 10.2519/jospt.2022.11062.
23. Alfatafta H, Onchonga D, Alfatafta M, Zhang L, Boncz I, Lohner S, Molics B. Effect of using knee valgus brace on pain and activity level over different time intervals among patients with medial knee OA: systematic review. BMC musculoskeletal disorders. 2021. 22(1), 687, doi: 10.1186/s12891-021-04513-0.
24. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis care & research. 2018. 70(11), 1569-75, doi: 10.1002/acr.23608.
25. Mapinduzi J, Ndacayisaba G, Mitchaϊ PM, Kossi O, Bonnechère B. Supervised or HomeBased? Exploring the Best Exercise Approach for Knee Osteoarthritis Management: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2025. 14(2), 525, doi: 10.3390/jcm14020525.
26. Si J, Sun L, Li Z, Zhu W, Yin W, Peng L. Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2023. 18(1), 503, doi: 10.1186/s13018-023-04004-z.
27. Zhang Z-Y, Huang L, Tian L, Yi J, Gao M, Wang X-Q, et al. Home-based vs center-based exercise on patient-reported and performance-based outcomes for knee osteoarthritis: a systematic review with meta-analysis. Frontiers in Public Health. 2024. 121360824, doi: 10.3389/fpubh.2024.1360824.
28. Torstensen TA, Østerås H, LoMartire R, Rugelbak GM, Grooten WJA, Äng BO. High-versus low-dose exercise therapy for knee osteoarthritis: a randomized controlled multicenter trial. Annals of Internal Medicine. 2023. 176(2), 154-65, doi: 10.7326/M22-2348.
29. Messier SP, Mihalko SL, Beavers DP, Nicklas BJ, DeVita P, Carr JJ, et al. Effect of highintensity strength training on knee pain and knee joint compressive forces among adults with knee osteoarthritis: the START randomized clinical trial. Jama. 2021. 325(7), 646-57, doi: 10.1001/jama.2021.0411.
30. Ahmad MA, Hamid MSA, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy. 2022. 11485-95, doi: 10.1016/j.physio.2021.03.011.
31. Ni X, Hu L, Zhang X, Wang Z, Yan C, Peyrodie L, et al. Physical therapy options for knee osteoarthritis: A review. Medicine. 2024. 103(30), e38415, doi: 10.1097/MD.0000000000038415.
32. Dantas LO, Moreira RdFC, Norde FM, Mendes Silva Serrao PR, Alburquerque-Sendin F, Salvini TF. The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials. Clinical Rehabilitation. 2019. 33(8), 1310-9, doi: 10.1177/0269215519840406.
2. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & rheumatology. 2020. 72(2), 220 -33, doi: 10.1002/art.41142.
3. Moseng T, Vlieland TPV, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Annals of the rheumatic diseases. 2024. 83(6), 730-40, doi: 10.1136/ard-2023-225041.
4. Wood G, Neilson J, Cottrell E, Hoole SP. Osteoarthritis in people over 16: diagnosis and management—updated summary of NICE guidance. Bmj. 2023. 380, doi: 10.1136/bmj.p24.
5. Bannuru RR, Osani M, Vaysbrot E, Arden N, Bennell K, Bierma-Zeinstra S, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and cartilage. 2019. 27(11), 1578-89, doi: 10.1016/j.joca.2019.06.011.
6. Goff AJ, Silva DDO, Merolli M, Bell EC, Crossley KM, Barton CJ. Patient education improves pain and function in people with knee osteoarthritis with better effects when combined with exercise therapy: a systematic review. Journal of Physiotherapy. 2021. 67(3), 177-89, doi: 10.1016/j.jphys.2021.06.011.
7. Wu Z, Zhou R, Zhu Y, Zeng Z, Ye Z, Wang Z, et al. Self‐management for knee osteoarthritis: a systematic review and meta‐analysis of randomized controlled trials. Pain Research and Management. 2022. 2022(1), 2681240, doi: 10.1155/2022/2681240.
8. Gibbs AJ, Gray B, Wallis JA, Taylor NF, Kemp JL, Hunter DJ, Barton CJ.Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis Cartilage. 2023. 31(10), 1280-92, doi: 10.1016/j.joca.2023.05.015.
9. Lan X, Li L, Jia Q, He F, Kuang G, Zeng W, et al. Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis. Aging Clinical and Experimental Research. 2025. 37(1), 121, doi: 10.1007/s40520-025-03015-6.
10. Dantas LO, Osani MC, Bannuru RR. Therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis with grade quality assessment. Brazilian journal of physical therapy. 2021. 25(6), 688-97, doi: 10.1016/j.bjpt.2021.07.003.
11. Liu Y, Wang Y, Wang Y, Jia X. A meta‐analysis of analgesic effect of ultrasound therapy for patients with knee osteoarthritis. Journal of Ultrasound in Medicine. 2022. 41(8), 1861-72, doi: 10.1002/jum.15866.
12. Rodríguez-Grande E-I, Osma-Rueda J-L, Serrano-Villar Y, Ramírez C. Effects of pulsed therapeutic ultrasound on the treatment of people with knee osteoarthritis. Journal of Physical Therapy Science. 2017. 29(9), 1637-43, doi: 10.1589/jpts.29.1637.
13. Chen H, Wang Z, Zhang X, Sun M. Effects of low-intensity pulsed ultrasound on knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation. 2022. 36(9), 1153-69, doi: 10.1177/02692155221097035.
14. Wu Y, Zhu F, Chen W, Zhang M. Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: a systematic review and meta-analysis. Clinical rehabilitation. 2022. 36(4), 472-85, doi: 10.1177/02692155211065636.
