International and French recommendations emphasize non-pharmacological interventions (NPIs) for knee osteoarthritis (OA). These elements are essential to improve patient outcomes and foster behavior change. We aimed to understand patient and healthcare professionals’ experiences regarding exercise, weight reduction, education and self-management programs.

We conducted a systematic review of qualitative studies using data from PubMed, Cochrane, Pascal and Francis, and the Public Health Database, published between 2001 and 2024. The selected articles were evaluated using the Critical Appraisal Skills Program checklist, followed by thematic synthesis.

Out of 529 preselected articles, 75 were included, involving 1,313 patients, 389 healthcare providers, and 46 family caregivers. The thematic synthesis highlights how perceptions shape behaviors through barriers and facilitators. Barriers included a fatalistic view of knee OA as an inevitable degenerative process, providers’ doubts about patient engagement, and the perception of NPIs as ineffective or harmful. Facilitators comprised an optimistic view of patient's remaining abilities, recognition of physical activity and weight management benefits, and supportive approaches such as patient-centered care, professional supervision, and peer support. Recognizing each professional's role in multidisciplinary care enhanced NPI implementation. Patient-centered education programs combining exercise and weight control provided physical, psychological, and social benefits. Enhancing professional skills and optimizing resources were identified as essential to strengthen NPI uptake.

This review emphasizes the importance of perceptions and a personalized, patient-centered approach. Highlighting remaining abilities and non-pharmacological interventions empowers patients, whereas a fatalistic view of joint wear hinders engagement.