See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/346572299

Effectiveness of Physiotherapy Management in Knee Osteoarthritis: A

Systematic Review

Article in Indian Journal of Medical Specialities · November 2020

DOI: 10.4103/INJMS.INJMS_96_20

CITATIONS READS
9 7,323

4 authors, including:

Sharick Shamsi Shabana Khan

Tawazun clinic for physiotherapy and Rehabilitation Prince Sultan Military Medical City
40 PUBLICATIONS 103 CITATIONS 29 PUBLICATIONS 88 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Sharick Shamsi on 02 December 2020.

The user has requested enhancement of the downloaded file.

[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]

Original Article

Effectiveness of Physiotherapy Management in Knee

Osteoarthritis: A Systematic Review
Sharick Shamsi, Abdullah Al‑Shehri, Khaled Othman Al Amoudi, Shabana Khan
Department of Physiotherapy, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia

Abstract
Background: Osteoarthritis is a major cause of musculoskeletal disability. Nonpharmacological and nonsurgical treatment is preferred
for the management of knee osteoarthritis (OA). However, evidences are lacking regarding the effectiveness of multimodal physiotherapy
program including, combination of various physical modalities (TENS, IR, US etc.) with therapeutic exercises, for the management of
knee OA. Objectives: To determine recent research evidences for the effectiveness of combination of physical therapy interventions for
treatment of knee OA patients. Methods: This systematic review mainly includes randomized controlled trails. Searching done by Google
scholar, Pub med and PEDro from 2010 to 2019. We used terms like‑knee pain, OA, TENS, exercise, and physiotherapy management.
Results: Present outcomes shows that physiotherapy treatment is effective technique in reducing pain in patients with Knee OA without
adverse effects. After implementing the inclusion and exclusion criteria, 100 articles were retrieved using the key words, but only 10
articles were selected for the study. Conclusion: Electrotherapy modalities in conjunction with exercise therapy program designed for
treating knee OA patients proved to be more superior to exercise alone at improving quadriceps muscle activation by reducing pain and
increasing function during exercise.

Keywords: Electrotherapy, exercise, knee osteoarthritis, physiotherapy

Introduction and light amplification from stimulated emission of

Knee joint is the most common joint affected by
osteoarthritis (OA) in people older than 60 years. About
10%–20% of this population experience knee pain globally.[1,2]
Around 80% of them experience restriction in movement and
remaining 20% are not able to perform activities of daily
living; certainly, 11% of knee OA patients need assistance in
basic individual care.[3]
Current conventional treatments include nonpharmacological
measures, medication, and surgical procedures. Among
nonpharmacologic interventions, manual therapy is widely
used for musculoskeletal conditions.[4]
Exercises are considered as core nonpharmaceutical therapy
and recommended by International guidelines for treating
patients suffering with OA. Exercises help in improving
function and the overall health of individuals and it is also
safer than drug therapy.[5]
Many electrical modalities like‑transcutaneous electrical
nerve stimulation (TENS), ultrasound (US), infrared (IR),
Access this article online
Quick Response Code:
Website:
www.ijms.in
radiation (LASER) therapy are being used in conjunction
to drug therapy and exercise for improving symptoms
clinically.[6]
Many researchers have shown the effectiveness of these
electrotherapy modalities and exercise therapy separately
in the management of knee OA. Only few of them, have
investigated the combined effect. However, studies that
particularly examined different physiotherapy interventions
such as electrotherapy, exercise, and manual therapy together
are lacking.
Address for correspondence: Dr. Sharick Shamsi,
Department of Physiothrapy, Prince Sultan Military Medical City, Riyadh,
Kingdom of Saudi Arabia.
E‑mail: sharickshamsi@gmail.com
Submitted: 06‑Aug‑2020 Revised: 13-Sep-2020
Accepted: 25-Sep-2020 Published: 06-Nov-2020
This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work non‑commercially, as long
as appropriate credit is given and the new creations are licensed under the identical
terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com

DOI: How to cite this article: Shamsi S, Al-Shehri A, Al Amoudi KO,

10.4103/INJMS.INJMS_96_20 Khan S. Effectiveness of physiotherapy management in knee osteoarthritis:
A systematic review. Indian J Med Spec 2020;4:185-91.

