Rehabilitation efficacy of neuromuscular training for individuals suffering from knee osteoarthritis: a systematic review and meta-analysis based on randomized controlled trials
TL;DR
NMT may partially alleviate comprehensive symptoms, facilitate activities of daily living, and enhance knee-related QoL in patients with KOA, whereas consistent benefits were not demonstrated for KOOS Pain, sport and recreational function, or most objective functional outcomes.
Abstract
This study aimed to comprehensively assess the efficacy of neuromuscular training (NMT) in function, symptoms, quality of life (QoL), pain, and safety in individuals with knee osteoarthritis (KOA), thereby providing evidence-based support for rehabilitation strategies in KOA management. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception to August 30, 2025. Randomized controlled trials (RCTs) assessing NMT for KOA were included. For multiple reports originating from the same underlying randomized trial, a trial family was established based on trial registration number, randomized sample size, baseline characteristics, intervention protocols, and follow-up duration to avoid duplicate counting. A random-effects model was applied for meta-analysis, and sensitivity analysis, publication bias assessment, prespecified subgroup analyses, and tests for subgroup interactions were performed. The certainty of evidence for primary outcomes and adverse events was evaluated using the approach proposed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group. A total of 17 study reports were included, corresponding to 14 independent RCTs with 1,029 participants, of whom 516 were in the NMT group and 513 in the control group. Compared with control interventions, NMT significantly alleviated KOOS Symptoms (MD = 4.44, 95% CI : 1.62, 7.26, P = 0.002), KOOS ADLs (MD = 3.94, 95% CI : 0.09, 7.79, P = 0.04), and KOOS QoL (MD = 5.59, 95% CI : 0.97, 10.21, P = 0.02). The between-group differences for KOOS Pain (MD = 1.95, 95% CI : -0.27, 4.17, P = 0.08) and KOOS Sport/Rec (MD = 1.64, 95% CI -2.24, 5.53, P = 0.41) did not reach statistical significance. The meta-analysis of adverse events showed no statistically significant difference in the incidence of adverse events between the NMT and control groups (RR = 0.83, 95% CI : 0.50, 1.37, P = 0.46). Nevertheless, given the heterogeneity across studies in the definitions, monitoring, and reporting of adverse events, this result should not be interpreted as evidence of equivalent safety between the interventions. The subgroup analyses suggested differences in certain specific subgroups. Most subgroup interaction tests were not statistically significant; however, a significant interaction was observed for mean age in the KOOS QoL analysis ( P for interaction = 0.02), which should be interpreted cautiously given the limited number of studies. NMT may partially alleviate comprehensive symptoms, facilitate activities of daily living, and enhance knee-related QoL in patients with KOA, whereas consistent benefits were not demonstrated for KOOS Pain, sport and recreational function, or most objective functional outcomes. No statistically significant difference in reported adverse events was observed; however, heterogeneity in adverse-event definitions and reporting limits conclusions regarding comparative safety. Additional well-designed RCTs with standardized NMT protocols, adequate sample sizes, and longer follow-up are needed to confirm the magnitude and clinical relevance of these effects. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251118258 , identifier CRD420251118258.