Supervised or Home-Based? Exploring the Best Exercise Approach for Knee Osteoarthritis Management: A Systematic Review and Meta-Analysis

Abstract

Background/Objective: Knee osteoarthritis (OA) is a common and debilitating condition affecting older adults, often progressing to advanced stages and requiring total joint replacement. Exercise therapy is widely recognized as the first-line approach for the prevention and initial management of OA. This systematic review assessed the effectiveness of home-based exercises (HBEs) compared to supervised exercises in alleviating pain and reducing disability among patients with knee OA. Methods: A systematic search of PubMed, Cochrane Library, and ScienceDirect identified randomized controlled trials (RCTs) published between January 2001 and October 2024. Methodological quality was evaluated using the Physiotherapy Evidence Database (PEDro) scale, and a meta-analysis was conducted to quantify the efficacy of these interventions. Results: Ten RCTs involving 917 patients were included, ranging in moderate to high methodological quality (PEDro score: 6.3 +/- 1.2). Intervention durations ranged from 4 to 12 weeks. Both supervised and HBEs were found to be effective, but supervised exercises demonstrated statistically significant improvements in pain (SMD = -0.45 [95% CI -0.79; -0.11], p = 0.015) and disability (SMD = -0.28 [95% CI -0.42; -0.14], p < 0.001) compared to HBEs. Conclusions: Despite the superiority of supervised exercises over HBEs, considering the cost-effectiveness and ease of implementation of HBEs, we developed recommendations to create a hybrid rehabilitation program that combines both approaches to maximize clinical outcomes.