Interpretation of <i>Chinese Guideline for the Rehabilitation Treatment of Knee Osteoarthritis (2023 Edition)</i>_West China Medical Journal

Authors：

CHEN Jiayi ^1,2 , ZHU Siyi ^1,2 , ZHU Linsen ^1,2 ,  HE Chengqi ^1,2

1. Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HE Chengqi, Email: hxkfhcq@126.com

Keywords：

Knee osteoarthritis; interpretation of guideline; rehabilitation

DOI：

10.7507/1002-0179.202503217

Video：

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The Chinese Guideline for the Rehabilitation Treatment of Knee Osteoarthritis (2023 Edition) were jointly developed by the Chinese Society of Physical Medicine and Rehabilitation and West China Hospital of Sichuan University, aiming to standardize the rehabilitation treatment of knee osteoarthritis (KOA). This article focuses on the 11 core clinical issues of KOA rehabilitation assessment and treatment in the above guidelines, with a focus on introducing rehabilitation strategies such as KOA rehabilitation assessment and treatment, and proposes multiple corresponding recommendations. While interpreting the guidelines, it provides reference and inspiration for professionals engaged in KOA diagnosis, treatment, and rehabilitation management in China to optimize the standardization and scientificity of KOA rehabilitation treatment and improve patients’ rehabilitation prognosis.

Citation： CHEN Jiayi, ZHU Siyi, ZHU Linsen, HE Chengqi. Interpretation of Chinese Guideline for the Rehabilitation Treatment of Knee Osteoarthritis (2023 Edition). West China Medical Journal, 2025, 40(6): 853-858. doi: 10.7507/1002-0179.202503217 Copy

