Comparative Effectiveness of Combined Orthotic and Physiotherapy Interventions Versus Monotherapy in the Management of Knee Osteoarthritis on Clinical Parameters: A Systematic Review of Randomized Controlled Trials

Background and Aims: Knee osteoarthritis (OA) is a common degenerative joint disease affecting 22.9% of individuals over 40 years of age, causing pain and functional impairment. Orthotic devices and physiotherapy are standard treatments, but their combined effectiveness compared with that of monotherapy is unclear. This systematic review aimed to evaluate the effectiveness of combined orthotic and physiotherapy interventions versus monotherapy in improving clinical (e.g., pain, function) and quality of life (QOL) outcomes in knee OA patients. Methods: Following the PRISMA 2020 guidelines, a comprehensive search was conducted across four databases for studies published until September 7, 2025. The review included Randomized Controlled Trials (RCTs) that specifically compared the outcomes of combined orthotic and physiotherapy interventions versus monotherapy. A narrative synthesis was performed due to the heterogeneity among the studies. Results: Four RCTs involving 240 participants were included. Monotherapy with orthotics or physiotherapy significantly improved clinical parameters such as pain and function. Combined interventions showed enhanced benefits in some cases, although the results varied. The risk of bias ranged from low to moderate in RCTs. Conclusion: Both orthotic and physiotherapy interventions are effective for knee OA, with combined approaches potentially offering additional benefits. However, heterogeneity and bias limit the certainty of the evidence. Future research should focus on large-scale, stratified RCTs to enhance the generalizability of the findings and inform personalized treatment strategies.