Effectiveness of Isokinetic Muscle Strength Training on Knee Osteoarthritis Patients: A Meta-Analysis and Grading Recommendations (GRADE) System

Abstract

Background: Isokinetic muscle strength training (IMST) is a method of assessing and training muscle strength through a fixed speed of movement to test and enhance muscle strength. The purpose of this systematic review was to systematically evaluate the effects of isokinetic exercises on knee osteoarthritis (KOA), and to provide a basis for further application and research of this training method.

Methods: We searched for randomized controlled trials (RCTs) comparing isokinetic exercises versus other medical care for KOA patients, six databases (CBM, PubMed, Cochrane Library, Web of Science, CNKI, and WanFang), two clinical trial registries and one gray literature database were searched from inception to January 1, 2024. Two investigators independently screened literature, extracted data, and assessed risk of bias according to the Cochrane Handbook Version 6.1.0. The RevMan 5.4 software was used to perform the meta-analysis. Overall quality of evidence was rated using GRADE (Grading of Recommendations, Assessment, Development and Evaluation).

Results: 19 RCTs involving 1386 patients were finally included. Three of which had high risk bias. Compared with other treatments, IMST can significantly increase Lysholm score (SMD = 1.21, 95% CI: [-0.62, 3.04], I²=95%, P < .05, very low certainty), extensor peak torque (SMD = 4.12, 95% CI: [-0.17, 8.41], I²=74%, P < .05, very low certainty) and flexor peak torque of KOA patients (SMD = 7.94, 95% CI: [4.23, 11.66], I²=71%, P < .05, low certainty). Besides, IMST can significantly decrease the VAS score (SMD = -0.64, 95% CI: [-1.19, -0.10], I²=95%, P < .05, Moderate certainty) and WOMAC total score (SMD = -6.96, 95% CI: [-15.85, 1.92], I²=98%, P < .05, Moderate certainty), as well as improved the function of knee, relief the pain and stiffness.

Conclusion: IMST can effectively improve motor function and reduce pain of KOA. In order to better improving the quality of life of relevant patients and give more reliable advice, more trials of direct comparisons are needed to inform clinical decision making with greater confidence.