© 2020 Indian Journal of Medical Specialities | Published by Wolters Kluwer ‑ Medknow 185

[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]
Shamsi, et al.: Physiotherapy in Knee OA- A Review
Thus, this review was conceived to determine the treatment
of OA knee by physiotherapists in order to find out if
physiotherapy management approach is consistent with
existing recommendations and guidelines for clinical practice.
Methods
This review study is performed in accordance to
PRISMA‑Preferred Reporting Items for Systematic Reviews
and Meta‑Analyses.[7]
Search strategy
The searching was done in PubMed, Google scholar and
PEDro. Key words like‑ knee pain, exercise, TENS, ultrasound,
knee OA, physiotherapy management, and OA knee combined
with exercise or electrotherapy. We included past 10 years
articles (mainly RCTs‑Randomized controlled trial) published
in English language only from 2010 to 2019. This research was
carried out from February 2020 to June 2020.
The title and abstracts of all articles in the searches were screened
in accordance with the inclusion and exclusion criteria to identify
potentially eligible articles. Full texts of potential articles were
read and assessed independently by the two reviewers.
Inclusions criteria
• Age greater than or equal to 40 years
• Ability to perform physical therapy exercise
• Chronic knee pain ≥3 months
• Studies were published in English language only
• The study patients have no knee surgery history
• Studies which determined effects of electrotherapy and
exercise on Knee OA.
Exclusion criteria
• Studies including patients <40 years
• Patients admitted in hospital or in long‑term center
• Studies with surgical treatments for knee OA and those
who had total knee replacement within 6 months before
the study
• Diseases and surgeries related to lower limb and spine
• Neurological disorders and Cardio vascular problems with
increased heart rate.
Quality assessment
Methodological quality of selected articles was assessed using
PEDro Scale[8] consisting of 11 questions in two aspects.
Criteria 2–9 assess internal validity and criteria 10–11 assess
statistical information required to make a study interpretable.
Scoring of each question is done in accordance to its existence
or nonexistence in the assessed study. The final scoring is done
by the addition of all positive answers.
Studies considered of high quality scoring ≥5 (5/10) as stated
by Moseley et al.[9] Therefore in our review all included studies
scoring ≥5 were found to be of high in methodological quality.
The studies were analyzed in PEDro scale by two independent
investigators.
186 Indian Journal of Medical Specialities ¦ Volume 11 ¦ Issue 4 ¦ October-December 2020
Data analysis
The screening of included articles was done by two independent
investigators. The selected articles were analyzed in an
organized manner including parameters given: author‑year,
study design, subjects‑age, interventions, study duration,
outcome measures, and results. Differences between the
investigators were solved by conversation to reach agreement
and settled using Cohen’s kappa statistics.
Results
Studies identified
After implementing the inclusion and exclusion criteria, 100
articles were retrieved using the key words‑knee pain, OA,
TENS, exercise and physiotherapy management. Sixty‑five
articles were excluded as they were found in more than one
database. For eligibility criteria, 35 articles were screened.
Further 25 articles excluded because either they were not
available in full text, objective not available, they did not meet
exclusion and inclusion criteria or no control group [Figure 1].
Finally, 10 articles were selected by agreement for quality
assessment phase.
Quality assessment of study
Average PEDro score of 10 selected articles was 6.9/10,
as shown in Table 1. This score might be due to various
sources of bias which may affect the result. The commonest
limitations were dearth of concealed allocation and blinding
of patient, therapist, or assessor. Five trials failed to meet
the concealed allocation criterion,[11‑13,16,18] four trials failed
to meet participants blinding criterion,[11,12,14,16] five trials
failed to meet therapist blinding criterion, [10‑12,16,18] five
trials failed to meet assessor blinding criterion,[10‑12,16,18] one
trial failed to meet the randomization criterion[16] and one trial
failed to meet the follow‑up[10] criterion. However, when these
articles were scanned together, strong scientific proof was
found with reliable results showing that the physical therapy
interventions especially TENS and exercise had significant
effect in reducing pain and disability patients suffering from
knee OA.
While assessing risk of bias through the selected articles,
agreement between evaluators for Cohen’s kappa value was
0.85. The details of risk of bias of assessed articles are shown
Table 2. In general, the final assessment for risk of bias
specified that it was low in five articles, high in four articles,
and unclear in the other one article.
General data of the included studies
Selected articles in this review are summarized in Table 3
including given parameters: author‑year, study design,
subjects‑age, interventions, study duration, outcome
measures, and results. Out of the 10 studies included, eight
were RCTs, [10,11,13‑15,17‑19] one was experimental design [12]
and one was Quasi experimental design [16] study. All
studies were conducted between 2010 and 2019. Number
of participants in the studies ranged from 15 to 130, while
[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]