1.	Holden MA, Nicolson PJA, Thomas MJ, et al. Osteoarthritis year in review 2022: rehabilitation. Osteoarthritis Cartilage, 2023, 31(2): 177-186.
2.	何成奇. 骨关节炎康复指南. 人民卫生出版社, 2016: 511.
3.	中华医学会物理医学与康复学分会, 岳寿伟, 何成奇. 物理医学与康复学指南与共识. 人民卫生出版社, 2019: 479.
4.	中华医学会物理医学与康复学分会, 四川大学华西医院. 中国膝骨关节炎康复治疗指南(2023 版). 中国循证医学杂志, 2024, 24(1): 1-14.
5.	周奇, 邢丹, 李沁原, 等. 指南解读类文献报告规范的制订指南(RIGHT for INT). 中国循证医学杂志, 2022, 22(5): 497-507.
6.	Nussbaumer-Streit B, Grillich L, Glechner A, et al. GRADE: evidence to decision (EtD) frameworks - a systematic and transparent approach to making well informed healthcare choices. 1: introduction. Z Evid Fortbild Qual Gesundhwes, 2018, 134: 57-66.
7.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
8.	Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
9.	Whiting PF, Weswood ME, Rutjes AW, et al. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol, 2006, 6: 9.
10.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
11.	Perrot S, Marty M, Legout V, et al. Ecological or recalled assessments in chronic musculoskeletal pain? A comparative study of prospective and recalled pain assessments in low back pain and lower limb painful osteoarthritis. Pain Med, 2011, 12(3): 427-436.
12.	Nejadhosseinian M, Djalalinia S, Haerian H, et al. The effects of antioxidants on knee osteoarthritis: a systematic review and meta-analysis. Front Nutr, 2022, 9: 1026450.
13.	Bossmann T, Kirchberger I, Glaessel A, et al. Validation of the comprehensive ICF core set for osteoarthritis: the perspective of physical therapists. Physiotherapy, 2011, 97(1): 3-16.
14.	Dreinhöfer K, Stucki G, Ewert T, et al. ICF core sets for osteoarthritis. J Rehabil Med, 2004(Suppl 44): 75-80.
15.	Muraki S, Akune T, Teraguchi M, et al. Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study. BMC Musculoskelet Disord, 2015, 16: 305.
16.	Conroy MB, Kwoh CK, Krishnan E, et al. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis Care Res (Hoboken), 2012, 64(1): 15-21.
17.	Shull PB, Huang Y, Schlotman T, et al. Muscle force modification strategies are not consistent for gait retraining to reduce the knee adduction moment in individuals with knee osteoarthritis. J Biomech, 2015, 48(12): 3163-3169.
18.	Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
19.	Jones G, Ding C, Scott F, et al. Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females. Osteoarthritis Cartilage, 2004, 12(2): 169-174.
20.	van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, et al. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care, 2020, 18(4): 575-595.
21.	Salsabil JR, Pane RV, Hasan H, et al. Hypertonic dextrose prolotherapy injection in grade IV knee osteoarthritis with obesity: a case report. Acta Med Indones, 2024, 56(3): 349-355.
22.	Bayrak G, Alkan H. Factors influencing pain intensity in knee osteoarthritis: a cross-sectional biopsychosocial perspective. BMC Musculoskelet Disord, 2025, 26(1): 196.
23.	王振中, 崔寅鹏, 郭艾. SF-36 量表对髋膝关节置换术后患者健康情状评估的应用. 首都医科大学学报, 2015(6): 974-977.
24.	Keefe FJ, Caldwell DS, Baucom D, et al. Spouse-assisted coping skills training in the management of osteoarthritic knee pain. Arthritis Care Res, 1996, 9(4): 279-291.
25.	Mazzuca SA, Brandt KD, Katz BP, et al. Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Arthritis Rheum, 1997, 40(8): 1466-1474.
26.	Ravaud P, Flipo RM, Boutron I, et al. ARTIST (osteoarthritis intervention standardized) study of standardised consultation versus usual care for patients with osteoarthritis of the knee in primary care in France: pragmatic randomised controlled trial. BMJ, 2009, 338: b421.
27.	Waller B, Ogonowska-Slodownik A, Vitor M, et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Phys Ther, 2014, 94(10): 1383-1395.
28.	Xu Z, Wang Y, Zhang Y, et al. Efficacy and safety of aquatic exercise in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2023, 37(3): 330-347.
29.	Dias JM, Cisneros L, Dias R, et al. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther, 2017, 21(6): 449-456.
30.	Munukka M, Waller B, Rantalainen T, et al. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage, 2016, 24(10): 1708-1717.
31.	Luan L, Bousie J, Pranata A, et al. Stationary cycling exercise for knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 2021, 35(4): 522-533.
32.	Mete E, Sari Z. The efficacy of exergaming in patients with knee osteoarthritis: a randomized controlled clinical trial. Physiother Res Int, 2022, 27(3): e1952.
33.	Holsgaard-Larsen A, Clausen B, Søndergaard J, et al. The effect of instruction in analgesic use compared with neuromuscular exercise on knee-joint load in patients with knee osteoarthritis: a randomized, single-blind, controlled trial. Osteoarthritis Cartilage, 2017, 25(4): 470-480.
34.	Villadsen A, Overgaard S, Holsgaard-Larsen A, et al. Immediate efficacy of neuromuscular exercise in patients with severe osteoarthritis of the hip or knee: a secondary analysis from a randomized controlled trial. J Rheumatol, 2014, 41(7): 1385-1394.
35.	Kumar S. Proprioceptive training as an adjunct in osteoarthritis of knee. J Musculoskelet Res, 2013, 16(1): 10.
36.	Cheung C, Wyman JF, Resnick B, et al. Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial. BMC Complement Altern Med, 2014, 14: 160.
37.	Zeng C, Li H, Yang T, et al. Effectiveness of continuous and pulsed ultrasound for the management of knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis Cartilage, 2014, 22(8): 1090-1099.
38.	Dantas LO, Osani MC, Bannuru RR. Therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis with GRADE quality assessment. Braz J Phys Ther, 2021, 25(6): 688-697.
39.	Wu Y, Zhu S, Lv Z, et al. Effects of therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 2019, 33(12): 1863-1875.
40.	Zhang C, Xie Y, Luo X, et al. Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 2016, 30(10): 960-971.
41.	Li S, Yu B, Zhou D, et al. Electromagnetic fields for treating osteoarthritis. Cochrane Database Syst Rev, 2013(12): CD003523.
42.	Yang X, He H, Ye W, et al. Effects of pulsed electromagnetic field therapy on pain, stiffness, physical function, and quality of life in patients with osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Phys Ther, 2020, 100(7): 1118-1131.
43.	Stausholm MB, Naterstad IF, Joensen J, et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open, 2019, 9(10): e031142.
44.	Avendaño-Coy J, Comino-Suárez N, Grande-Muñoz J, et al. Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Int J Surg, 2020, 82: 64-75.
45.	Wang YC, Huang HT, Huang PJ, et al. Efficacy and safety of extracorporeal shockwave therapy for treatment of knee osteoarthritis: a systematic review and meta-analysis. Pain Med, 2020, 21(4): 822-835.
46.	Belk JW, Kraeutler MJ, Houck DA, et al. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med, 2021, 49(1): 249-260.
47.	Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials. Eur J Orthop Surg Traumatol, 2020, 30(6): 955-967.
48.	Shen L, Yuan T, Chen S, et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res, 2017, 12(1): 16.
49.	Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.

