Effect Of Active Physiotherapy On Knee Function And Knee Pain: A Randomized Clinical Trial

Chronic knee pain disrupts daily life, with functional impairments leading to neuromuscular imbalance—a key factor in musculoskeletal pain. Active physiotherapy (AP) adopts a patient-centered approach, utilizing active movements to integrate sensory-motor information for functional recovery and pain relief. Passive physiotherapy (PP) involves direct therapist intervention and passive treatment. However, research on the therapeutic potential of AP and PP for chronic musculoskeletal pain is limited. PURPOSE: This study aimed to determine whether AP is superior to PP in improving knee function over a 12-month follow-up period in patients with knee pain. METHODS: 84 patients with symptomatic and radiographically confirmed knee pain were randomly assigned to either 3 months AP or PP (n = 42, respectively). The AP protocol integrated Mulligan Mobilization (MWM), active myofascial release technique, therapeutic exercises, with a focus on muscle balance, neuromuscular control and coordination. The PP protocol consisted of physical agents' therapy and passive manual therapy. The primary outcome was the change from baseline in the Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). Key secondary outcomes included pain intensity (VAS), quality of life (SF-36), and functional performances (40-meter fast walk and 6-minute walk test) , measured at different intervals. Intention-to-treat and per-protocol analyses was performed. Linear mixed-model analysis was utilized. RESULTES: Over a 12-month follow-up period, knee function improved in the AP by 20.5 ± 13.5 and in the PP by 14.2 ± 12.5. The overall between-group difference was 6.2 points (97.5% CI, 1.8 to 10.7; P = 0.007). The mean difference of the VAS was -5.3 mm (95% CI, -8.7 to -1.8; P = 0.003), favoring AP. No difference between groups was observed in SF-36. AP group exhibited substantial improvements in all functional performance variables compared to the PP group (P < 0.05). Adverse events: 4 in AP, 7 in PP, with additional knee pain outpatient visits most frequent (2 in AP, 6 in PP). CONCLUSION: Active physiotherapy demonstrates superiority in improving function and alleviating pain in patients with knee pain. These findings underscore the considerable therapeutic value of active physiotherapy for chronic knee pain treatment. 1 the Fundamental Research Funds for the China Institute of Sport Science (2023-43).