Several individual RCTs demonstrated clinical ly important improvements in pain and disability with aerobic exercise .
Other PT interventions demonstrated no sustained benefit .
Individual RCTs showed similar benefits with aerobic , aquatic , and strengthening exercise .
Adverse events were uncommon and did not deter participants from continuing treatment .
Low-strength evidence suggested that only a few PT interventions were effective .
BACKGROUND Osteoarthritis is a leading cause of disability .
Nonsurgical treatment is a key first step .
PURPOSE Systematic literature review of physical therapy ( PT ) interventions for community-dwelling adults with knee osteoarthritis .
Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritic knee pain?
Objective : To evaluate the cumulative effect of repeated transcutaneous electrical nerve stimulation ( TENS ) on  chronic osteoarthritic ( OA ) knee pain  over a four-week treatment period , comparing it to that of placebo stimulation and exercise training given alone or in combination with TENS . Design : Sixty-two patients , aged 50–75 , were stratified according to age , gender and body mass ratio before being r and omly assigned to four groups . Interventions : Patients received either ( 1 ) 60 minutes of TENS , ( 2 ) 60 minutes of placebo stimulation , ( 3 ) isometric exercise training , or ( 4 ) TENS and exercise ( TENS & Ex ) five days a week for four weeks . Main outcome measures : Visual analogue scale ( VAS ) was used to measure knee pain intensity before and after each treatment session over a four-week period , and at the four-week follow-up session . Results : Repeated measures ANOVA showed a significant cumulative reduction in the VAS scores across the four treatment sessions ( session 1 , 10 , 20 and the follow-up ) in the TENS group ( 45.9 % by session 20 , p < 0.001 ) and the placebo group ( 43.3 % by session 20 , p = 0.034 ) . However , linear regression of the daily recordings of the VAS indicated that the slope in the TENS group ( slope = -2.415 , r = 0.943 ) was similar to the exercise group ( slope = -2.625 , r = 0.935 ) , which were steeper than the other two groups . Note that the reduction of OA knee pain was maintained in the TENS group and the TENS & Ex group at the four-week follow-up session , but not in the other two groups . Conclusions : The four treatment protocol s did not show significant between-group difference over the study period . It was interesting to note that isometric exercise training of the quadriceps alone also reduced knee pain towards the end of the treatment period
Several individual RCTs demonstrated clinical ly important improvements in pain and disability with aerobic exercise .
Other PT interventions demonstrated no sustained benefit .
Individual RCTs showed similar benefits with aerobic , aquatic , and strengthening exercise .
Adverse events were uncommon and did not deter participants from continuing treatment .
Low-strength evidence suggested that only a few PT interventions were effective .
BACKGROUND Osteoarthritis is a leading cause of disability .
Nonsurgical treatment is a key first step .
PURPOSE Systematic literature review of physical therapy ( PT ) interventions for community-dwelling adults with knee osteoarthritis .