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

IntroductionKnee 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.MethodsWe 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.ResultA 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.ConclusionThere 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).ConclusionThere 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).