Comparing Different Stretching Exercises on Pain, Stiffness, and Physical Function Disability in Older Adults With Knee Osteoarthritis

Objective To assess and compare the effects of different stretching exercise programs on pain, stiffness, and physical function disability in older adults with knee osteoarthritis (KOA). Data Sources This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline for network meta-analysis (NMA). Relevant randomized controlled trials were identified by searching 7 databases up to December 2022. Study Selection Inclusion criteria included (1) older adults with KOA; (2) intervention included stretching exercises; (3) control groups received no stretching exercise; and (4) outcome measurements included pain, stiffness, or physical function disability. Methodological quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. Data Extraction NMA was performed using R and MetaInsight, with results presented as a standardized mean difference (SMD) with 95% confidence interval (CI). Data Synthesis We examined 17 studies, and NMA results indicated that proprioceptive neuromuscular facilitation (PNF) stretching, mind-body exercises, and multi-component exercise programs were effective in mitigating pain in older adults with KOA (SMD=2.54 [95% CI: 1.23; 3.84], SMD=1.09 [95% CI: 0.27; 1.92], SMD=0.57 [95% CI: 0.06; 1.09]). Moreover, mind-body exercises and multi-component exercises were the most effective programs in reducing stiffness (SMD=1.31 [95% CI: 0.12; 2.51]) and physical function disability (SMD=1.67 [95% CI: 0.01; 3.33]) in older adults with KOA, respectively. Conclusion Findings suggest that PNF stretching, mind-body exercises, and multi-component exercises can be incorporated into exercise programs to better mitigate pain, stiffness, and physical function disability in older adults with KOA.