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BACKGROUND: Non-pharmacological treatments, including exercise, education, and physical modalities, are central to conservative care for knee osteoarthritis and are strongly recommended by international guidelines. However, in daily practice these interventions are often delivered in combinations rather than as isolated therapies, and the actual patterns remain poorly characterized. While randomized trials have shown the efficacy of individual modalities, little is known about how different real-world combinations are associated with short-term pain outcomes. This study aimed to classify treatment patterns and examine their relationship with early pain reduction.METHODS: This retrospective observational study was conducted at a single orthopedic hospital in Japan. Patients who received non-pharmacological interventions within one month of diagnosis were included. Nine treatments were assessed: muscle strengthening, range of motion, aerobic exercise, thermotherapy, electrical stimulation, ultrasound, home exercise instruction, disease education, and orthotic insoles. Hierarchical cluster analysis classified treatment patterns. The primary outcome was pain improvement, defined as a reduction of at least 20 millimeters on a 100-millimeter visual analog scale one month after the first visit. Logistic regression examined associations between clusters and pain improvement.RESULTS: Fifty-one patients were analyzed. Three clusters were identified: Cluster 1 (Active Exercise), Cluster 2 (Educational Therapy), and Cluster 3 (Multimodal Approach). Pain improvement rates were 75.0, 40.9, and 66.7 percent. Compared with Cluster 1, Cluster 2 showed significantly lower odds of improvement.CONCLUSIONS: The composition of non-pharmacological treatments may influence short-term pain outcomes in knee osteoarthritis. Exercise-based interventions appear particularly effective.