Effects of land-based exercise on knee joint proprioception in individuals with knee osteoarthritis: A systematic review and meta-analysis

Proprioception is significantly impaired in individuals with knee osteoarthritis (OA), which induces impaired functionality and quality of life. Exercise therapy is widely recommended by various guidelines, and land-based exercise is commonly used in previous studies. However, the effects of land-based exercise on proprioception and optimal exercise type remain unclear.

This systematic review and meta-analysis aimed to evaluate the effectiveness of land-based exercise interventions on knee joint proprioception in individuals with knee OA.

A comprehensive search was conducted in PubMed, CINAHL, MEDLINE, Cochrane Library, and EMBASE for randomized controlled trials (RCTs) from inception to June 2024. Methodological quality was assessed using the PEDro scale, and the risk of bias was evaluated using the Cochrane risk-of-bias tool.

Finally, a total of 9 RCTs were included, with a mean PEDro score of 6.11. The pooled data showed that land-based exercise may improve proprioception compared to control interventions (SMD ​= ​−0.82, 95% CI: 1.33, −0.31; p ​= ​0.002), with substantial heterogeneity observed (I² ​= ​84%). However, the subgroup analysis indicated that only mind-body exercise showed statistically significant improvements in proprioceptive outcomes, while functional training and strength exercise did not yield significant effects. Moreover, statistically significant improvements were observed only in position sense measured by the Joint Position Sense (JPS) test, whereas motion sense measured by Threshold to Detect Passive Motion (TTDPM) did not show significant changes.

These findings suggest that land-based exercise, especially mind-body exercises, should be included in proprioceptive training programs for knee OA. However, further research is needed to standardize interventions and reduce heterogeneity to strengthen the evidence.