Baseline predictors of treatment response to Chinese tuina and manual physical therapy in knee osteoarthritis: a secondary analysis of a randomized controlled trial

Introduction Although manual therapy, including traditional Chinese tuina and manual physical therapy, is generally effective for knee osteoarthritis (KOA), individual responses vary considerably. This secondary analysis aimed to identify the quantifiable baseline characteristics that predict treatment response, thereby supporting personalized care. Methods Data from a randomized controlled trial comparing tuina and manual physical therapy for KOA were analyzed. At week 4, 59 of 127 patients (46.5%) were responders by Outcome Measures in Rheumatology–Osteoarthritis Research Society International (OMERACT–OARSI) criteria. Candidate variables were screened by univariate analysis (P  Results Univariate analysis identified disease duration, Kellgren-Lawrence grade, prior treatment satisfaction, all Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscales, numeric rating scale (NRS) pain score, 12-item short form health survey (SF-12) mental health score, functional tests, and treatment expectations as associated with response (P Conclusion Patients with more severe baseline pain and better mental health are more likely to respond favorably to either tuina or manual physical therapy. These findings bridge pain and mental health as predictors, providing evidence for precision manual therapy in KOA; external validation in larger cohorts is required. Registration: This study was registered with ClinicalTrials.gov (https://clinicaltrials.gov/, NCT03966248).