Health & medicine

A 14-person trial put knee braces top of an arthritis ranking

A 2025 analysis said it pooled 139 trials of drug-free treatments for knee osteoarthritis and ranked knee braces first. In its own data, braces appear in two small trials, and much of their lead comes from pooling scores measured on different scales. Exercise's benefit is the more dependable finding: at rest, a bit over 1 point less pain on a 10-point scale.

9 October 2026 · How we rate evidence

Evidence labelBraces best: Speculative Exercise: Promising, close to Solid Pool therapy: Early Popular claim: Overstated

Claim: Braces best (Speculative): Knee braces were the most effective of the 12 treatments, ranked first on four of six measures and overall.
Exercise (Promising, close to Solid): Exercise reduced pain compared with placebo or usual care: about 1.25 points on a 10-point scale at rest (range 0.6 to 1.9).
Pool therapy (Early): Pool-based therapy (hydrotherapy) ranked first for pain at rest: about 2.4 points less than placebo on a 10-point scale (range 0.3 to 4.6).
Popular claim (Overstated): "Nearly 10,000 patients reveal what works best for knee arthritis pain relief" (ScienceDaily, 14 Sep 2026, from PLOS press material, which quotes the authors: "Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis"). Morning Overview, on MSN: braces "outperform every other drug-free option"
Studied in: People with mild to moderate knee osteoarthritis in randomized trials run most often in Turkey, Brazil, China, Iran, the US and Australia, among others. The paper says 139 trials and 9,644 patients; the data file the authors published holds about 74 trials and 4,600 patients (our count). Braces: two trials, 81 people
Design: Network meta-analysis: a pooled analysis that compares treatments through shared comparison groups, including pairs never tested head to head. Treatments ranked by SUCRA, a 0–100% score for how high each tends to rank. Registered on PROSPERO (we couldn't read the record). Scores from different versions of the same questionnaire were combined without converting them to a common scale. Every pain figure on this label is our conversion of the paper's Table 3 (see notes)
Status: Peer-reviewed, PLOS One 20(6):e0324864, published 18 June 2025
Replicated: Braces: no. A large 2026 trial found a small benefit from adding a brace, not superiority. Exercise: yes, in an independent 2025 analysis of 217 trials. Pool therapy: no
Funding: No specific funding; the authors declare no competing interests. One of the two brace trials was paid for by the brace's maker
We read: Full paper (free via PubMed Central, CC BY), its peer-review history, and the authors' data spreadsheet, which we reanalysed. We didn't examine the figure images or the 405-page extraction file. Later trials are described from their abstracts. Coverage: ScienceDaily, Morning Overview and Welltica+ (both on MSN)
Would change our mind: Up for braces: a reanalysis that puts every trial on a common scale, includes all the brace trials the paper lists, and still finds braces ahead of exercise. Up for exercise: similar benefits in trials whose comparison group got equal attention

Point estimates in pain-scale units are our calculation from the paper's Table 3 and data file (see notes); the paper reports none. The 2 cm threshold is from Tubach and colleagues, 2005. No numbers come only from coverage. We found no independent expert comment in the coverage.

In a study published in 2019, 21 people with arthritic knees in Iran were split at random into three groups of seven: one got a knee brace, one a wedged shoe insole, and one both. Six years later, the brace group from that small study carries most of the weight behind a claim that has travelled a long way: that knee braces are the best drug-free treatment for knee osteoarthritis.

The claim going around. In mid-September ScienceDaily ran "Nearly 10,000 patients reveal what works best for knee arthritis pain relief," from press material by the journal's publisher, PLOS. It quotes the authors: "Knee braces, hydrotherapy, and exercise are the most effective non-drug therapies for knee osteoarthritis. ... Patients and clinicians should prioritize these evidence-based options." Morning Overview, on MSN, went further: braces "outperform every other drug-free option."

What they did. Four researchers at the First People's Hospital of Neijiang, in China, searched for randomized trials of 12 drug-free treatments: exercise, knee braces, pool therapy (hydrotherapy), shoe insoles, kinesiology tape, two kinds of laser, shock waves, ultrasound, electrical nerve stimulation and two heat or current therapies. They report 139 trials with 9,644 patients. Because most trials compare one treatment with a dummy or usual care, not with each other, they used a network meta-analysis, which chains comparisons together: if A beats placebo by a lot and B beats it by a little, A is estimated to beat B.

Pain, stiffness and function were measured with a standard questionnaire called WOMAC, and pain also on a 10-point line. The paper ranked every treatment on six measures and put braces first overall.

Parts of the groundwork are sound. They searched six databases, two researchers picked and extracted trials independently, the review was registered on PROSPERO, and the authors published their data spreadsheet, which is what made the checks below possible.

