Swedish massage versus hip strengthening exercises for pain and function in older adults with knee osteoarthritis: a randomized controlled trial

Knee osteoarthritis (KOA) is a progressive disease that impairs mobility and quality of life in older adults. To compare the effects of Swedish massage (SM) and hip strengthening exercises (HSE) versus control on pain, range of motion (ROM), and function in older adults with KOA. Seventy-five adults > 60 years with symptomatic KOA were randomized to SM, HSE, or control for 8 weeks of home-based intervention (3 sessions/week, 30 min each). Outcomes included pain, function, and ROM at baseline and week 8. Intention-to-treat analysis used ANCOVA adjusted for baseline values, with Bonferroni correction for two pre-specified comparisons (α = 0.025). Seventy participants completed the study (93.3%); adherence exceeded 85%. No serious adverse events occurred. Both active interventions significantly outperformed control across all outcomes. Compared with control, SM reduced VAS pain by an adjusted mean of 0.81 cm (95% CI 0.38–1.24, p < 0.001, d = 0.69) and HSE by 0.77 cm (95% CI 0.34–1.20, p < 0.001, d = 0.65). KOOS-ADL improved by 3.59 points with SM (95% CI 1.62–5.56, p < 0.001, d = 0.71) and 3.40 points with HSE (95% CI 1.43–5.37, p = 0.001, d = 0.67). Active knee flexion ROM increased by 3.42° (SM, p = 0.001, d = 0.73) and 3.69° (HSE, p < 0.001, d = 0.77) vs. control. This study shows SM and HSE as safe, feasible home-based options for pain relief in frail older adults with KOA. SM and HSE mitigate KOA pain, with SM uniquely enhancing daily function, supporting integration into clinical practice to promote independence and reduce healthcare burdens in aging populations. IRCT20150519022320N33 (August 12, 2023).