Effect of traditional Chinese exercises on knee osteoarthritis: A network meta-analysis

Background Osteoarthritis is the third leading risk factor for disability in older adults. Objective To compare the efficacy of different traditional Chinese exercises on knee osteoarthritis by network meta-analysis, and to provide a reference basis for patients to choose the best method. Methods Seven databases, including Pubmed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and China Science and Technology Journal Database were searched for literature on traditional Chinese exercise to improve the symptoms of patients with knee osteoarthritis. The search period was from inception of the database until February 14, 2024. Literature screening and data extraction were carried out independently by 2 investigators, and the quality of the included studies was evaluated using the Cochrane Risk of Bias 2.0 assessment tool. R4.2.3 and Stata 15.0 were used for analysis. Results Forty-two studies involving 2843 patients were ultimately included, encompassing 4 kinds of traditional Chinese exercise. The surface under the cumulative ranking curve (SUCRA) showed that Baduanjin was the best traditional Chinese exercises for Western Ontario and McMaster University Osteoarthritis Index scores including pain score (SUCRA = 0.85), stiffness score (SUCRA = 0.87), physical function score (SUCRA = 0.88) and overall score (SUCRA = 0.83). For Visual Analog Scale pain score, the most effective traditional Chinese exercise was Tai Chi (SUCRA = 0.93). Conclusion The efficacy of Tai Chi, Baduanjin, Yijinjing, and Wuqinxi on knee osteoarthritis patients is superior to that of usual care. Baduanjin had the best effect in improving stiffness, physical function and overall score, and both Baduanjin and Tai Chi were the best options for improving pain.