Comparative Effectiveness of Otago and Neuromuscular Exercise Programs in Knee Osteoarthritis

Riphah International University

Status: Not yet enrolling

Conditions: Knee Osteoarthritis

Treatments: Other: Otago Exercise Program; Other: Neuromuscular Exercise

Study type: Interventional

Funder types: Other

Identifiers

NCT07078526

REC/RCR & AHS/24/0163

Details and patient eligibility

About

This randomized controlled trial aims to compare the effects of the Otago Exercise Program (OEP) and neuromuscular exercises on pain, functional status, postural control, and balance in patients with knee osteoarthritis (KOA). A total of 58 participants with X-ray confirmed Grade 2-3 KOA will be enrolled from clinical centers in Lahore, Pakistan. Eligible participants will be randomly assigned to either the OEP group or the neuromuscular exercise group. Both groups will receive standardized physiotherapy alongside their respective interventions twice weekly for six weeks. Outcomes including pain (NPRS), functional status (WOMAC), dynamic mobility (TUG), and postural control (mCTSIB) will be measured at baseline, week 3, and week 6. Data will be analyzed to determine which intervention provides greater improvements in pain reduction, functional capacity, mobility, and balance. This study is expected to inform clinical practice by identifying a more effective exercise approach for managing KOA symptoms and enhancing patients' quality of life.

Full description

Knee osteoarthritis (KOA) is a highly prevalent degenerative joint disease that significantly impairs mobility, functional capacity, and balance, often resulting in increased fall risk and reduced quality of life. Exercise-based interventions are widely recognized as key components of conservative management for KOA, yet comparative evidence for specific programs remains limited.

This randomized controlled trial is designed to compare the effectiveness of the Otago Exercise Program (OEP) and neuromuscular exercises in managing pain, improving functional status, enhancing postural control, and restoring balance in patients with Grade 2-3 knee osteoarthritis.

Eligible participants aged 45-65 years, with confirmed KOA and fulfilling inclusion criteria, will be recruited from multiple clinical centers in Lahore, Pakistan. After providing informed consent, participants will be randomized into two groups using computer-generated allocation with concealed envelopes.

Group A (OEP group) will receive the Otago Exercise Program, which consists of 17 structured exercises targeting lower limb strength and balance. Each session will include a warm-up, exercise circuit, and cool-down, conducted twice per week for six weeks under supervision.

Group B (neuromuscular group) will perform a series of neuromuscular exercises focused on functional, proprioceptive, and balance training. This protocol, also including warm-up and cool-down, will match the frequency and duration of the OEP group.

Both groups will receive standardized physiotherapy, including pain-relief modalities and gentle stretching exercises. Outcome measures, Numeric Pain Rating Scale (NPRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Timed Up and Go (TUG), and Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), will be collected at baseline, 3 weeks, and 6 weeks by an independent blinded assessor.

Data will be analyzed using appropriate parametric and non-parametric tests to evaluate within-group and between-group differences over time. It is hypothesized that both exercise interventions will yield significant improvements in pain and functional measures, but the Otago Exercise Program may offer superior benefits in balance and mobility performance.

Findings from this study are expected to guide clinicians in selecting effective exercise regimens to optimize rehabilitation outcomes and reduce the burden of knee osteoarthritis in the community.

Enrollment: 58 estimated patients

Sex: All

Ages: 45 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults aged 45 to 65 years
• X-ray confirmed Grade 2-3 knee osteoarthritis (Kellgren-Lawrence scale)
• NPRS pain score between 3 and 8
• TUG score ≥ 14 seconds
• Able and willing to participate in twice-weekly sessions for six weeks
• Signed informed consent

Exclusion criteria

• History of heart attack or stroke within the past year
• Knee or hip surgery within the past 6 months
• Resting systolic blood pressure >160 mmHg or <100 mmHg
• Resting diastolic blood pressure >100 mmHg or <60 mmHg
• Neurological disorders affecting balance
• Current participation in another exercise program
• Recent fractures, cancer, or vascular diseases

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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58 participants in 2 patient groups

Otago Exercise Program

Experimental group

Description:

Participants in this arm will receive the Otago Exercise Program (OEP) consisting of 17 structured exercises (5 strengthening and 12 balance/proprioception exercises). Each session includes warm-up and cool-down, and lasts approximately 40 minutes. Sessions will be supervised twice weekly for a total duration of six weeks, in addition to standard physiotherapy (hot pack and gentle stretching).

Treatment:

Other: Otago Exercise Program

Neuromuscular Exercise

Active Comparator group

Description:

Participants in this arm will receive a structured neuromuscular exercise protocol including functional, proprioceptive, and balance exercises such as side stepping, high knees march, pelvic lifts, bridging with marching, lateral leg step, sit to stand, single leg clock reach, and single leg stand. Each session includes warm-up and cool-down, lasts approximately 40 minutes, and will be supervised twice weekly for six weeks, alongside standard physiotherapy (hot pack and gentle stretching).

Treatment:

Other: Neuromuscular Exercise