Efficacy of non-pharmacological interventions for knee osteoarthritis in the elderly: A systematic review and...

Knee osteoarthritis (KOA) is highly prevalent in the elderly. Non-pharmacological treatments are recommended as first-line management, but high-quality evidence synthesis is lacking.

We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Databases were searched from January 2002 to July 2025. Two reviewers independently screened literature, extracted data, and assessed risk of bias using Cochrane Risk of Bias 2.0. Meta-analysis was performed using a random-effects model.

A total of 13 randomized controlled trials were included in this meta-analysis. Exercise therapy significantly relieved pain and improved physical function in elderly patients with KOA (standardized mean difference [SMD] = -0.66, 95% confidence interval (CI): -1.25 to -0.06, I2 = 80%) (after sensitivity analysis). TCM non-pharmacological therapies also yielded significant beneficial effects (SMD = -0.21, 95% CI: -0.54 to 0.12, I2 = 72%), whereas physical therapy modalities showed no statistically significant difference (SMD = -0.16, 95% CI: -0.43 to 0.10, I2 = 65%). High heterogeneity was mainly attributed to diverse outcome measurement scales and intervention intensity, duration, and protocols.

Non-pharmacological interventions effectively relieve pain and improve function in elderly KOA patients. Exercise therapy is the most consistent and reliable intervention.