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In people who have knee osteoarthritis, physical therapy improves balance and reduces risk of falls

Mat S, Tan MP, Kamaruzzaman SB, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015;44:16-24.

Review question

In people who have knee osteoarthritis, does physical therapy improve balance and reduce risk of falls?


Osteoarthritis is a common form of arthritis that damages joints, such as the knee, and may cause pain and stiffness. People who have osteoarthritis may have impaired balance and be at greater risk of falling.

It has been suggested that, in addition to weight loss and exercise, physical therapy may improve balance and reduce risk of falls in people who have knee osteoarthritis.

How the review was done

The researchers did a systematic review, based on studies available up to November 2013.

They found 15 randomized controlled trials with 1,482 people (average age more than 60 years).

The key features of the trial were:

  • all people had knee osteoarthritis and did not have hip or spine osteoarthritis;
  • most physical therapies fell into the categories of strength training, Tai Chi, or aerobic exercise;
  • people may also have had other types of treatment, including medications;
  • duration of physical therapies and follow-up ranged from 2 weeks to 18 months; and
  • physical therapies were compared with control conditions, such no intervention, wellness education and stretching, education, subtherapeutic knee ultrasound, computer-skills training, less frequent physical therapy, or instructions to not engage in new physical therapy.

What the researchers found

Compared with control, strength training, Tai Chi, and aerobic exercise, improved balance.

Compared with control, strength training and aerobic exercise reduced risk of falls.


In people who have knee osteoarthritis, physical therapy improves balance and reduces risk of falls.

Treatments for balance in people with knee osteoarthritis


Type of physical therapy

Number of trials



Strength training, Tai Chi, or aerobic exercise


Medium improvement


Strength training


Small improvement


Tai Chi


Large improvement


Aerobic exercises


Medium improvement

Risk of falls

Strength training, Tai Chi, or aerobic exercises


Medium improvement


Strength training


Small improvement


Tai Chi


No improvement


Aerobic exercises


Large improvement

*Amount of improvement compared with control based on standard mean differences: 0.2 to 0.49 = small improvement, 0.5 to 0.79 = medium improvement, 0.8 or more = large improvement.


Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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