Effects of proprioceptive exercise for knee osteoarthritis: a systematic review and meta-analysis.

The authors rate the overall certainty of the evidence as low, downgrading it two levels for risk of bias and for likely publication bias on the stiffness outcome. Only three of the 22 trials were at low risk of bias; most had some concerns and seven were at high risk. Only one trial was double-blind, so people knew whether they were exercising, which may have inflated the pain ratings they reported themselves. Four trials described their randomisation so poorly that it could not be checked. Exercise programmes varied in content, length and method, and none of the trials reported how hard the exercise was, so this review cannot tell you what dose to use. Controls were a mix of no treatment and active therapy, which the authors say may help explain results that were statistically significant but too small to matter to patients. Only English-language papers were included. For the stiffness outcome, testing suggested some publication bias, so that result may be flattering.

The authors declare that financial support was received for the research, in the form of a grant from the Joint Funds for the Innovation of Science and Technology, Fujian Province (grant number 2024Y9052). No competing interests are declared in the paper's funding and conflicts statement.

Do not read this as proof that proprioceptive exercise works for knee osteoarthritis. The only finding that reached the level patients can feel was balance on the Timed Up and Go test; the overall symptom score and both pain scales that did change fell short of their clinical thresholds, the pain, stiffness and function subscales were not significant, and the authors rate the evidence as low certainty.