OBJECTIVE: To examine whether graded motor imagery (GMI) was as effective as transcutaneous electrical nerve stimulation (TENS) in improving pain and functionality in patients with knee osteoarthritis (PwKOA). DESIGN: Forty-six PwKOA were randomized (1:1) into the GMI and the TENS groups. Both groups participated in home-based and functional exercises. A visual analog scale (VAS), the pressure pain threshold, range of motion (ROM), muscle strength, the Timed Up and Go Test, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated at baseline, after 8 weeks of treatment, and after a 6-week follow-up period. RESULTS: The within-group comparisons showed significant improvements in outcomes for both treatments. However, the difference between the groups was significant in favor of the GMI group in knee flexion ROM, knee extensor muscle strength, and WOMAC-pain and WOMAC-function parameters at the end of the treatment, and VAS-activity, knee flexor muscle strength, and WOMAC-stiffness values showed greater improvement in the GMI group compared with the TENS group at the end of the 6-week follow-up (for all, p < 0.05). CONCLUSIONS: GMI seems to be a more effective adjuvant than TENS. If applied in PwKOA, pain and functional recovery improved, and results were maintained for up to 6 weeks.

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