Shamsi, et al.: Physiotherapy in Knee OA- A Review

Identification Articles searched through electronic

database searching (n = 100)
PubMed-50
PEDro-20
Google Scholar - 30

Articles excluded due to duplicity

(n = 65)

Screening

Articles assessed Articles excluded due to

(n = 35) absence inclusion exclusion
criteria
(n = 10)

Eligibility

Article excluded due to-

Full-text articles assessed full-text not available (n = 10),
for eligibility (n = 25) no control group (n = 02),
objective not related
to the review (03)

Included

Articles included in
qualitative assessment
(n =10)

Figure 1: Flow diagram showing the screening and selection of articles

the age ranged from 40 to 80 years. Three studies did not
mention the range and two studies did not report age.
All articles were experimental, with 9 studies including
pre‑interventional (baseline) and postinterventional
assessments and 1 study with long‑term treatment
evaluation (1 month, 3 months and 1 year follow‑up).
Concerning the efficacy of results established in most of
the articles, both physiotherapy modalities and exercises
were found to be significantly effective on pain and function
between pre‑ and post‑intervention assessments.
Outcome measures
The main outcome measures are physical function and muscle
strength evaluated by stair climb test, Timed Up and Go test,
6 meter walk test, locomotive syndrome risk test, 4 m walk
distance, Oxford grading Scale, Knee injury and Osteoarthritis
outcome Score questionnaire, Western Ontario and McMaster
Universities Osteoarthritis Index (WOMAC), Disability
Index Questionnaire and Patient Assessment Scale (PAS and
DIQ) score. Pain was assessed with the help of pressure pain
threshold, numeric pain rating scale (NPR) and visual analog
scale (VAS).[20]
Discussion
The present systematic review was done to examine the
effectiveness of physical therapy interventions in decreasing
pain, increasing functional level and improving quality
of life in patients with knee OA. Evidences from RCTs
and quasi‑experimental designs were used to examine the
effectiveness of core physiotherapy interventions in knee OA.
In this review, 10 studies were evaluated including eight RCTs,
one quasi experimental and one experimental study. In the
present review, all articles were assessed according to PEDro
scale[8] and proved to be high in methodological quality. Our
findings are consistent with guidelines[21‑23] and systematic
reviews[4,24,25] about basic physical therapy management,
published previously. The analysis indicated that physical
therapy modalities along with exercises under supervision are
frequently involved in clinic‑based physiotherapy management
for persons suffering from knee OA.
In this review, 6 studies[10‑12,15‑17] revealed TENS interventions,
with or without therapeutic exercise were effective in decreasing
pain and improving function in knee OA patients. TENS alone[10]

Indian Journal of Medical Specialities ¦ Volume 11 ¦ Issue 4 ¦ October-December 2020 187

[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]

Shamsi, et al.: Physiotherapy in Knee OA- A Review

is proved to be beneficial and effective in managing pain at rest

Cumulative score
(maximum=10)
as well as while performing functional activities irrespective
of the frequency used as stated by Mukesh yadav.[12] However,

10/10

10/10
10/10
10/10
9/10
5/10

6/10
5/10
5/10
9/10

6.9
when TENS applied in conjunction with exercise,[11,15,17] TENS
after exercise was proved to be more effective in increasing
function and reducing disability in knee OA patients.[16]
One study showed combination of strengthening exercise and
Kirthika
et al.[19]

IR radiation along with analgesics was superior to analgesics

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
10
alone in decreasing pain, improving muscle strength and
function in knee OA patients.[13] According to RCT conducted
with 1 year follow‑up in knee OA patients showed significant
et al.[18]
Ahmad

improvement in pain and function in group receiving exercise

Yes

Yes
Yes

Yes
Yes
Yes
Yes
No

No
No

7
along with nonsteroidal anti‑inflammatory drugs, acupuncture
and physiotherapy modalities like TENS, US and IR when
compared nonexercise group.[14]
Pietrosimone
et al.[17]

