LLM-Guided Rehabilitation in Degenerative Knee Disease (LLM-RehabKnee)

Kirsehir Ahi Evran Universitesi

Status: Enrolling

Conditions: Degenerative Knee Disease

Treatments: Behavioral: ChatGPT-5-assisted exercise planning; Behavioral: DeepSeek V3.1-assisted exercise planning; Behavioral: Gemini 2.5 Pro-assisted exercise planning; Biological: Supervised conventional physiotherapy

Study type: Interventional

Funder types: Other

Identifiers

NCT07267962

2025/1056

Details and patient eligibility

About

This randomized, four-arm clinical trial will investigate the effects of large language model (LLM)-assisted exercise prescriptions integrated with conventional physiotherapy on pain, function and quality of life in adults with degenerative knee disease. Participants will be randomly assigned to conventional physiotherapy alone or to conventional physiotherapy plus an exercise program planned with the assistance of ChatGPT-5, Gemini 2.5 Pro, or DeepSeek V3.1. All participants will receive supervised outpatient physiotherapy two times per week for 8 weeks (16 sessions in total). Outcomes will be assessed at baseline and at the end of the 8-week intervention period by physiotherapists blinded to group allocation.

Full description

Degenerative knee disease, including knee osteoarthritis, is a common cause of pain, disability and loss of independence in middle-aged and older adults. Exercise-based rehabilitation is a core component of evidence-based management, but the content and progression of exercise programs often vary between clinicians. Large language models (LLMs) such as ChatGPT-5, DeepSeek V3.1 and Gemini 2.5 Pro can generate exercise suggestions based on clinical information and may support physiotherapists in designing and progressing individualized programs. However, their impact on clinical outcomes in degenerative knee disease has not been evaluated in randomized controlled trials.

This single-center, randomized, parallel-group clinical trial will be conducted in adults with degenerative knee disease referred to the physiotherapy clinic of Kirsehir Ahi Evran University. After written informed consent and baseline assessments, participants will be randomly assigned (1:1:1:1) to one of four groups. All groups will receive a standardized outpatient physiotherapy program including hot pack, conventional TENS, therapeutic ultrasound and strengthening, range of motion, proprioceptive and functional exercises for the knee joint. In the three experimental groups, the content and progression of the exercise program will be planned with the assistance of standardized prompts to ChatGPT-5, DeepSeek V3.1 or Gemini 2.5 Pro, and all LLM-generated suggestions will be reviewed for safety and appropriateness by physiotherapists before being implemented. Sessions will be delivered two times per week for 8 weeks (16 supervised visits) under the supervision of a physical medicine and rehabilitation specialist and physiotherapists.

Outcomes will be evaluated at baseline (week 0) and after the 8-week intervention by a physiotherapist blinded to group allocation. Main outcome domains include knee pain, knee-related patient-reported outcomes, objective functional performance tests, isometric muscle strength, knee range of motion, psychosocial factors and health-related quality of life. Data will be analyzed according to CONSORT guidelines for randomized trials.

Enrollment: 80 estimated patients

Sex: All

Ages: 40 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age between 40 and 65 years.
• Clinical and radiographic diagnosis of degenerative knee disease in the target knee.
• Knee pain in the target knee for at least 3 months.
• Ability to bear weight on the target limb and perform the planned functional tests.
• Sufficient cognitive and physical capacity to participate in an 8-week supervised exercise program.
• Willingness to participate and ability to provide written informed consent.

Exclusion criteria

• Intra-articular corticosteroid or similar injection to the target knee within the previous 3 months.
• Knee surgery on the target knee within the previous 6 months.
• Severe malalignment of the knee or concomitant severe neurological disease and/or balance disorder that would interfere with safe testing or exercise.
• Pregnancy or any systemic disease that would contraindicate participation in the rehabilitation program according to the physician.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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80 participants in 4 patient groups

Conventional physiotherapy

Active Comparator group

Description:

Participants receive supervised conventional physiotherapy including hot pack, TENS, ultrasound and a standardized knee exercise program two times per week for 8 weeks (16 sessions).

Treatment:

Biological: Supervised conventional physiotherapy

Conventional physiotherapy plus ChatGPT-5-assisted exercise planning

Experimental group

Description:

Participants receive supervised conventional physiotherapy plus an exercise program whose content and progression are planned with the assistance of the ChatGPT-5 large language model, under physiotherapist supervision, two times per week for 8 weeks (16 sessions).

Treatment:

Behavioral: ChatGPT-5-assisted exercise planning

Conventional physiotherapy plus DeepSeek V3.1-assisted exercise planning

Experimental group

Description:

Participants receive supervised conventional physiotherapy plus an exercise program whose content and progression are planned with the assistance of the DeepSeek V3.1 large language model, under physiotherapist supervision, two times per week for 8 weeks (16 sessions).

Treatment:

Behavioral: DeepSeek V3.1-assisted exercise planning

Conventional physiotherapy plus Gemini 2.5 Pro-assisted exercise planning

Experimental group

Description:

Participants receive supervised conventional physiotherapy plus an exercise program whose content and progression are planned with the assistance of the Gemini 2.5 Pro large language model, under physiotherapist supervision, two times per week for 8 weeks (16 sessions).

Treatment:

Behavioral: Gemini 2.5 Pro-assisted exercise planning