Comparative effectiveness of traditional Chinese exercises for knee osteoarthritis: a systematic review and Bayesian network meta-analysis

Purpose: This study aims to evaluate the therapeutic effects of various traditional Chinese exercises on knee osteoarthritis (KOA) in middle-aged and older adult(s) individuals through a systematic review and Bayesian network meta-analysis. Methods: Following the PRISMA guidelines, randomized controlled trials (RCTs) were retrieved from six databases: Web of Science, PubMed, Cochrane Library, Scopus, Embase, and Google Scholar. A total of 20 RCTs involving 1,457 middle-aged and older adult(s) KOA patients were included. Interventions included Tai Chi, Baduanjin, Wuqinxi, and Yijinjing. Mean Difference (MD) was used as the effect size for continuous outcomes (WOMAC subscales, SF-36, VAS, 6MWT). A Bayesian network meta-analysis was performed, and interventions were ranked using the Surface Under the Cumulative Ranking Area (SUCRA). Results: The network meta-analysis, based on SUCRA rankings, showed: For pain relief, Yijinjing combined with electroacupuncture (WOMAC Pain SUCRA: 0.77) and Tai Chi (SUCRA: 0.72) performed best; Tai Chi was also optimal for VAS score (SUCRA: 0.97). For improving joint stiffness (WOMAC Stiffness SUCRA: 0.90) and physical function (WOMAC Function SUCRA: 0.84), Baduanjin was the most effective. Regarding quality of life, Tai Chi ranked highest for physical health (SF-36 PCS SUCRA: 0.89), while Yijinjing ranked highest for mental health (SF-36 MCS SUCRA: 0.99). Usual care (SUCRA: 0.80) and Tai Chi (SUCRA: 0.66) performed best on the 6-min walk test (6MWT). Conclusion: Tai Chi and Baduanjin appear to be highly effective non-pharmacological options for alleviating pain, improving function, and enhancing quality of life in middle-aged and older adult(s) KOA patients. These findings support individualized exercise prescriptions. However, these results should be interpreted with caution. The included studies were overwhelmingly from China, which may introduce regional bias. Future research with more diverse populations is needed to confirm these findings. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/home, identifier: CRD4202457307.