Total knee arthroplasty (TKA) is a common surgery used to treat advanced knee osteoarthritis, especially when other treatments no longer help. While the surgery often reduces pain and improves joint alignment, many patients still have problems with balance and movement afterward. This study will explore whether adding balance training using the Tecnobody ProKin system to standard physical therapy helps patients recover better after TKA. The researchers will measure balance, walking ability, leg strength, and body awareness (also called proprioception) using special equipment. The main goal is to test the hypothesis that technology-supported balance training improves recovery outcomes more effectively than standard rehabilitation alone.
Knee osteoarthritis is a prevalent condition among older adults, often leading to pain, reduced mobility, and functional limitations. When conservative treatments fail to provide adequate relief, total knee arthroplasty (TKA) is commonly performed. Although outcomes following TKA are generally satisfactory, patients may continue to experience impairments in proprioception and balance, which can negatively affect gait and postural control. Restoring balance and proprioceptive function is critical for optimizing functional recovery and quality of life after TKA. However, research shows that many patients fail to fully regain these abilities, even in the long term. Instrumented platforms are frequently used to objectively assess balance and proprioception, providing detailed parameters based on body sway during standing tasks. Previous studies have evaluated the effects of balance training using systems such as Biodex in TKA patients. However, no study has yet investigated the use of the Tecnobody ProKin dynamometric platform (Bergamo, Italy) to assess and train static and dynamic balance, proprioception, muscle strength, and gait within a controlled rehabilitation framework. This study is designed to generate scientific evidence on the effectiveness of balance training using the Tecnobody ProKin platform as an adjunct to standard rehabilitation in patients following total knee arthroplasty.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
46
Balance training using Tecnobody ProKin dynamometric platform, administered 5 sessions per week for 3 weeks in addition to standard rehabilitation.
The standard rehabilitation protocol includes cold pack application to the knee region, transcutaneous electrical nerve stimulation (TENS), quadriceps muscle stimulation, knee stretching, active-assisted and active range of motion (ROM) exercises, strengthening exercises for the knee extensors and hip abductors/extensors, gait training, and balance exercises. Each patient will undergo a total of 15 physical therapy sessions.
Ankara Etlik City Hospital
Ankara, Yenimahalle, Turkey (Türkiye)
RECRUITINGChange in statokinesiogram path length during eyes-open standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin platform. Represents the total distance traveled by the center of pressure (CoP) during static standing with eyes open (also referred to as perimeter). Lower values indicate better postural control.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in statokinesiogram path length during eyes-closed standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin platform. Represents the total distance traveled by the center of pressure (CoP) during static standing with eyes closed (also referred to as perimeter). Lower values indicate better postural control.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in ellipse area of center of pressure during eyes-open standing (Tecnobody ProKin)
Measured in mm² using the Tecnobody ProKin platform during static standing with eyes open. The ellipse area reflects postural sway dispersion. A reduction in this area indicates improved balance control without visual input.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in ellipse area of center of pressure during eyes-closed standing (Tecnobody ProKin)
Measured in mm² using the Tecnobody ProKin platform during static standing with eyes closed. The ellipse area reflects postural sway dispersion. A reduction in this area indicates improved balance control without visual input.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in average center of pressure position on the side-to-side (X) axis during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters (mm). Indicates the average center of pressure (CoP) position along the side-to-side (X) axis during eyes-open static standing. Deviations from the midline suggest postural asymmetry or uneven weight distribution.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in average center of pressure position on the forward-backward (Y) axis during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform. Indicates the average forward-backward (Y axis) position of the center of pressure (CoP) during eyes-open static standing. Deviations from neutral may reflect altered postural control or compensatory leaning in the sagittal plane.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in average center of pressure position on the side-to-side (X) axis during eyes-closed static standing (Tecnobody ProKin)
Measured in millimeters (mm). Indicates the average center of pressure (CoP) position along the side-to-side (X) axis during eyes-closed static standing. Deviations from the midline suggest postural asymmetry or uneven weight distribution.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in average center of pressure position on the forward-backward (Y) axis during eyes-closed static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform. Indicates the average forward-backward (Y axis) position of the center of pressure (CoP) during eyes-closed static standing. Deviations from neutral may reflect altered postural control or compensatory leaning in the sagittal plane.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Proprioception
