300 Section - Do adjunct treatments enhance the effectiveness of exercise therapy in people with knee osteoarthritis? A systematic review and meta-analysis

Objectives : To evaluate the effects of adjunct treatments combined with exercise therapy versus exercise therapy alone in people with knee osteoarthritis (OA).

Design: We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) identified from MEDLINE, Cochrane Central, Embase, PEDro, SPORTDiscus, and Web of Science from inception to May 2025. Eligible RCTs compared exercise therapy plus adjunct treatments with exercise therapy alone in adults with knee OA. The primary outcome was self-reported pain; secondary outcome was self-reported physical function. Effect sizes were expressed as standardised mean differences (SMDs) with random-effects models. Risk of bias was assessed using RoB 2, and certainty of evidence rated with GRADE.

Results: Eighty-five RCTs (5049 participants) were included; 74 contributed data to meta-analyses. Very low-certainty evidence suggested that ultrasound therapy, laser therapy, extracorporeal shockwave therapy, and whole body vibration reduced short-term pain (SMD [95% CI] −0.65 [−1.16, −0.14], −0.52 [−0.89, −0.16], −2.37 [−4.17, −0.56], and −0.84 [−1.33, −0.35], respectively), and ultrasound therapy, manual therapy, whole-body vibration and pain coping skills training improved short-term function (−0.77 [−1.26, −0.28], −2.52 [−3.87, −1.17], −0.41 [−0.71, −0.12], and −4.30 [−4.70, −3.89], respectively). Whole-body vibration provided mid-term benefit for pain (−0.73 [−0.85, −0.62]) and function (−2.99 [−3.32, −2.66]). No adjunct treatment improved long-term outcomes.

Conclusion: Some adjunct treatments may offer short- to mid-term benefit when combined with exercise therapy for knee OA, but evidence certainty is very low. No adjunct treatment showed added long-term benefit over exercise alone.