Effects of neuromuscular training on pain intensity, functionality, and quality of life in people with knee osteoarthritis: Systematic review with moderator analysis.

Abstract

To determine the effects of neuromuscular training (NMT) on improvements in disability/functionality, pain intensity, quality of life, and balance in patients with knee osteoarthritis (OA), and to determine the dose-response association between NMT dose (total minutes of NMT) and improvements in variables of interest in patients with knee OA. This systematic review and meta-analysis included a search of MEDLINE, Web of Science, CINAHL, SCOPUS, and Embase for randomized controlled trials of NMT in patients with knee OA on pain intensity, disability/functionality, and quality of life from baseline to June 25, 2025. A random-effects meta-analysis was applied, and the dose-response relationship was analyzed through regression coefficients. Ten randomized controlled trials were included. The meta-analysis showed that there are no significant differences in disability/functionality, pain intensity, and quality of life between NMT and other therapies. A minimum dose of 878 and 501 total minutes of NMT was estimated to be necessary to achieve a very large effect size (standardized mean difference ≥2) for improving disability/functionality and pain intensity, respectively. These findings indicate that NMT is as effective as other therapies in improving disability/functionality, pain intensity, and quality of life in people with knee OA. Furthermore, the findings may be useful for optimizing the dose of NMT to obtain large clinical effects on the health of people with knee OA. Further experimental studies applying NMT are required to deepen and strengthen the results obtained in our research.