Short lesson

Why "ranked first" doesn't mean "works best"

A treatment ranking answers a narrow question: if you had to bet on which option comes out on top, which would you pick? A common score for this, called SUCRA, turns each treatment's estimated effect and its uncertainty into a single number between 0 and 100%.

The trouble is that a ranking hides how big the differences are and how sure anyone is about them. A treatment tested in one tiny trial with a lucky result can top the table, because its estimate is large even though its range runs from harm to huge benefit. Two treatments can sit first and fifth while differing by less than anyone would feel.

So the useful questions come after the ranking: how much better, in points on the pain scale? Is that more than patients notice? Does the range rule out no difference? And how many people's results is the estimate built on?

What they found. The paper reports no effects in points. Its main table prints numbers like 4.68 × 10¹⁹, which can't be score differences. They make sense once converted: taking the logarithm of each printed value gives back the differences in the authors' own data, to the decimal place, so the table appears to print them in exponential form. Every point figure below is our conversion.

Exercise has the most consistently significant result, though results varied widely from trial to trial. Pooled across the network (16 trials tested it directly against a comparison group), it lowered pain at rest by about 1.25 points on a 10-point scale compared with placebo or usual care (range 0.6 to 1.9). A 2005 study of about 600 people with knee osteoarthritis put the improvement an individual patient rates as important at about 2 points, but that threshold is for one person's change, not a difference between group averages, so the two can't be compared directly. An independent 2025 analysis of 217 exercise trials called the effects on pain large. Our rating for this finding sits between Promising and Solid, and the call turns on one point: people in exercise trials know they are exercising and rate their own pain, which can colour the result.

Pool therapy topped two measures: about 2.4 points less pain at rest than placebo (range 0.3 to 4.6). Only one small direct trial, with 24 people, compared it with placebo. The rest of that estimate comes through indirect comparisons.

Braces are where the ranking breaks down. In the authors' published data, braces appear in exactly two trials. One is the Iranian study: 7 people with a brace against 7 with an insole. It is the only brace trial feeding the WOMAC measures. The other, a French trial funded by the brace maker, compared 32 people wearing a brace with 35 getting usual care. Measured against placebo or usual care, the brace's pain benefit on WOMAC was not clear of chance. On pain during activity, no treatment was clearly better than any other, yet braces still ranked first.

Stiffness shows how the lead arose. Most trials scored stiffness on a scale that runs from 0 to 8. The Iranian trial used a 0 to 100 version, and its brace group scored 41 points better than its insole group. Treating those as the same units hands braces a stiffness "effect" five times the entire range of the scale other trials used. Function has the same problem.

What it doesn't show. It doesn't show that braces beat exercise, pool therapy or anything else except one insole group. It can't separate treatment from expectation either. By the paper's own risk-of-bias table, participants knew their treatment in 55 of the 139 trials, and every outcome was self-reported. The "placebo" group mixes dummy devices, usual care and no treatment at all. The paper reports no measure of how much results varied between trials; in our check, the spread was very large for most comparisons.

The headline number is also shaky. The authors' data file holds about 74 trials and 4,600 patients, roughly half of what the paper claims. Several large trials, including the two biggest brace trials in its list, aren't in it. The Iranian trial appears twice in that list under different names, once as a 2019 study and once as a 2021 one.

What it means beyond the study. For someone with a sore knee, the question is which of these is worth their time and money. On this evidence, exercise is the safest bet, with a real effect that varied a lot between trials. A brace is a reasonable thing to try. PROP OA, a trial of 466 people in England published in January in The BMJ, found that adding a brace to advice and exercise improved pain by about 6 points on a 100-point scale at six months (range 3.4 to 8.9), a benefit that shrank by a year, according to its abstract. That's a small add-on, not a winner.

Why it's still interesting. The authors posted the numbers behind their analysis, which is why anyone can see where the ranking came from. That openness turns the paper into a useful case: a big number of trials, a tidy league table, and a first place that traces back to seven people and a mismatched scale. It also shows how durable a ranking is. Months after publication, "what works best" was still travelling, while the effect sizes behind it had never been reported in points.

Open questions.

Do braces still come out ahead on a common scale? Re-run the analysis with every trial's scores converted to one scale and with all the brace trials the paper lists. If braces still lead, they deserve their place; if they drop back, advice should rest on exercise and trials like PROP OA.

How much is expectation? Compare trials where people couldn't tell which treatment they got with those where they could, or run brace trials against a convincing dummy brace. The answer decides whether a treatment is worth paying for, or whether any attentive care would do as well.

Does it last? Most trials followed people for weeks; knee osteoarthritis lasts decades. Group trials by follow-up length. A benefit that fades by a year, as PROP OA's did, is a different offer from one that holds.

A note on timing. The paper came out on 18 June 2025. The ScienceDaily story is dated 14 September 2026, 15 months later, and a second wave on MSN followed within two weeks. The study hadn't changed.