1. Holden MA, Nicolson PJA, Thomas MJ, et al. Osteoarthritis year in review 2022: rehabilitation. Osteoarthritis Cartilage, 2023, 31(2): 177-186.
2. 何成奇. 骨关节炎康复指南. 人民卫生出版社, 2016: 511.
3. 中华医学会物理医学与康复学分会, 岳寿伟, 何成奇. 物理医学与康复学指南与共识. 人民卫生出版社, 2019: 479.
4. 中华医学会物理医学与康复学分会, 四川大学华西医院. 中国膝骨关节炎康复治疗指南(2023 版). 中国循证医学杂志, 2024, 24(1): 1-14.
5. 周奇, 邢丹, 李沁原, 等. 指南解读类文献报告规范的制订指南(RIGHT for INT). 中国循证医学杂志, 2022, 22(5): 497-507.
6. Nussbaumer-Streit B, Grillich L, Glechner A, et al. GRADE: evidence to decision (EtD) frameworks - a systematic and transparent approach to making well informed healthcare choices. 1: introduction. Z Evid Fortbild Qual Gesundhwes, 2018, 134: 57-66.
7. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
8. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 2011, 343: d5928.
9. Whiting PF, Weswood ME, Rutjes AW, et al. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol, 2006, 6: 9.
10. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
11. Perrot S, Marty M, Legout V, et al. Ecological or recalled assessments in chronic musculoskeletal pain? A comparative study of prospective and recalled pain assessments in low back pain and lower limb painful osteoarthritis. Pain Med, 2011, 12(3): 427-436.
12. Nejadhosseinian M, Djalalinia S, Haerian H, et al. The effects of antioxidants on knee osteoarthritis: a systematic review and meta-analysis. Front Nutr, 2022, 9: 1026450.
13. Bossmann T, Kirchberger I, Glaessel A, et al. Validation of the comprehensive ICF core set for osteoarthritis: the perspective of physical therapists. Physiotherapy, 2011, 97(1): 3-16.
14. Dreinhöfer K, Stucki G, Ewert T, et al. ICF core sets for osteoarthritis. J Rehabil Med, 2004(Suppl 44): 75-80.
15. Muraki S, Akune T, Teraguchi M, et al. Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study. BMC Musculoskelet Disord, 2015, 16: 305.
16. Conroy MB, Kwoh CK, Krishnan E, et al. Muscle strength, mass, and quality in older men and women with knee osteoarthritis. Arthritis Care Res (Hoboken), 2012, 64(1): 15-21.
17. Shull PB, Huang Y, Schlotman T, et al. Muscle force modification strategies are not consistent for gait retraining to reduce the knee adduction moment in individuals with knee osteoarthritis. J Biomech, 2015, 48(12): 3163-3169.
18. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis, 1957, 16(4): 494-502.
19. Jones G, Ding C, Scott F, et al. Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females. Osteoarthritis Cartilage, 2004, 12(2): 169-174.
20. van Doormaal MCM, Meerhoff GA, Vliet Vlieland TPM, et al. A clinical practice guideline for physical therapy in patients with hip or knee osteoarthritis. Musculoskeletal Care, 2020, 18(4): 575-595.
21. Salsabil JR, Pane RV, Hasan H, et al. Hypertonic dextrose prolotherapy injection in grade IV knee osteoarthritis with obesity: a case report. Acta Med Indones, 2024, 56(3): 349-355.
22. Bayrak G, Alkan H. Factors influencing pain intensity in knee osteoarthritis: a cross-sectional biopsychosocial perspective. BMC Musculoskelet Disord, 2025, 26(1): 196.
23. 王振中, 崔寅鹏, 郭艾. SF-36 量表对髋膝关节置换术后患者健康情状评估的应用. 首都医科大学学报, 2015(6): 974-977.
24. Keefe FJ, Caldwell DS, Baucom D, et al. Spouse-assisted coping skills training in the management of osteoarthritic knee pain. Arthritis Care Res, 1996, 9(4): 279-291.
25. Mazzuca SA, Brandt KD, Katz BP, et al. Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Arthritis Rheum, 1997, 40(8): 1466-1474.
26. Ravaud P, Flipo RM, Boutron I, et al. ARTIST (osteoarthritis intervention standardized) study of standardised consultation versus usual care for patients with osteoarthritis of the knee in primary care in France: pragmatic randomised controlled trial. BMJ, 2009, 338: b421.
27. Waller B, Ogonowska-Slodownik A, Vitor M, et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Phys Ther, 2014, 94(10): 1383-1395.
28. Xu Z, Wang Y, Zhang Y, et al. Efficacy and safety of aquatic exercise in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil, 2023, 37(3): 330-347.
29. Dias JM, Cisneros L, Dias R, et al. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther, 2017, 21(6): 449-456.
