KOA is a prevalent joint disorder significantly impacting patients' quality of life. Tuina and manual interventions are prioritized in clinical practice within the Chinese healthcare context. Current qualitative studies mostly focus on symptom management and basic disease perceptions, overlooking patient-centered treatment expectations, therapeutic process perceptions, and doctor-patient interaction impacts during manual therapy. This study aims to address these gaps by exploring Chinese KOA patients' experiences, perceptions, and expectations of manual therapy, emphasizing contextual factors affecting therapeutic outcomes and interactions.Participants with KOA were sampled using a simple sampling method from a randomized controlled trial of Tuina treatment versus manual physical therapy (MPT). The interviews were conducted by two researchers who have extensive experience interviewing KOA patients, and data were gathered through face-to-face, semi-structured interviews to ensure a high level of information power. Three experienced researchers subsequently analyzed employing thematic analysis to assess patient experiences and outcomes from both treatment modalities.The study interviewed a total of 61 participants, thematic saturation was reached when interviewing 42 participants, and seven codes along with 5 sub-themes were utilized to depict potential doctor-patient interactions and influencing factors. This process led to the formation of three themes: Understanding and Impact, Treatment Expectations and Satisfaction, and Treatment Goals and Outcomes, which helped in constructing a model to understand the underlying influences among these themes.Our study generated three themes-Understanding and Impact, Treatment Expectations and Satisfaction, and Treatment Goals and Outcomes, and developed a manual therapy model based on these themes. The generated model shows the important factors of doctor-patient interaction in KOA manual therapy management. Future research should expand to multidisciplinary and cross-cultural models to align standardized protocols with individualized patient needs.© 2025. The Author(s).