Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis
Bibliographic record
Abstract
OBJECTIVE: This network meta-analysis (NMA) aimed to compare the efficacy of various physical modalities in alleviating pain, stiffness, and functional impairment in patients with knee osteoarthritis (KOA). METHODS: In accordance with PRISMA-P guidelines, we systematically searched nine databases(CNKI, VIP Database, Wanfang Database, SinoMed, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library) from inception to October 2024 to identify randomized controlled trials (RCTs) evaluating physical therapies for KOA. The interventions assessed included electrical stimulation therapy (EST), low-level light therapy (LLLT), thermotherapy (TT), cryotherapy (CT), and extracorporeal shock wave therapy (ESWT), with resistance and range of motion exercises (RRE) serving as comparators. Outcome measures comprised the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 6-minute walk test (6 MWT). Bayesian network meta-analyses and pairwise meta-analyses were performed using Stata 17.0 and R 4.4.1 software. RESULTS: 32 RCTs involving 2,078 participants were included. LLLT demonstrated the highest efficacy for pain reduction (VAS: MD=-3.32, 95% CI:-3.82 to-0.75; WOMAC pain: MD=-3.74, 95% CI:-6.68 to-0.72) and joint function improvement (SUCRA = 79.8). ESWT ranked second for pain relief (VAS: MD=-1.31, 95% CI:-2.42 to-0.16) and mobility enhancement (6 MWT: SUCRA = 71.5), while TT showed superior efficacy in reducing stiffness (WOMAC stiffness: MD=-2.09, 95%CI:-3.06 to-0.94; SUCRA = 98.1). In contrast, ultrasonic therapy (UT) did not provide significant benefits. CONCLUSIONS: The findings suggest that LLLT and ESWT may be optimal for pain relief and functional improvement in patients with KOA, whereas TT appears to be the most effective in reducing stiffness. Optimal dosing parameters of these physical modalities are crucial for maximizing clinical benefits. Clinicians should individualize treatment strategies based on patient-specific factors. Future large-scale RCTs are warranted to validate these protocols and address the heterogeneity of existing evidence. CLINICAL TRIAL NUMBER: Not applicable.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".