Comparative Efficacy and Safety of Blood Flow Restriction Training for Knee Osteoarthritis: A Network Meta-Analysis

Knee osteoarthritis leads to pain, functional limitations, and muscle weakness. This study compared the efficacy and safety of blood flow restriction training with high- and low-intensity resistance training in knee osteoarthritis patients. Randomized controlled trials comparing these interventions were identified through database searches. Primary outcomes included knee pain, function, muscle strength, safety, and quality of life. A network meta-analysis estimated treatment effects, ranked interventions, and assessed risk of bias (Cochrane tool) and network consistency. Fourteen randomized controlled trials involving 866 participants were included. Blood flow restriction significantly reduced knee pain (mean difference: -1.72; 95% confidence interval: [-2.44, -1.00]), improved function (mean difference: 7.12; 95% confidence interval: [2.21, 12.02]), and increased muscle strength (mean difference: 0.89; 95% confidence interval: [0.18, 1.20]) compared to low-intensity resistance training. Compared to high-intensity resistance training, blood flow restriction yielded comparable or slightly better outcomes in pain (mean difference: -0.43; 95% confidence interval: [-2.26, 1.40]) and strength (mean difference: 0.54; 95% confidence interval: [0.39, 1.48]), with fewer adverse effects. Funnel plots and rankograms showed no major publication bias or inconsistency. Blood flow restriction training seems to be a safe and effective alternative to high- and low-intensity resistance training for improving pain, strength, and function in knee osteoarthritis patients, especially those intolerant to high-intensity exercise.