Supervised Exercise Therapy versus Home Exercise Program in Patients with Knee Osteoarthritis: A Narrative Review

Abstract

Background: Knee Osteoarthritis (KOA) is a leading cause of pain and disability worldwide. Exercise therapy is a universally endorsed core treatment, yet the optimal delivery model supervised clinical sessions versus independent home programs remains a point of clinical debate. This review synthesizes current evidence comparing the efficacy, adherence, cost-effectiveness, and long-term outcomes of Supervised Exercise Therapy (SET) versus Home Exercise Programs (HEP) for managing KOA. Methods: A narrative review was conducted, synthesizing findings from recent systematic reviews, meta-analyses, randomized controlled trials (RCTs), and clinical guidelines .Results: Current evidence suggests SET typically yields superior short-to-medium-term outcomes in reducing pain, improving physical function (e.g., walking, stair climbing), and increasing muscle strength compared to HEP. This is attributed to closer adherence, proper technique correction, and the motivational context of supervision. However, well-structured, progressive HEPs with initial instruction and periodic review can achieve comparable long-term (≥12 month) benefits for pain and function in motivated patients. SET is associated with higher direct healthcare costs, while HEP offers greater scalability and accessibility. Technology-assisted HEP (telerehabilitation) is emerging as a promising hybrid model. Conclusion: no significant differences were observed between supervised and non-supervised physical exercises in terms of pain and function of the osteoarthritis knee, However SET represents the most effective delivery model for achieving robust clinical improvements, particularly for patients with higher pain levels, functional deficits, or low self-efficacy. HEP is a vital, cost-effective component for long-term management. A personalized, stepped-care approach is recommended, where SET is used to initiate treatment and impart self-management skills, followed by a transition to a maintained, technology-supported HEP. Future research should focus on defining predictive factors for success in each model and optimizing telerehabilitation protocols.