15. Reichenbach S, Jüni P, Hincapié C, Schneider C, Meli D, Schürch R, et al. Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis and cartilage. 2022. 30(3), 426-35, doi: 10.1016/j.joca.2021.10.015.
16. Chen H-L, Yang F-A, Lee T-H, Liou T-H, Escorpizo R, Chen H-C. Effectiveness of interferential current therapy in patients with knee osteoarthritis: a systematic review and metaanalysis of randomized controlled trials. Scientific reports. 2022. 12(1), 9694, doi: 10.1038/s41598-022-13478-6.
17. de Almeida CC, da Silva VZM, Júnior GC, Liebano RE, Durigan JLQ. Transcutaneous electrical nerve stimulation and interferential current demonstrate similar effects in relieving acute and chronic pain: a systematic review with meta-analysis. Brazilian journal of physical therapy. 2018. 22(5), 347-54, doi: 10.1016/j.bjpt.2017.12.005.
18. Tong J, Chen Z, Sun G, Zhou J, Zeng Y, Zhong P, et al. The Efficacy of Pulsed Electromagnetic Fields on Pain, Stiffness, and Physical Function in Osteoarthritis: A Systematic Review and Meta‐Analysis. Pain Research and Management. 2022. 2022(1), 9939891, doi: 10.1155/2022/9939891.
19. Wang Q-w, Ong MT-y, Man GC-w, Franco-Obregón A, Choi BC-y, Lui PP-y, et al. The effects of pulsed electromagnetic field therapy on muscle strength and pain in patients with end-stage knee osteoarthritis: A randomized controlled trial. Frontiers in Medicine. 2024. 111435277, doi: 10.3389/fmed.2024.1435277.
20. Zhou X, Yu Y, Guo J, Cao L, Zhang X, Deng Z. The effects of various physical modalities on pain in patients with knee osteoarthritis: A network meta-analysis. Journal of Orthopaedics. 2025. doi: 10.1016/j.jor.2025.03.045.
21. Li L-L, Hu X-J, Di Y-H, Jiao W. Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: A systematic review and meta-analysis. World journal of clinical cases. 2022. 10(3), 954, doi: 10.12998/wjcc.v10.i3.954.
22. Runge N, Aina A, May S. The benefits of adding manual therapy to exercise therapy for improving pain and function in patients with knee or hip osteoarthritis: a systematic review with meta-analysis. journal of orthopaedic & sports physical therapy. 2022. 52(10), 675-A13, doi: 10.2519/jospt.2022.11062.
23. Alfatafta H, Onchonga D, Alfatafta M, Zhang L, Boncz I, Lohner S, Molics B. Effect of using knee valgus brace on pain and activity level over different time intervals among patients with medial knee OA: systematic review. BMC musculoskeletal disorders. 2021. 22(1), 687, doi: 10.1186/s12891-021-04513-0.
24. Messier SP, Resnik AE, Beavers DP, Mihalko SL, Miller GD, Nicklas BJ, et al. Intentional weight loss in overweight and obese patients with knee osteoarthritis: is more better? Arthritis care & research. 2018. 70(11), 1569-75, doi: 10.1002/acr.23608.
25. Mapinduzi J, Ndacayisaba G, Mitchaϊ PM, Kossi O, Bonnechère B. Supervised or HomeBased? Exploring the Best Exercise Approach for Knee Osteoarthritis Management: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2025. 14(2), 525, doi: 10.3390/jcm14020525.
26. Si J, Sun L, Li Z, Zhu W, Yin W, Peng L. Effectiveness of home-based exercise interventions on pain, physical function and quality of life in individuals with knee osteoarthritis: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2023. 18(1), 503, doi: 10.1186/s13018-023-04004-z.
27. Zhang Z-Y, Huang L, Tian L, Yi J, Gao M, Wang X-Q, et al. Home-based vs center-based exercise on patient-reported and performance-based outcomes for knee osteoarthritis: a systematic review with meta-analysis. Frontiers in Public Health. 2024. 121360824, doi: 10.3389/fpubh.2024.1360824.
28. Torstensen TA, Østerås H, LoMartire R, Rugelbak GM, Grooten WJA, Äng BO. High-versus low-dose exercise therapy for knee osteoarthritis: a randomized controlled multicenter trial. Annals of Internal Medicine. 2023. 176(2), 154-65, doi: 10.7326/M22-2348.
29. Messier SP, Mihalko SL, Beavers DP, Nicklas BJ, DeVita P, Carr JJ, et al. Effect of highintensity strength training on knee pain and knee joint compressive forces among adults with knee osteoarthritis: the START randomized clinical trial. Jama. 2021. 325(7), 646-57, doi: 10.1001/jama.2021.0411.
30. Ahmad MA, Hamid MSA, Yusof A. Effects of low-level and high-intensity laser therapy as adjunctive to rehabilitation exercise on pain, stiffness and function in knee osteoarthritis: a systematic review and meta-analysis. Physiotherapy. 2022. 11485-95, doi: 10.1016/j.physio.2021.03.011.
31. Ni X, Hu L, Zhang X, Wang Z, Yan C, Peyrodie L, et al. Physical therapy options for knee osteoarthritis: A review. Medicine. 2024. 103(30), e38415, doi: 10.1097/MD.0000000000038415.
32. Dantas LO, Moreira RdFC, Norde FM, Mendes Silva Serrao PR, Alburquerque-Sendin F, Salvini TF. The effects of cryotherapy on pain and function in individuals with knee osteoarthritis: a systematic review of randomized controlled trials. Clinical Rehabilitation. 2019. 33(8), 1310-9, doi: 10.1177/0269215519840406.