Effect of neuromuscular electrical stimulation associated with therapeutic exercise on pain, function, and strength of people with knee osteoarthritis: a systematic review with meta-analysis of randomized clinical trials with GRADE recommendations
Disabil Rehabil. 2026 Feb 26:1-17. doi: 10.1080/09638288.2026.2633271. Online ahead of print.
ABSTRACT
OBJECTIVE: To determine whether NMES combined with therapeutic exercise improves pain, function, and muscle strength compared to exercise alone in adults with KOA.
METHODS: We searched nine databases (PubMed, MEDLINE-Ovid, EMBASE, Cochrane Library, Web of Science, Scopus, SPORTDiscus, LILACS, SciELO) up to 5 April 2025. Randomized controlled trials comparing NMES + exercise with exercise alone were eligible. Two reviewers independently screened records, extracted data, and assessed methodological quality and risk of bias using the PEDro scale and the RoB 2. Random-effects meta-analyses generated mean differences (MD) or standardized mean differences (SMD). Certainty of the evidence was assessed with GRADE (PROSPERO CRD42023393616).
RESULTS: Eight trials (354 participants; mean age ≈59 years; 71% women) were included. Immediately post-intervention, NMES + exercise did not reduce pain versus exercise alone (SMD -0.90, 95% CI -1.84 to 0.03; I2 = 84%). At 8-12 weeks, small benefits were observed for pain (SMD -1.30, 95% CI -1.87 to -0.73; I2 = 0%) and TUG (SMD -0.67, 95% CI -0.98 to -0.35). No differences were found for WOMAC total or quadriceps strength. Certainty was very low.
CONCLUSIONS: NMES + exercise may modestly improve long-term pain and mobility in KOA, though evidence certainty is very low.
PMID:41742784 | DOI:10.1080/09638288.2026.2633271