Comparative effectiveness of advanced multimodal therapy versus conventional physiotherapy in early-stage knee osteoarthritis: a randomised controlled trial

Abstract

Background: Knee osteoarthritis (KOA) is one of leading causes of pain, disability, and reduced functional independence among middle-aged and older adults worldwide. Early-stage KOA presents an important opportunity for conservative intervention to alleviate symptoms, improve physical function, and potentially delay disease progression. To compare effectiveness of an advanced multimodal physiotherapy (APT) program with conventional physiotherapy (CPT) in reducing pain and improving functional outcomes in patients with early-stage KOA.

Methods: This study was conducted among 97 diagnosed with KL Grade I or II KOA. Participants were randomly allocated to APT (n=63) and CPT group (n=34). APT integrates Laser Therapy, PEMF, SIS, Magneto therapy, whereas in CPT comprising of NMES, US, and TENS, along with standard exercises as clinically indicated. NPRS and WOMAC for assessing pain intensity and functional disability before and after treatment.

Results: Data normality was assessed using Kolmogorov-Smirnov and Shapiro-Wilk tests, Wilcoxon Signed Rank tests were used for within-group comparisons, and Mann-Whitney U tests were performed for between-group analysis, with statistical significance established at p <0.001.

Conclusion: Both physiotherapy approaches effectively reduced pain and improved functional status in individuals with early-stage KOA. However, AMT shows significantly greater improvements in pain intensity, functional disability and overall clinical outcomes compared with CPT. These superior outcomes are likely attributable to positive integration effects of neuromuscular rehabilitation, progressive strengthening, proprioceptive training, functional movement retraining, and advanced electrophysical modalities that collectively address biomechanical, neuromuscular, and inflammatory components of KOA.