Knee osteoarthritis rehabilitation: an integrated framework of exercise, nutrition, biomechanics, and physical therapist guidance-a narrative review.

Researchers reviewed the best ways to help people with knee osteoarthritis (KOA), a common joint disease that causes pain, stiffness, and difficulty moving. They looked at four main treatment approaches that work together: exercise therapy (including aerobic exercise, strength training, and balance exercises), which helps reduce pain and improve movement by strengthening muscles around the knee; dietary changes (weight loss and anti-inflammatory foods), which reduce the load on joints and decrease inflammation throughout the body; biomechanical adjustments (like knee braces and walking retraining), which reduce stress on the knee joint; and guidance from physical therapists who create personalized exercise plans, provide hands-on treatment, and educate patients. The review found that while these approaches show promise when combined, many patients don't stick with recommended treatments in real-world settings. Regarding acupuncture specifically, the researchers noted it is commonly used for knee osteoarthritis but currently lacks strong scientific evidence. The studies examining acupuncture have been small, of low quality, and show inconsistent results, meaning more rigorous research is needed to determine its true effectiveness. For patients considering acupuncture as part of their knee osteoarthritis treatment, this suggests it may be worth trying as a complementary approach alongside proven therapies like exercise and weight management, but expectations should be realistic given the limited evidence. The researchers emphasized that future treatments should be personalized to each patient's needs, potentially using new technologies to improve outcomes. If considering acupuncture, seek a licensed, qualified practitioner with experience treating musculoskeletal conditions.

This narrative review synthesizes evidence for an integrated knee osteoarthritis (KOA) rehabilitation framework encompassing exercise therapy (aerobic, resistance, neuromuscular training), dietary interventions (weight management, anti-inflammatory diets), biomechanical optimization (bracing, gait retraining), and physical therapist-guided strategies. While these core components demonstrate synergistic potential for pain reduction and functional improvement through enhanced muscle activation, joint stability, reduced mechanical load, and decreased systemic inflammation, the review identifies significant gaps in clinical implementation and adherence to guideline-recommended therapies. Notably, supplementary treatments including acupuncture are critically evaluated and found to lack robust evidence, characterized by low-quality RCTs, insufficient sample sizes, and inconsistent findings. Clinical takeaway: Practitioners should prioritize evidence-based multimodal interventions (exercise, nutrition, biomechanics) with personalized approaches while recognizing that acupuncture, though commonly utilized, requires further rigorous research before definitive clinical recommendations can be established. Future research directions include machine learning-based personalization and mobile health technologies for real-time monitoring.