Impact of therapeutic exercises on pain-related outcomes in patients with knee osteoarthritis: an umbrella review of 116 systematic reviews

Background and objectives Chronic knee pain is highly prevalent in various knee diseases. It significantly decreases patients’ quality of life. Among non-surgical interventions, exercise is considered a promising approach for alleviating chronic knee pain. This umbrella review aimed to systematically synthesize and critically appraise evidence from recent systematic reviews on the effectiveness of therapeutic exercises for knee osteoarthritis across pain, physical function, quality of life, and biomechanical outcomes. Materials and methods We searched for systematic reviews with/without meta-analyses in PubMed, Scopus, and Cochrane Library databases. Results A total of 116 systematic reviews and meta-analyses were included, published predominantly after 2014. Interrater agreement was substantial ( κ = 0.76). Methodological quality was generally low, with 81% of reviews rated low or critically low by AMSTAR-2. Most reviews focused on knee osteoarthritis (72%) and evaluated strength/resistance, aerobic, or mind–body exercises. Pain was the most frequently reported outcome, with improvement noted in 69 reviews, followed by physical function (44 reviews) and quality of life (22 reviews). However, biomechanical outcomes were infrequently assessed and often inconclusive. Across outcomes, positive findings were largely derived from reviews with methodological limitations, warranting cautious interpretation. Thus, the percentages reflect the distribution of reported effects, and the magnitude and reliability of these effects remain limited. Conclusions Therapeutic exercises may help reduce pain, improve physical function and quality of life in patients with knee osteoarthritis. However, the overall certainty of evidence is limited by the variable methodological quality of the included systematic reviews. At present, no single type of therapeutic exercise can be considered the most effective for all individuals with knee osteoarthritis. Systematic Review Registration https://osf.io/pqgrv/overview , doi: 10.17605/OSF.IO/PQGRV.