Concerning the evaluated outcome measures, using reliable

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
10

and valid tools in the articles reinforces their quality. The

WOMAC and VAS scales were most reliable and valid
instruments commonly used for assessing pain and function
in knee OA patients.
et al.[16]
Bello

Yes

Yes
Yes
Yes
Yes
No
No

No
No
No

The diagnosis of knee OAwas done on the basis of criteria described

by American college of Rheumatology in 6 articles.[13‑15,17‑19]
In this criterion, clinical and radiographic assessment of knee
Table 1: Methodological classification assessed by physiotherapy evidence database ro scale

et al.[15]
Akodu

OA is according to Kellgren and Lawrence Scale having I

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
10

to IV grades. Radiographic imaging criteria was used in 2

articles,[10,11] Altman clinical criteria in 1 article[12] and no
report about the diagnostic criteria was mentioned in remaining
et al.[14]
Parisa

1 article.[16] OA knee is most widely diagnosed using these

Yes
Yes
Yes

Yes
Yes
Yes
Yes
Yes
Yes
No

criteria in observational and clinic‑based research articles. Five

articles out of 10 selected, mentioned about the degree (grades)
of OA in the knee joint in their sample.[14,15,17‑19]
et al.[13]
Ebere

Yes

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No

Regarding prior sample size calculation, only three articles

have described about sampling method to decide minimum
number of participants essential in each group for acceptable
Mukesh
et al.[12]

results.[10,13,18] Although the methods and interventions utilized

Yes

Yes

Yes
Yes
Yes
Yes
No

No
No
No

in these articles varied widely, the outcome measures improved

significantly in most of these articles after application of
electrotherapy modalities with or without therapeutic exercises.
et al.[11]
Pradip

The duration and the type of the exercise protocol used in our
Yes

Yes

Yes
Yes
Yes
Yes
No

No
No
No

review also varied considerably. The duration of interventions

recorded from immediate effect to 12 months involving various
Shimoura

treatment interventions like TENS, IR, US, while most of them

et al.[10]
Yes
Yes
Yes
Yes

Yes
Yes
Yes
No
No
No

used exercise protocol including several types of exercises such

7

as isometric and isotonic strengthening exercises for quadriceps

and hamstrings, pilates, stretching, balance and proprioception
Point and variability measures?

exercise, range of motion, and resistance exercise. Most of

high‑quality articles involved combining of electrotherapy and
Intention‑to‑treat analysis?
Baseline comparability?

exercise therapy with consistent positive outcomes.[11‑18]

Concealed allocation?

Group comparisons?
Random allocation?

Blind participants?

The validity of this review can be considered low due to

Cumulative score
Blind assessors?
Blind therapists

the variability in design, structure and selection of outcome

Follow‑up?

measures in the selected articles. Such as, the total length

Criteria

intervention varies from immediate effects to 12 months as two

studies showed immediate effect of physiotherapy treatment

188 Indian Journal of Medical Specialities ¦ Volume 11 ¦ Issue 4 ¦ October-December 2020

[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]

Shamsi, et al.: Physiotherapy in Knee OA- A Review

Table 2: Risk of bias of included studies

Citations Adequate sequence Allocation Blinding? Incomplete Outcome Free of selective Conclusions
generation? concealment? Data addressed? reporting?
Shimoura et al.[10] Yes Yes Yes Yes Yes Low risk of bias
Pradip et al.[11] Unclear No No Yes Yes High risk of bias
Mukesh et al.[12] No No No Yes Yes High risk of bias
Ebere et al.[13] No No Yes Yes Yes High risk of bias
Parisa et al.[14] Yes Yes Yes Yes Yes Low risk of bias
Akodu et al.[15] Yes Yes Yes Yes Yes Low risk of bias
Bello et al.[16] No No No Yes Yes High risk of bias
Pietrosimone et al.[17] Yes Yes Yes Yes Yes Low risk of bias
Ahmad et al.[18] Unclear Unclear Yes Yes Yes Unclear risk of bias
Kirthika et al.[19] Yes Yes Yes Yes Yes Low risk of bias

