{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:46:19Z","timestamp":1792586779088,"version":"4.5.0"},"reference-count":78,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This systematic review aimed to analyse the additional effects of manual therapy (MT) to exercise (EX) compared to EX alone on pain, function, and PPT in individuals with knee osteoarthritis (KOA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Six databases (MEDLINE, PEDro, EMBASE, CENTRAL, CINAHL, and Web of Science) were searched from inception up to May 2026. Two independent reviewers selected randomized clinical trials. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated by random\u2010effects for meta\u2010analyses. The review was registered in PROSPERO (CRD42024525169), and the certainty of a body of evidence was classified using GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010nine studies were included. MT combined with EX, compared to EX alone, reduced pain in the immediate (mean difference [MD]\u2009=\u2009\u22120.53; 95% CI\u2009=\u2009\u22120.97 to \u22120.09 very low certainty of evidence), short\u2010term (MD\u2009=\u2009\u22121.30; 95% CI\u2009=\u2009\u22121.74 to \u22120.87 very low certainty of evidence), and medium\u2010term (MD\u2009=\u2009\u22120.98; 95% CI\u2009=\u2009\u22121.86 to \u22120.10 moderate certainty of evidence). Function also improved in the short\u2010term (SMD\u2009=\u2009\u22120.89; 95% CI\u2009=\u2009\u22121.49 to \u22120.29 very low certainty of evidence) and medium\u2010term (SMD\u2009=\u2009\u22120.62; 95% CI\u2009=\u2009\u22121.13 to \u22120.10 very low certainty of evidence). However, no significant long\u2010term effects were observed for either pain and function. No eligible studies assessing pressure pain threshold (PPT) were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An additional effect of MT to EX was observed; however, the certainty of the evidence was very low to low. MT can be considered an adjunctive intervention in KOA, as it appears to provide short\u2010duration effects on both pain relief and functional outcomes, but does not seem to extend to the long term.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This systematic review identifies that MT can be considered a complementary intervention when combined with EX, which appears to provide immediate, short\u2010 and medium\u2010term effects, both in pain relief and functional outcomes in KOA. The use of MT with EX may assist patients at the beginning of the rehabilitation process. However, its benefits do not appear to extend to the long term, highlighting that MT can serve as a strategy to support exercise, particularly during the initial phase of treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70397","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T08:03:27Z","timestamp":1792137807000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Additional Effects of Manual Therapy to Exercise on Pain and Function in Individuals With Knee Osteoarthritis: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3444-1592","authenticated-orcid":false,"given":"Viviane R.","family":"da Silva","sequence":"first","affiliation":[{"name":"Physiotherapy Department of the Federal University of S\u00e3o Carlos  S\u00e3o Carlos Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3635-8170","authenticated-orcid":false,"given":"Rebecca B.","family":"Ramalho","sequence":"additional","affiliation":[{"name":"Physiotherapy Department of the Federal University of S\u00e3o Carlos  S\u00e3o Carlos Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8514-6337","authenticated-orcid":false,"given":"Marcos","family":"de Noronha","sequence":"additional","affiliation":[{"name":"Physiotherapy Department of the La Trobe University \u2013 Bendigo Campus  Bendigo Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0611-6106","authenticated-orcid":false,"given":"Marcelo A.","family":"Bracht","sequence":"additional","affiliation":[{"name":"Physiotherapy Department of the Regional University of Blumenau  Blumenau Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5227-2599","authenticated-orcid":false,"given":"Luiz Felipe","family":"Tavares","sequence":"additional","affiliation":[{"name":"Physiotherapy Department of the Federal University of S\u00e3o Carlos  S\u00e3o Carlos Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6649-9794","authenticated-orcid":false,"given":"Luiz F. 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