30. Munukka M, Waller B, Rantalainen T, et al. Efficacy of progressive aquatic resistance training for tibiofemoral cartilage in postmenopausal women with mild knee osteoarthritis: a randomised controlled trial. Osteoarthritis Cartilage, 2016, 24(10): 1708-1717.
31. Luan L, Bousie J, Pranata A, et al. Stationary cycling exercise for knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 2021, 35(4): 522-533.
32. Mete E, Sari Z. The efficacy of exergaming in patients with knee osteoarthritis: a randomized controlled clinical trial. Physiother Res Int, 2022, 27(3): e1952.
33. Holsgaard-Larsen A, Clausen B, Søndergaard J, et al. The effect of instruction in analgesic use compared with neuromuscular exercise on knee-joint load in patients with knee osteoarthritis: a randomized, single-blind, controlled trial. Osteoarthritis Cartilage, 2017, 25(4): 470-480.
34. Villadsen A, Overgaard S, Holsgaard-Larsen A, et al. Immediate efficacy of neuromuscular exercise in patients with severe osteoarthritis of the hip or knee: a secondary analysis from a randomized controlled trial. J Rheumatol, 2014, 41(7): 1385-1394.
35. Kumar S. Proprioceptive training as an adjunct in osteoarthritis of knee. J Musculoskelet Res, 2013, 16(1): 10.
36. Cheung C, Wyman JF, Resnick B, et al. Yoga for managing knee osteoarthritis in older women: a pilot randomized controlled trial. BMC Complement Altern Med, 2014, 14: 160.
37. Zeng C, Li H, Yang T, et al. Effectiveness of continuous and pulsed ultrasound for the management of knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis Cartilage, 2014, 22(8): 1090-1099.
38. Dantas LO, Osani MC, Bannuru RR. Therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis with GRADE quality assessment. Braz J Phys Ther, 2021, 25(6): 688-697.
39. Wu Y, Zhu S, Lv Z, et al. Effects of therapeutic ultrasound for knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 2019, 33(12): 1863-1875.
40. Zhang C, Xie Y, Luo X, et al. Effects of therapeutic ultrasound on pain, physical functions and safety outcomes in patients with knee osteoarthritis: a systematic review and meta-analysis. Clin Rehabil, 2016, 30(10): 960-971.
41. Li S, Yu B, Zhou D, et al. Electromagnetic fields for treating osteoarthritis. Cochrane Database Syst Rev, 2013(12): CD003523.
42. Yang X, He H, Ye W, et al. Effects of pulsed electromagnetic field therapy on pain, stiffness, physical function, and quality of life in patients with osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Phys Ther, 2020, 100(7): 1118-1131.
43. Stausholm MB, Naterstad IF, Joensen J, et al. Efficacy of low-level laser therapy on pain and disability in knee osteoarthritis: systematic review and meta-analysis of randomised placebo-controlled trials. BMJ Open, 2019, 9(10): e031142.
44. Avendaño-Coy J, Comino-Suárez N, Grande-Muñoz J, et al. Extracorporeal shockwave therapy improves pain and function in subjects with knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials. Int J Surg, 2020, 82: 64-75.
45. Wang YC, Huang HT, Huang PJ, et al. Efficacy and safety of extracorporeal shockwave therapy for treatment of knee osteoarthritis: a systematic review and meta-analysis. Pain Med, 2020, 21(4): 822-835.
46. Belk JW, Kraeutler MJ, Houck DA, et al. Platelet-rich plasma versus hyaluronic acid for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Am J Sports Med, 2021, 49(1): 249-260.
47. Hohmann E, Tetsworth K, Glatt V. Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials. Eur J Orthop Surg Traumatol, 2020, 30(6): 955-967.
48. Shen L, Yuan T, Chen S, et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res, 2017, 12(1): 16.
49. Chen Y, Yang K, Marušic A, et al. A reporting tool for practice guidelines in health care: the RIGHT statement. Ann Intern Med, 2017, 166(2): 128-132.

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Interpretation of Chinese Guideline for the Rehabilitation Treatment of Knee Osteoarthritis (2023 Edition)

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