The Effect of Two Walking Training Methods on the Physical Function of People with Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Studies

Osteoarthritis of the knee (KO) is a chronic and common disease that is associated with pain, limits of movement, and reduced physical performance, and walking forward and backward may be an effective form of rehabilitation in knee osteoarthritis. Therefore, the aim of the study was to examine the effect of two walking methods on the physical function of people with knee osteoarthritis: a systematic review and meta-analysis of studies that walking ability was considered as the main variable in measuring people's physical function in the research.

Among the articles published from January 1990 to July 2024 in the field of knee osteoarthritis and various exercises-related keywords such as Muscle Strength AND Osteoarthritis AND Pain AND Rehabilitation, Walking OR Walking Speed in combination with the Physical Function keyword, 1515 articles were reviewed from Medline/PubMed, Science Direct, Scopus, and Web of science databases. Moreover, Prisma flowchart was used to perform the research steps and for the validity of each study, the Pedro scale was used.

Among the 1515 studies, twenty relevant studies were finally selected, and in the present meta-analysis, 20 studies and 69 sub-studies were evaluated as walking exercise intervention and control groups that they reported their results by pain instruments using visual analog scale as well as numerical rating scale and physical function by Western Ontario and McMaster Universities standardized arthritis index and knee injury and osteoarthritis outcome score as well as quadriceps muscle strength assessment. Forward walking training significantly improved physical function in participants with KO (SMD=1.177, 95% CI=1.011-1.344, P=0.0001). Moreover, backward walking training had a significant effect on improving physical function in osteoarthritis individuals (SMD = 1.578, 95% CI = 1.17 - 1.98, P = 0.0001). In addition, no bias was observed between studies and subgroups related to the effect of walking training using Egger and Begg tests (p < 0.05).

The findings of the study demonstrated that walking training intervention regardless of the type of training method can be an important modality in improving KO (effect size = 17.21). Therefore, forward and backward walking exercises can be used as part of the rehabilitation program for these patients.