Table 3: Description of the included studies

Author/year Study design Subject/age Interventions Study duration Outcome measures Result
Shimoura RCT with pre n=50 Experimental group: One time Study VAS was used to Significant immediate
et al.[10] post design Male=15 TENS measure knee pain (stair improvement in TENS
Female=35 Placebo group: climb test, TUG test, group in terms of walk
sham‑TENS and 6MW test).JKOM distance and VAS score
50‑69 years
used for measuring knee of 6MW test compared to
pain and disability sham ‑TENS group
Pradip RCT with pre n=30 Group A: Balancing 4 weeks Outcome measures were Statistically significant
et al.[11] post design 50‑65 years exercise + TENS (4 days per VAS‑ used to measure improvement was more
Gender not Group B: Strengthening week) intensity of knee pain in Group A compared to
reported exercise + TENS and WOMAC‑used Group B after 4 weeks of
for pain, stiffness and treatment. Both groups
functional ability. showed significant
reduction in WOMAC and
VAS score.
Mukesh Experimental n=45 Group 1:HF TENS + 2 weeks PPT and NPRS used Both HF and LF TENS
et al.[12] design with Male=26 strengthening for pain measurement, produced significant
randomized Female=19 Group 2:LF TENS + TUG and WOMAC improvement in PPT and
sampling strengthening were evaluated to functional abilities as
50‑80 years
Group 3:Placebo TENS measure functional measured by WOMAC and
+ strengthening abilities. TUG compared to Placebo
group. No significant
difference between the
effect of HF and LF TENS
Ebere RCT n=130 Group 1:Quariceps 7 weeks (3 Knee pain, function and Statistically significant
et al.[13] Male=43 strengthening + IR + times a week) strength were measured reduction in the knee pain
Female=87 oral diclofenac sodium using Numerical Pain and 30.4m walk‑time was
Group 2:Quadriceps Scale, 30.4metres walk seen in all 3 groups. But
45‑68 years
strengthening + IR distance and Oxford significant improvement
Group 3:Oral diclofenac grading Scale. in quadriceps strength was
sodium found only in groups 1
and 2
Group 4:Control/
placebo
Parisa RCT n=56 Exercise group: 5 weeks twice Pain and functional Exercise group showed
et al.[14] ˃50 years Exercise + NSAIDs per week with 1 status were evaluated significant improvement
Gender not + acupuncture year follow‑up by VAS , KOOS in pain, function and
reported + physiotherapy questionnaire and 4 disability as compared
modalities. steps, 5 sit up, and 6 to non‑exercise group.
Non‑exercise group: min walk test At 1 year follow up there
Similar treatments was significant difference
except between groups in VAS and
exercise program in KOOS questionnairein
functional status

Contd....

Indian Journal of Medical Specialities ¦ Volume 11 ¦ Issue 4 ¦ October-December 2020 189

[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]

Shamsi, et al.: Physiotherapy in Knee OA- A Review

Table 3: Contd...
Author/year Study design Subject/age Interventions Study duration Outcome measures Result
Akodu RCT n=33 Group A: Pilates 8 weeks (Twice Pain, functional Both groups showed
et al.[15] Gender, age exercises + TENS daily) disability and ROM significant decrease in
not reported Group B: Isometric were measured using pain, function, disability
exercise + TENS, VAS scores, WOMAC and ROM in patients with
Group C: Lifestyle scores and Goniometer knee OA
modification+TENS
Bello et al.[16] Quasi‑ n=15 Group A: TENS before 8 weeks (Thrice Numerical rating scale TAE showed less
experimental Male=4 exercise (TBE) Group weekly) for pain, goniometer for significant than TBE on
design Female=11 B: TENS after exercise ROM. The participants DIQ and PAS. However,
(TAE) also rated their activity both groups did not
40‑71 years
and disability levels significantly differ on
with respect to the knee the selected impairment
functions on PAS and measures.
the DIQ respectively
Pietrosimone RCT n=36 Group A: 4 weeks Quadriceps CAR and Quadriceps CAR showed
et al.[17] Male=15 TENS+exercise MVIC used to assess significant improvement in
Female=21 Group B: Placebo knee strength TENS and exercise group
TENS + exercise The WOMAC score in comparison with placebo
Age not
Group C: Exercise was used to assess and exercise group and
reported
alone dysfunction, pain, and exercise group only. No
stiffness significant improvement
noted in WOMAC scores
in all 3 groups
Ahmad Randomized n=30 Intervention group: 3 weeks (5 Knee instability Both (balance exercises
et al.[18] Clinical trial Both Male/ Balance exercise times per week) measured by group and control
Female Control group: self‑reported WOMAC group) groups improved
include but F Strengthening exercise questioner. VAS score significantly in pain and
in majority + TENS + US was used to measure knee instability mean
46‑72 years pain intensity scores during inter and
intra group comparison
Kirthika RCT n=40 Treatment group: 3 months (5 Pain was measured Both the groups showed a
et al.[19] Female=40 Group A: Conventional times per week) by using VAS score. Significant improvement
˃50 years treatment WOMAC Index in VAS and WOMAC
Group B: Conventional used for pre and score, but proprioceptive
treatment + postintervention exercises were more
proprioceptive exercises effective than conventional
treatment
RCT: Randomized controlled trial, JKOM: Japanese knee OA measure, WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index,
VAS: Visual analog Scale, DIQ: Disability Index Questionnaire, PAS: Patient Assessment Scale, OA: Osteoarthritis, KOOS: Knee injury and Osteoarthritis
outcome Score, ^MW: 6 meter walk, PAS: Patient Assessment Scale, TAE: TENS after exercise, TBE: TENS before exercise

