The effects of neuromuscular training on functional outcome measures in patients with knee osteoarthritis: a systematic review and meta-analysis.

BACKGROUND

Previous studies indicate exercises are a crucial component in managing knee osteoarthritis (KOA). It appears interventions targeting sensorimotor performance may offer advantages for individuals with KOA. This study aimed to perform a systematic review and meta-analysis to evaluate the impact of neuromuscular exercises (NEMEX) on patient-reported and performance-based outcome measures of physical function in this population.

METHODS

We systematically searched for studies in electronic databases (Web of Science, Science Direct, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Medline and ProQuest) from 1990 to March 2025, prioritizing KOOS and WOMAC as primary outcomes and other measures as secondary outcomes. In meta-analyses, we used weighted mean differences along with 95% confidence interval to assess absolute difference in KOOS, WOMAC, timed up-and-go and chair stand test scores. We used forest plots to represent our data.

RESULTS

Eight articles of clinical trials were eligible to include in this review. The meta-analysis showed KOOS-quality-of-life scores (mean difference = 5.36, 95%CI = 1.07 to 9.65, p = .01, I2 = 0.00%) were significantly higher in the NEMEX group compared to control groups. The WOMAC (mean difference = -5.21, 95%CI = -10.31 to -0.11, p = .05, I2 = 81.48%) showed lower scores trending toward significance in NEMEX group compared to control groups. The timed up-and-go test (mean difference = -0.05, 95%CI = -0.52 to 0.42, p = .58, I2 = 0.00%) and chair stand test (mean difference = 0.47, 95%CI = -0.31 to 1.24, p = .08, I2 = 67.87%) indicated no significant difference between the NEMEX and control groups. However, studies assessing the effect of NEMEX on stair climb test, Y balance test, muscle strength of quadriceps and hamstrings, and quality of life questionnaire had conflicting results.

CONCLUSION

The NEMEX effectively promoted quality of life among individuals with KOA and should be included in rehabilitation programs.