Effect of Combined Quadriceps and Calf Strengthening Program on Gait in Knee Osteoarthritis Patients

Официальное название

Effect of Combined Quadriceps and Calf Strengthening Program on Gait, Functionality, and Sleep Quality in Knee Osteoarthritis Patients

Обзор

The aim of this study is to determine the effects of a combined quadriceps and calf strengthening program on gait, strength, pain, disability, functional mobility, and sleep quality in patients with knee osteoarthritis. A randomized controlled trial will be conducted at Hayatabad Medical Complex, Peshawar. A total of 52 participants aged 40-60 years with grade 2-3 knee osteoarthritis will be recruited using non-probability convenience sampling and randomly allocated into experimental and control groups. Outcome measures include Kinovea software for gait analysis, hand-held dynamometer for strength, Numeric Rating Scale for pain, WOMAC for disability, Timed Up and Go test for function, and Pittsburgh Sleep Quality Index for sleep quality. Data will be analyzed using SPSS version 27 employing repeated measures ANOVA and mixed-way ANOVA.

Подробное описание

Knee osteoarthritis (KOA) is a chronic, progressive degenerative condition commonly affecting older adults and is a major cause of disability. It is characterized by degeneration of articular cartilage, subchondral bone changes, and synovial inflammation. KOA results in pain, stiffness, impaired balance, reduced physical function, and diminished quality of life, leading to significant psychological and socioeconomic burden. Knee osteoarthritis (KOA) develops due to several factors including mechanical stress, obesity, joint injury, aging-related cartilage wear and tear, genetic predisposition, and low-grade inflammation that damages the cartilage.

Physical therapy is a key component of KOA management and focuses on pain reduction, restoration of joint mobility, and improvement in functional ability and quality of life through exercises such as quadriceps strengthening, gait and balance training, and aerobic or aquatic exercises. Quadriceps strengthening helps stabilize the knee joint, reduce abnormal loading, and improve shock absorption, thereby decreasing joint stress during daily activities.

In addition to quadriceps weakness, patients with KOA commonly exhibit reduced calf muscle strength compared to healthy individuals. The calf muscles, particularly the gastrocnemius, play an important role in knee stabilization, load absorption, and functional movements such as walking. Altered gastrocnemius activation during weight-bearing activities can negatively affect knee biomechanics and contribute to disease progression. Muscle strengthening exercises have been shown to improve muscle strength, balance, and reduce joint inflammation in KOA patients.

Literature review: In a study carried out by Paul DeVita et al in 2018 weaker quadriceps increased the risk and progression of KOA, while strengthening the quadriceps improves pain, physical function, and quality of life by providing better knee stability and reducing joint stress.

A 2020 study by Ali M. Alshami et al. reported that compared to healthy adults, calf muscle weakness and atrophy is common in patients with KOA, with muscle strength notably decreased despite flexibility and girth not being significantly affected to be.

Zhanliang Tan et al in 2025 stated that HKE targeting gastronomies muscle effectively and safely alleviated knee pain and restored function.

A systemic review by Disha D hedge et al in 2025 states that Quadriceps strengthening as a part of lower extremity strengthening is effective in reducing pain in KOA. Emine Kiyak (2018) reported that about 81% of KOA patients significant difficulties in maintaining sleep. Patients with KOA suffered from night pain, which significantly disrupted sleep and contributed to poorer overall sleep quality, ultimately diminishing quality of life.

Вмешательства

• Другое Group A (Combined Quadriceps and Calf Strengthening)
  During weeks 1-2, Group A will receive a heating pad for 10 minutes followed by Grade II joint mobilization. This will be followed by strengthening exercises including quadriceps strengthening in the form of straight leg raises, quadriceps sets, and leg extension exercises with 1 kg weight. Calf strengthening exercises will also be performed, including standing heel raises, seated calf raises, and standing single heel raises with support. All exercises will be initially performed with 10 repetit
• Другое Group B( Conventional)
  During weeks 1-2, Group B will receive a heating pad for 10 minutes followed by Grade II joint mobilization. This will be followed by quadriceps strengthening in the form of straight leg raises, quadriceps sets, and leg extension exercises with 1 kg weight. All exercises will be initially performed with 10 repetitions and 1 set. During weeks 3-4, the exercise protocol will progress by increasing the repetitions to 12, sets to 2, and external resistance to 1.5 kg. During weeks 5-6, further prog

Первичные конечные точки

• Temporo-spatial Gait [Срок оценки: from baseline to 6 weeks]
• Quadriceps Strength [Срок оценки: from baseline to 6 weeks]
• Calf Strength [Срок оценки: from baseline to 6 weeks]

Вторичные конечные точки (4)

• Knee Pain [Срок оценки: from baseline to 6 weeks]
• knee Disability [Срок оценки: from baseline to 6 weeks]
• knee Function [Срок оценки: from baseline to 6 weeks]
• Sleep Quality [Срок оценки: from baseline to 6 weeks]

Критерии участия

Критерии включения

• Both Male and Female
• Participants aged 40-60years.
• Diagnosed with grade 2 and 3 of knee osteoarthritis according to Kellgren-Lawrence
• Quads manual muscle grading <4
• Ability to understand and comply with exercise instructions.

Критерии исключения

• History of recent knee surgery or trauma in the past six months.
• Inflammatory joint diseases (e.g., rheumatoid arthritis, gout).
• Severe cardiovascular or neurological disorders.
• Uncontrolled hypertension or diabetes.
• Participation in other physiotherapy or pharmacological interventions for knee OA during the study period.
• Cognitive impairment or inability to follow commands

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Другое

Центры проведения

Пакистан · 1 центр

• Hayatabad Medical Complex — Peshawar

Идентификаторы

NCT: NCT07402447 · RiphahIU - Sarah Rehman

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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