Effects of Diagonal Proprioceptive Neuromuscular Facilitation Patterns on Pain and Functional Outcomes in Patients With Knee Osteoarthritis
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises, Conventional Strength Training Exercises, Heat Therapy.
- Who it may be relevant to
- Registry conditions: Knee Osteoarthristis, Osteearthritis, Knee Pain Arthritis. Basic parameters: 40 years — 60 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Pakistan
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Overview
A randomized controlled trial will be conducted at the Department of Physiotherapy, Dr. Ziauddin Hospital and Al-Rayaz Hospital, Karachi, Pakistan. A total of 150 patients diagnosed with knee osteoarthritis, aged between 40-60 years, will be recruited through a non-probability purposive sampling technique. Written informed consent will be obtained from all eligible participants prior to enrollment. The participants will be randomly allocated by the help of computer generated randomization sheet, into two groups i.e. experimental and the control group, with 75 participants in each group. Group A (experimental group) will receive diagonal proprioceptive neuromuscular facilitation (PNF) pattern exercises, while Group B (control group) will receive conventional strength training exercises. Heat therapy will be administered to both groups. All participants will be assessed using a standardized assessment form. Outcome measures will include pain intensity, knee range of motion, functional disability, hamstring flexibility, dynamic balance, and fatigue level. A single blinded assessor will assess all participants at baseline and at post intervention. Treatment sessions will be given thrice a week on alternate days for 6 weeks.
Detailed description
The Statistical Package for the Social Sciences (SPSS) version 23 will be used for data analysis. Mean and standard deviation will be calculated for quantitative variables such as age. Qualitative variables will be presented as frequencies and percentages. Outcome measures (decrease pain intensity, improve functional disability, increase knee range of motion, improve hamstring flexibility, dynamic balance, and fatigue level) recorded at baseline and after 18th session of intervention will be compared and analyzed. Repeated measures ANOVA will be applied for statistical analysis. A p-value of less than 0.05 will be considered as the level of statistical significance.
Interventions
- Other Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises
Diagonal PNF pattern exercises include Diagonal 1 and Diagonal 2 lower limb pattern movements performed against resistance to improve strength, flexibility, and functional performance. - Other Conventional Strength Training Exercises
The conventional strength training exercises include quadriceps and hip abductor strengthening performed using resisted active movements to improve muscle strength and functional ability. - Other Heat Therapy
Heat therapy will be given for 10 minutes by the help of electric heating pad.
Primary outcome measures
- Change in pain intensity will be assessed with Visual Analogue Scale [Time frame: Baseline and after 6 weeks of intervention]
- Change in range of motion will be assessed with Universal Goniometer [Time frame: Baseline and after 6 weeks of intervention.]
Secondary outcome measures (4)
- Change in functional disability will be assessed with Knee Injury and Osteoarthritis Outcome Score (KOOS) [Time frame: Baseline and after 6 weeks of intervention.]
- Change in hamstring flexibility will be assessed with Active Knee Extension test. [Time frame: Baseline and after 6 weeks of intervention.]
- Change in dynamic balance will be assessed with Four Step Square Test (FSST) [Time frame: Baseline and after 6 weeks of intervention.]
- Change in fatigue level will be assessed with Multidimensional Fatigue Inventory questionnaire. [Time frame: Baseline and after 6 weeks of intervention.]
Eligibility criteria
Inclusion criteria
- Both male and females with an age range between 40-60 years.
- Patients diagnosed with unilateral or bilateral Knee OA.
- Grade-II or grade-III on kellgren and Lawrence classification.
- Patients having pain intensity more than 3.4 cm on VAS as minimum cut off value.
- Duration of knee OA more than 3 months (chronic).
Exclusion criteria
- Patients with any neurological disorder.
- History of lower limb arthroplasty or any other knee surgery.
- Septic knee arthritis.
- Inflammatory rheumatic disease such as rheumatoid arthritis and gout.
- Cancer or any other malignancy such as bone tumor.
- Knee deformities such as contracture, genu valgum and genu varum.
- History of ligamentous injury and meniscal tear.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Single blind
- Primary purpose
- Treatment
Study locations
Pakistan · 2 centers
- Al-Rayaz Hospital — Karachi
- Dr. Ziauddin Hospital — Karachi
Publications
- Nafees K, Baig AAM, Ali SS, Ishaque F. Dynamic soft tissue mobilization versus proprioceptive neuromuscular facilitation in reducing hamstring muscle tightness in patients with knee osteoarthritis: a randomized control trial. BMC Musculoskelet Disord. 2023 Jun 2;24(1):447. doi: 10.1186/s12891-023-06571-y. PMID 37268961
- Gao B, Li L, Shen P, Zhou Z, Xu P, Sun W, Zhang C, Song Q. Effects of proprioceptive neuromuscular facilitation stretching in relieving pain and balancing knee loading during stepping over obstacles among older adults with knee osteoarthritis: A randomized controlled trial. PLoS One. 2023 Feb 13;18(2):e0280941. doi: 10.1371/journal.pone.0280941. eCollection 2023. PMID 36780435
- Geng R, Li J, Yu C, Zhang C, Chen F, Chen J, Ni H, Wang J, Kang K, Wei Z, Xu Y, Jin T. Knee osteoarthritis: Current status and research progress in treatment (Review). Exp Ther Med. 2023 Aug 25;26(4):481. doi: 10.3892/etm.2023.12180. eCollection 2023 Oct. PMID 37745043
- Song Q, Shen P, Mao M, Sun W, Zhang C, Li L. Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis. Scand J Med Sci Sports. 2020 Sep;30(9):1655-1663. doi: 10.1111/sms.13709. Epub 2020 Jun 1. PMID 32407583
Identifiers
NCT: NCT07396233 · IBC KU-549/2025