Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis: A systematic review and meta-analysis

Objective: To systematically review the efficacy of blood flow restriction training (BFRT) on individuals with knee osteoarthritis (OA). Design: Systematic review with meta-analysis. Literature search: Eight electronic databases were searched by one researcher. Study selection criteria: Randomised clinical trials (RCTs) comparing BFRT to regular resistance training (RT) for knee OA. Data synthesis: One reviewer selected the eligible RCTs and exported the data. Two reviewers evaluated study quality using the PEDro scale. We performed meta-analysis where appropriate using a random effects model. We rated the quality of evidence using GRADE. Results: Five studies were eligible. The key outcomes analysed were pain, self-reported function, objective physical function, strength and muscle size. Across all comparisons, there was low to moderate quality evidence of no difference between BFRT and traditional RT. Conclusion: The limited available evidence does not suggest that BFRT enhances outcomes for people with knee OA. These findings do not support clinicians using BFRT in people with knee OA. Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation. Additional studies should clarify whether some people with knee OA who cannot complete an adequate exercise programme due to pain, might still benefit from BFRT to facilitate less painful exercise.