Simple Therapies Outperform Drugs in Major Analysis of 10,000 Knee Arthritis Patients

A network meta-analysis published June 18, 2025, in PLOS One examined nearly 10,000 knee osteoarthritis patients across 139 clinical trials worldwide. Researchers led by Yuan Luo of the First People’s Hospital of Neijiang, China, found that simple therapies such as knee braces, water-based therapy, and exercise were more effective than drug treatments in reducing pain and improving function.

The analysis ranked knee braces, water-based therapy, and exercise as the most effective non-drug treatments for knee osteoarthritis, outperforming more complex interventions such as ultrasound and laser therapy, according to the study published June 18, 2025, in PLOS One. They compared 12 different non-pharmacological therapies using a statistical method known as the surface under the cumulative ranking curve (SUCRA) to assign effectiveness scores across pain, physical function, and stiffness outcomes.

Researchers led by Yuan Luo of the First People’s Hospital of Neijiang, China, evaluated 139 randomized clinical trials involving nearly 10,000 participants worldwide.

Knee braces consistently ranked highest across all measured domains, demonstrating significant improvements in pain relief, mobility, and stiffness reduction, the study found. Water-based therapy, also referred to as hydrotherapy or aquatic therapy, showed substantial benefits in reducing pain and enhancing physical function. Exercise was similarly effective, particularly for pain relief and overall mobility improvement. These three therapies were identified as the most effective options for managing symptoms of knee osteoarthritis without the risks associated with medications, according to Luo and colleagues.

The analysis also highlighted that exercise and high-intensity laser therapy performed well specifically for pain relief outcomes, though laser therapy did not surpass the simpler interventions overall. Physical therapy, encompassing various exercise and mechanical treatments, showed promising effects on knee osteoarthritis symptoms, the researchers reported. However, some variability existed in treatment effectiveness depending on the specific outcome measured, such as pain versus stiffness.

Non-drug therapies offer a safety advantage by avoiding gastrointestinal and cardiovascular risks commonly linked to anti-inflammatory medications like nonsteroidal anti-inflammatory drugs (NSAIDs), the study noted. Chronic use of these medications carries increased health concerns, prompting interest in safer alternatives. Physical and mechanical therapies, including knee braces and hydrotherapy, provide treatment options without the adverse events associated with drug therapies, according to the research team.

Cost and accessibility were additional factors favoring simple therapies. Knee braces, water-based exercise, and general exercise represent straightforward and affordable treatments that could reshape clinical guidelines toward safer, more cost-effective approaches. High-tech options such as ultrasound and laser therapy, despite their complexity and higher costs, were less effective than these basic interventions, the analysis showed. The authors recommended that future studies assess the cost-effectiveness of these non-pharmacological therapies to guide healthcare decision-making.

Clinical guidelines already recommend knee braces as a non-invasive, effective treatment for knee osteoarthritis, Luo’s team pointed out. Some evidence suggests aquatic therapy may outperform land-based exercise in pain relief, while combining multiple therapies could further optimize patient outcomes. The researchers concluded that physical therapy offers potential treatment benefits without the risks associated with anti-inflammatory drugs.

The study’s limitations include variability in study design, small sample sizes in some trials, and differences in treatment duration across the 139 included clinical trials, which may affect the precision of the rankings, the authors acknowledged. They called for future research to evaluate the clinical efficacy of combined therapies and to compare the cost-effectiveness of various treatment approaches to better inform clinical practice.

Knee osteoarthritis is a common degenerative joint disease causing pain, stiffness, and reduced mobility. Standard treatment often includes pain-relieving medications alongside physical interventions. The findings from this large-scale network meta-analysis provide evidence to support the prioritization of simple, non-drug therapies in managing knee osteoarthritis symptoms.