Non-Pharmacological Complementary and Alternative Therapies for Knee Osteoarthritis: A Scoping Review of Randomized Controlled Trials.

Background: Knee osteoarthritis (KOA) is a prevalent chronic degenerative joint disorder and a major contributor to pain, disability, and impaired quality of life. Non-pharmacological complementary and alternative medicine (CAM) approaches are widely used in KOA care, but randomized controlled trial (RCT) evidence is distributed across diverse intervention types, settings, comparators, and outcome measures. Methods: Following the Arksey and O'Malley scoping review framework and the PRISMA-ScR reporting guideline, we searched PubMed, Web of Science, Embase, and the Cochrane Library for RCTs published from 1 January 2016 to 10 January 2026. Eligible studies enrolled adults with clinically or imaging-confirmed KOA and evaluated non-pharmacological, non-surgical CAM or related integrative interventions. The review question was structured according to the population-concept-context framework. Two reviewers independently screened records and charted study characteristics, intervention features, comparator types, outcomes, follow-up time points, and key design features. Evidence was summarized descriptively and narratively; no pooled treatment-effect estimates were calculated. Results: Fifty-three RCTs were included. The evidence base covered acupuncture-related therapies, manual and body-based therapies, exercise and mind-body programs, physical agent modalities, psychological and behavioral interventions, and other complementary or integrative approaches. Studies were geographically concentrated in China, the United States, Turkey, and several other countries. Protocols, intervention dose, provider background, comparator selection, and follow-up duration varied substantially. Pain and physical-function outcomes were the most frequently mapped domains, whereas quality of life, psychological outcomes, mechanistic biomarkers, neuroimaging indices, adherence, and implementation variables were reported less consistently. Conclusion: This scoping review maps the breadth, distribution, and methodological features of RCT evidence on non-pharmacological CAM approaches for KOA. The findings identify a heterogeneous and expanding evidence base, but also reveal gaps in standardized intervention reporting, long-term follow-up, head-to-head comparisons, generalizability beyond TCM-centered Chinese settings, and design-characteristic reporting. These evidence-mapping findings can inform future systematic reviews, pragmatic trials, and implementation-focused research.