Effectiveness of backward walking exercises combined with conventional rehabilitation programs on managing pain intensity and disability in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.

Abstract

Background: Knee osteoarthritis (OA) causes pain and diminishes quality of life. Backward walking exercise (BWE) has been shown to improve lower muscle strength and reduce knee adduction moment, making it a recommended intervention for knee OA rehabilitation. This study aims to evaluate the effectiveness of BWE combined with conventional rehabilitation programs on pain intensity and disability among individuals with knee OA.

Material and methods: Following the PRISMA guidelines, we systematically searched for studies from the inception to June 2025, prioritizing pain intensity as the primary outcome and disability as the secondary outcome, standardized by Hedges' g. A random-effects model was utilized for data pooling. Subgroup analyses focused on different walking speeds, surfaces, and control group characteristics.

Results: Based on the final inclusion of 13 randomized controlled trials, combining BWE with conventional rehabilitation programs was found to significantly reduce pain intensity (Hedges' g = -0.997, 95% CI = -1.373 to -0.620) and improve disability (Hedges' g = -1.015, 95% CI = -1.326 to -0.703). Subgroup analyses revealed larger effect sizes for comfortable walking speed, and treadmill walking. Significant differences were observed across all control group comparisons (p < .05).

Conclusion: BWE combined with rehabilitation showed moderate-to-large effect sizes in reducing pain and disability in knee OA. Future research should assess its standalone efficacy, long-term impact, and certainty of the evidence.