Comparative efficacy of mind-body exercise for pain, function, quality of life in knee osteoarthritis: a systematic review and network meta-analysis

Abstract

Introduction: Knee osteoarthritis (KOA) is a prevalent chronic joint disease. Due to the risks of opioid use and limited pharmacological effectiveness, mind-body exercise (MBE) therapy and other non-pharmacological interventions have emerged as first-line treatments for this condition. However, the optimal MBE modes for KOA remain undetermined. This systematic review and network meta-analysis (NMA) aims to compare the efficacy of different MBE modes, including Pilates, Tai Chi, Yoga, and Qigong, in managing KOA.

Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Database from inception to 25 April 2024. Randomized clinical trials comparing MBE interventions for pain, physical function and quality of life (QoL) in KOA patients were eligible. The Cochrane Risk-of-Bias Tool 2.0 and Grading of Recommendations, Assessment, Development & Evaluation (GRADE) approach were used to assess literature quality and evidence certainty for each outcome.

Result: A total of 38 studies (N = 2561) were included, with 38 for pain, 36 for physical function, and 12 for QoL in the NMA. With moderate-certainty, both Pilates and TC showed significant improvements in pain reduction [Pilates: standardized mean difference (SMD) = - 1.19, 95% confidence intervals (95% CI): - 1.92 to - 0.46; TC: SMD = - 0.78, 95% CI - 0.97 to - 0.59] and physical function (Pilates: SMD = - 1.37, 95% CI - 2.13 to - 0.50; TC: SMD = - 0.85, 95% CI - 1.08 to - 0.63) compared to the usual care group, while TC [SMD = - 0.57, 95% CI = (- 1.07 to - 0.06)] showed statistically significant efficacy in improving QoL compared to the usual care group.

Conclusion: There is moderate-certainty evidence that Pilates and Tai Chi may be the most effective mind-body exercises for improving pain and physical function in knee osteoarthritis, while Tai Chi may be the best for improving quality of life. These findings may help clinicians guide their prescription of exercise types with respect to treatment outcomes. The limited number of large sample studies and the few studies with low bias risk are limitations. Trial registration The protocol for NMA has been registered with PROSPERO (CRD42024531878).

Keywords: Knee osteoarthritis; Mind–body exercises; Network meta-analysis; Systematic review.

Fig. 1

PRISMA flow diagram of the search process for studies examining the efficacy of mind–body exercise in patients with KOA

Fig. 2

Network of evidence of pain intensity and the size of the nodes relates to the number of participants in that intervention type and the thickness of lines between interventions relates to the number of studies for that comparison

Fig. 3

The rank probability of pain intensity various interventions based on the SUCRA. The SUCRA metric was used to rank the effectiveness of each treatment and identify the best treatment

Fig. 4

Network of evidence of physical function and the size of the nodes relates to the number of participants in that intervention type and the thickness of lines between interventions relates to the number of studies for that comparison

Fig. 5

The rank probability of physical function various interventions based on the SUCRA. The SUCRA metric was used to rank the effectiveness of each treatment and identify the best treatment

Fig. 6

Network of evidence of QoL and the size of the nodes relates to the number of participants in that intervention type and the thickness of lines between interventions relates to the number of studies for that comparison

Fig. 7

The rank probability of QoL various interventions based on the SUCRA. The SUCRA metric was used to rank the effectiveness of each treatment and identify the best treatment

Fig. 8

Risk of bias for included studies (pain intensity)

Fig. 9

Pain intensity: comparison-adjusted funnel plot showing the publication bias of the included randomized controlled trials. The red line represents the null hypothesis that independent effect size estimates do not differ from the comparison-specific pooled estimates. A Pilates, B Tai Chi, C Yoga, D Qigong, E control group (conventional therapeutic exercises), F control group (usual care), G control group (no treatment)

Fig. 10

Physical function: comparison-adjusted funnel plot showing the publication bias of the included randomized controlled trials. The red line represents the null hypothesis that independent effect size estimates do not differ from the comparison-specific pooled estimates. A Pilates, B Tai Chi, C Yoga, D Qigong, E control group (conventional therapeutic exercises), F control group (usual care), G control group (no treatment)

Fig. 11

QoL: comparison-adjusted funnel plot showing the publication bias of the included randomized controlled trials. The red line represents the null hypothesis that independent effect size estimates do not differ from the comparison-specific pooled estimates. A Pilates, B Tai Chi, C Yoga, D Qigong, E control group (usual care), F control group (no treatment)