and only one study investigated adherence and compliance for
exercise with 1 year follow‑up after treatment.[13] The size of
the sample also had a wide range, from 15 subjects[16] to 130
subjects[13] in this review articles.
Our concentration was focused on treatment protocols related
to physical therapy practice, but we did not consider that losing
weight might be beneficial in obese individuals having knee
OA, which is related with decreasing self‑reported disability
significantly.[10,14,19] In addition, majority of patients in this
review were females (F = 209, M = 103), so we recommend
that males and females to be included equally in future studies.
For the adherence and compliance of treatment protocol,
further reviews on the effect of motivation and supervision
by therapist with a longer follow‑up period is recommended.
Conclusion
We conclude that electrotherapy and therapeutic exercise
program designed for knee OA treatment can be more effective
at increasing quadriceps muscle activation by reducing pain
during exercise. In addition, knee OA patients can improve
self‑reported function with exercises including strength and
balance training, either with or without electrotherapy.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Goh SL, Persson MSM, Stocks J, Hou Y, Lin J, Hall MC, et al.
Efficacy and potential determinants of exercise therapy in knee and hip
osteoarthritis: A systematic review and meta‑analysis. Ann Phys Rehabil
Med 2019;62:356‑65.
2. Abdullah SB, Nezar AT, Shabana K, Sharick S. Efficacy of physiotherapy
exercises after elective total knee arthroplasty. J Adv Scholar Res Allied
Educ 2019;16:6:785‑792.
3. Abolhasani M, Halabchi F, Afsharnia E, Moradi V, Ingle L, Shariat A,
et al. Effects of kinesiotaping on knee osteoarthritis: A literature review.

