Comparative Effectiveness of Supervised Individualized Multimodal Physiotherapy versus Conventional Home-Based Exercise in Early Knee Osteoarthritis: A 12-Month Prospective Cohort Study

Abstract

Background: Knee osteoarthritis (KOA) is a leading cause of chronic pain and disability globally. Although exercise therapy is recommended as first-line management, outcomes from unsupervised home-based programs are often inconsistent. Supervised multimodal physiotherapy may provide superior clinical benefits through individualized progression and neuromuscular retraining.
Objective: To compare the long-term effectiveness of supervised individualized multimodal physiotherapy (MPP) and conventional structured home-based exercise (SHE) in adults with early-stage knee osteoarthritis.
Methods: A 12-month prospective observational cohort study was conducted among 200 adults aged 40–70 years with radiographically confirmed Kellgren–Lawrence grade I–II KOA. Participants selected either supervised MPP (n=100) or SHE (n=100). Primary outcomes were WOMAC Pain (0–20) and WOMAC Physical Function (0–68). Secondary outcomes included adherence rate and effect size magnitude. Mixed-effects linear regression models adjusted for baseline age, sex, BMI, and baseline WOMAC scores were used. Effect sizes were calculated using Cohen’s d.
Results: At 12 months, MPP demonstrated significantly greater reduction in WOMAC Pain (adjusted mean difference −1.92; 95% CI −2.41 to −1.43; p<0.001; d=0.78) and improvement in WOMAC Function (adjusted mean difference −9.47; 95% CI −13.02 to −5.92; p<0.001; d=1.61). Improvements exceeded established MCID thresholds. Significant group × time interaction confirmed sustained superiority (p<0.001).
Conclusion: Supervised individualized multimodal physiotherapy produces clinically meaningful and statistically robust improvements compared to home-based exercise in early KOA.