A meta-analysis of over 100 clinical trials involving nearly 10,000 participants found that knee braces, water therapy, and exercise are the most effective non-drug treatments.
Knee braces, water-based therapy, and regular exercise have emerged as the leading non-drug treatments for knee osteoarthritis, according to a new meta-analysis published in the open-access journal PLOS One. The study was led by Yuan Luo of the First People’s Hospital of Neijiang, China.
Knee osteoarthritis (KOA) is one of the most widespread and disabling joint conditions, affecting millions of older adults worldwide. It often causes persistent pain and stiffness in the knee, making daily activities difficult. Standard care frequently involves anti-inflammatory medications, but these drugs carry risks of gastrointestinal and cardiovascular side effects.
To explore safer treatment options, researchers evaluated the current body of evidence on non-drug interventions for KOA. They reviewed findings from 139 clinical trials that included nearly 10,000 participants, comparing 12 different approaches. These therapies ranged from laser therapy, electrical stimulation, and knee braces to insoles, kinesiology tape, water-based exercise, traditional exercise programs, and ultrasound. By pooling data across all trials in a large network meta-analysis, the team was able to rank the treatments by their overall effectiveness.
Key Findings
Knee braces came out on top across most categories, including reducing pain, improving function, and relieving stiffness. Hydrotherapy—exercises or treatments performed in warm water—was particularly effective at easing pain and general exercise was also consistently effective, improving both pain and physical function. High-intensity laser therapy and shock wave therapy showed some benefits, while ultrasound consistently scored the lowest in effectiveness.
The authors caution that differences in study design, small sample sizes, and variability in treatment duration between the 139 included studies may limit the precision of the rankings. However, they conclude that physical therapy has promising effects on KOA, offering potential treatments without the risks of anti-inflammatory drugs. Future studies should examine the clinical efficacy of combined therapies, as well as their cost-effectiveness.
The authors add: “Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis. They reduce pain and improve mobility without the gastrointestinal or cardiovascular risks linked to common pain medications. Patients and clinicians should prioritize these evidence-based options.”
“Our analysis of nearly 10,000 patients reveals that simple, accessible therapies like knee bracing and water-based exercise outperform high-tech options like ultrasound. This could reshape clinical guidelines to focus on safer, lower-cost interventions.”
Reference: “Clinical efficacy of different therapeutic options for knee osteoarthritis: A network meta-analysis based on randomized clinical trials” by Xiao Chen, Yuanhe Fan, Hongliang Tu and Yuan Luo, 18 June 2025, PLOS ONE.
DOI: 10.1371/journal.pone.0324864
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2 Comments
Good report of an essential study on KOA. PLOS ONE is a great journal. Thanks.
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