The Determinants of Knee Osteoarthritis Management; A Systematic Review

Abstract

Knee osteoarthritis (KOA) is one of the most common musculoskeletal disorders worldwide and represents a major cause of pain, disability, and reduced functional capacity among adults. Effective management of knee osteoarthritis typically involves a combination of therapeutic approaches aimed at reducing symptoms and improving joint function; however, treatment outcomes are often influenced by multiple determinants related to patient behavior, rehabilitation strategies, and healthcare delivery. This systematic review aimed to identify and synthesize the key determinants influencing the management of knee osteoarthritis. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. A comprehensive literature search was performed across four major electronic databases: PubMed, Scopus, Web of Science, and CINAHL, using keywords related to knee osteoarthritis, management strategies, exercise therapy, rehabilitation, treatment adherence, and self-management. A total of 237 records were initially identified, and after screening and eligibility assessment, 20 studies were included in the final synthesis. The findings indicate that exercise-based management and physiotherapy interventions represent fundamental components in improving pain reduction and physical function among individuals with knee osteoarthritis. Psychosocial factors, including motivation, beliefs about treatment effectiveness, and perceived barriers to physical activity, were also identified as important determinants influencing patient engagement in rehabilitation programs. In addition, treatment adherence plays a critical role in determining the effectiveness of management strategies. Emerging evidence also highlights the potential role of digital self-management and telehealth-based interventions in improving patient participation and access to rehabilitation services. Overall, the management of knee osteoarthritis is influenced by multiple interrelated determinants, and integrating these factors into patient-centered management strategies may enhance treatment effectiveness and improve long-term clinical outcomes.