Effectiveness of neuromuscular exercises (NEMEX) in knee osteoarthritis: a systematic review with metaanalysis

The main objective of the article was to evaluate the effectiveness of Neuromuscular exercises (NEMEX) on pain and function in patients with knee osteoarthritis. Pubmed, Cochrane, PEDro and Google Scholar were searched. The eligibility criteria were: Randomized controlled trials, single blinded controlled trials, controlled before and after study comparing and assessing the effectiveness of NEMEX in knee osteoarthritis, articles published in English language till 2020 with NEMEX either alone or in conjunction with other interventions (drugs, educational packages) in patients with knee osteoarthritis. Outcome measures used for meta-analysis were visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function and the other measures Knee Injury Osteoarthritis Outcome Score (KOOS), Knee Index and Knee Adduction Moment (KAM) and Hip Disability and Osteoarthritis Outcome Score (HOOS). The result of the meta-analysis for the included two studies showed statistically significant reduction in pain (VAS) in the NEMEX group as compared to the other group Z = 0.64, p = 0.03, I2 = 79% and no significant reduction in WOMAC scores Z = 0.70, P = 0.64. The study concludes that there was statistically significant improvement in pain (VAS) but no functional improvement (WOMAC) with the NEMEX whether used in isolation or in conjunction with other interventions was seen in the patients with knee OA. However, large numbers of studies are required to generalize the effectiveness of NEMEX in knee osteoarthritis. Based on this review, NEMEX can be used as a potential intervention in reducing pain, improving strength and function in knee osteoarthritis patients.