190 Indian Journal of Medical Specialities ¦ Volume 11 ¦ Issue 4 ¦ October-December 2020

[Downloaded free from http://www.ijms.in on Wednesday, December 2, 2020, IP: 10.232.74.23]
Shamsi, et al.: Physiotherapy in Knee OA- A Review
J Exerc Rehabil 2019;15:498‑503.
4. Xu Q, Chen B, Wang Y, Wang X, Han D, Ding D, et al. The effectiveness
of manual therapy for relieving pain, stiffness, and dysfunction in knee
osteoarthritis: A systematic review and meta‑analysis. Pain Physician
2017;20:229‑43.
5. Shahnawaz A, Ag A, Jean MB. Effect of home exercise program in
patients with knee osteoarthritis: A systematic review and meta‑analysis.
JPT 2016;39:38‑48.
6. Win MO, Myat TB. Efficacy of physical modalities in knee osteoarthritis:
Recent recommendations. Int J Phys Med Rehabil 2016;4:1‑2.
7. David M, Alessandro L, Jennifer T, Douglas GA, PRISMA Group.
Reprint preferred reporting items for systematic reviews and
meta‑analyses: The PRISMA statement. Phys Ther 2009:89:9:873‑80.
8. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M.
Reliability of the PEDro scale for rating quality of randomized
controlled trials. Phys Ther 2003;83:713‑21.
9. Moseley AM, Herbert RD, Sherrington C, Maher CG. Evidence for
physiotherapy practice: A survey of the Physiotherapy Evidence
Database (PEDro). Aust J Physiother 2002;48:43‑9.
10. Ornetti P, Dougados M, Paternotte S, Logeart I, Gossec L. Validation
of a numerical rating scale to assess functional impairment in hip and
knee osteoarthritis: Comparison with the WOMAC function scale. Ann
Rheum Dis 2011;70:740‑6.
11. Shimoura K, Iijima H, Suzuki Y, Aoyama T. Immediate effects of
transcutaneous electrical nerve stimulation on pain and physical
performance in Individuals with Preradiographic Knee Osteoarthritis:
A Randomized Controlled Trial. Arch Phys Med Rehabil
2019;100:300‑60.
12. Pradip KG, Debkumar R, Biplab C, Sankhadeb A, Adhikary S,
Anindita De. Comparative study of the effectiveness between balancing
exercises and strengthening exercises with common use of TENS to
improve functional ability in Osteoarthritis involving knee joint. IAIM
2015;2:10:1‑17.
13. Mukesh Y, Pooja A, Shalu K. High or low frequency tens in patients
with knee osteoarthritis‑  What works better? Int J Physiother Res
2017;5:4:2203‑8.
14. Ebere YI, Chima CI, Egwuonwn AV. Okonkwo uchenna prosper,
comparative efficacy of quadriceps strengthening, infrared radiation
therapy and oral Diclofenac sodium in the management of symptomatic
osteoarthritis of the knee. J Health Sci 2018;1:12‑8.
15. Parisa N, Azizeh F, Maziar ML. The effect of exercise therapy on knee
Indian Journal of Medical Specialities ¦ Volume 11 ¦ Issue 4 ¦ October-December 2020
View publication stats
osteoarthritis: A randomized clinical trial. MJIRI 2015;29:1‑9.
16. Akodu AK, Fapojuwo OA, Quadri AA. Comparative effects of pilates
and isometric exercises on pain, functional disability and range of motion
in patients with knee osteoarthritis. Res J Health Sci 2017;5:94‑103.
17. Ajediran B, Shirley C, Adegoke BO. Comparative treatment outcomes
of pre and post‑exercise TENS application on Knee osteoarthritis:
A preliminary Report. Rehabil Process Outcome 2014;3:1‑5.
18. Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC,
Ingersoll CD. Effects of transcutaneous electrical nerve stimulation and
therapeutic exercise on quadriceps activation in people with tibiofemoral
osteoarthritis. J Orthop Sports Phys Ther 2011;41:4‑12.
19. Ahmad RA, Narges JA, Mehdi M, Salman N. The Effect of Balance
Exercises on Knee Instability and Pain Intensity in Patients with Knee
Osteoarthritis: A Randomized Clinical Trial. J Res Med Dent Sci
2018;6:74‑82.
20. Kirthika V, Sudhakar S, Padmanabhan K, Ramachandran S, Kumar M.
Efficacy of combined proprioceptive exercises and conventional
physiotherapy in patients with knee osteoarthritis: A double‑blinded
two‑group pretest–posttest design. J Orthop Traumatol Rehabil
2018;10:94‑7.
21. American Academy of Orthopaedic Surgeons. Treatment of
Osteoarthritis of the Knee (Non-arthroplasty). Rosemont, IL: American
Acad Orthopaedic Surgeons; 2013. Accessed at - https://www.
guidelinecentral.com/summaries/american-academy-of-orthopaedic-
surgeons-clinical-practice-guideline-on-treatment-of-osteoarthritis-of-
the-knee-2nd-edition/#section-date. [Last accessed on 2013 May 18].
22. Richmond J, Hunter D, Irrgang J, Jones MH, Snyder‑Mackler L,
Van Durme D, et al. American Academy of Orthopaedic Surgeons
clinical practice guideline on the treatment of osteoarthritis (OA) of the
knee. J Bone Joint Surg Am 2010;92:990‑3.
23. Recommendations for the medical management of osteoarthritis of
the hip and knee: 2000 update. American College of Rheumatology
Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum
2000;43:1905‑15.
24. Chi Z, Yujie X, Xiaotian L, Qiaodan J, Chunlan L, Chengqi H, et al.
Effects of therapeutic ultrasound on pain, physical functions and safety
outcomes in patients with knee osteoarthritis: A systematic review and
meta‑analysis. Clin Rehabil 2015;30:960‑71.
25. Rutjes AW, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M,
et al. Transcutaneous electrostimulation for osteoarthritis of the knee.
Cochrane Database Syst Rev 2009;7:1‑68.
191