Effect of proprioceptive neuromuscular facilitation on pain and joint mobility in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective. To systematically assess the effect of proprioceptive neuromuscular facilitation (PNF), compared to control interventions or other rehabilitation techniques (RT), on pain intensity and knee active range of motion (AROM) in adults with knee osteoarthritis (KOA). Methodology. This systematic review and meta-analysis was reported in accordance with PRISMA guidelines. A systematic search was conducted in PubMed, Embase, Web of Science, CENTRAL, CNKI, Wanfang, and VIP for studies published from database inception to August 2025. Randomized controlled trials comparing PNF with control interventions or RT were identified in adults with KOA. Primary outcomes were change in pain and change in AROM from baseline to post-intervention. Data were pooled using a random effects model, with risk of bias assessed using the Revised Cochrane risk-of-bias tool (RoB-2) and the certainty of evidence rated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results. Five studies (nD201) comparing PNF versus control and four studies (n = 202) comparing PNF versus RT were included. Meta-analysis was conducted only for comparisons between PNF and control. In addition, PNF was qualitatively compared with RT, which included soft tissue mobilization (two randomized controlled trials (RCTs)), neuromuscular exercise (one RCT), and stretching (one RCT). Compared to control interventions, PNF demonstrated significantly greater benefits in pain reduction (standardized mean difference (SMD) = -1.14, p<0:001) and knee AROM improvement (weighted mean difference (WMD) = 10.08, p < 0:001), albeit the reduction in pain (WMD = -1.66, p<0:001, four RCTs) did not reach the minimal clinically important difference (MCID). When compared with RT, findings for change in pain were mixed across four RCTs (one favored RT, two showed no difference, one favored PNF); for knee AROM, one favored PNF, while the other showed no difference (no pooling due to methodological heterogeneity). Conclusions. PNF appears to yield greater improvements in pain reduction and joint mobility compared to control interventions among individuals with KOA. While its efficacy relative to RT remains inconclusive, PNF shows potential as an alternative or adjunct rehabilitation approach. Further high-quality RCTs are needed to determine the effects of PNF on pain reduction and joint mobility in KOA.