Change in Proprioception will be assessed using an isokinetic dynamometer. The test will measure joint position sense (JPS) at 45° knee flexion. Participants will be passively moved to the target angle 45° and then asked to actively replicate the position without visual feedback. The absolute angular error between the target and reproduced angles will be recorded pre- and post-intervention. A reduction in angular error after the training will indicate an improvement in proprioceptive accuracy.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in KOOS (Knee injury and Osteoarthritis Outcome Score) Total Score
The KOOS (Knee injury and Osteoarthritis Outcome Score) is a patient-reported questionnaire evaluating knee pain, function, and quality of life. It includes five subscales: Pain, Symptoms, Activities of Daily Living, Sport/Recreation, and QOL. The total score is the average of these subscales, ranging from 0 (worst) to 100 (best). This outcome measures the change in total KOOS score from baseline to post-intervention, with higher scores indicating improved knee health.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in gait
Change in Gait will be evaluated using the Timed Up and Go (TUG) test. Participants will be timed as they rise from a chair, walk 3 meters, turn, return, and sit down. The test will be performed before and after the intervention. A decrease in time to complete the task will indicate improvement in gait speed and functional mobility.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Pain Level
Pain intensity will be assessed using the Visual Analog Scale (VAS), a 10 cm line where 0 indicates "no pain" and 10 indicates "worst possible pain." Participants will mark their perceived knee pain level at rest and during activity. The distance from the "no pain" anchor to the mark will be measured in millimeters. A decrease in VAS score after intervention will indicate pain reduction.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Balance Performance
BBS (Berg balance scale) evaluates static and dynamic balance; higher scores indicate improvement.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in single-leg stance time on the operated limb with eyes open
Balance will be assessed using the Single-Leg Stance Test. The participant is asked to stand on the operated limb with eyes open, and the time they can maintain the position without losing balance is recorded in seconds. Longer durations indicate better static balance and postural control.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in average center of pressure position on the forward-backward (Y) axis during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform.. Indicates the average center of pressure (CoP) position along the axis during eyes-open static standing. Deviations from neutral suggest compensatory leaning or altered sagittal balance.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in average center of pressure position on the side-to-side (X) axis during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform.. Indicates the average center of pressure (CoP) position along the side-to-side (X) axis during eyes-open static standing. Deviations from the midline suggest postural asymmetry or uneven weight distribution.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in standard deviation of center of pressure in the medio-lateral direction during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform. Indicates variability in medio-lateral CoP movement during eyes-open static standing. Lower values suggest more stable posture and reduced lateral sway.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in standard deviation of center of pressure in the medio-lateral direction during eyes-closed static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform. Indicates variability in medio-lateral CoP movement during eyes-closed static standing. Lower values suggest more stable posture and reduced lateral sway.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in standard deviation of center of pressure in the forward-backward direction during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform. Indicates variability in forward-backward CoP movement during eyes-open static standing. Higher values suggest reduced postural stability and increased sway in the sagittal plane.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in standard deviation of center of pressure in the forward-backward direction during eyes-closed static standing (Tecnobody ProKin)
Measured in millimeters (mm) using the Tecnobody ProKin dynamometric platform. Indicates variability in forward-backward CoP movement during eyes-closed static standing. Higher values suggest reduced postural stability and increased sway in the sagittal plane.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average sway velocity in the forward-backward direction during eyes-open static standing (Tecnobody ProKin)
Measured in millimeters per second (mm/sec) using the Tecnobody ProKin platform. Indicates the average velocity of center of pressure (CoP) movement in the forward-backward direction during eyes-open static standing. Lower velocities indicate improved postural control in the sagittal plane.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average sway velocity in the forward-backward direction during eyes-closed static standing (Tecnobody ProKin)
Measured in millimeters per second (mm/sec) using the Tecnobody ProKin platform. Indicates the average velocity of center of pressure (CoP) movement in the forward-backward direction during eyes-closed static standing. Lower velocities indicate improved postural control in the sagittal plane.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average sway velocity in the medio-lateral direction during eyes-open static standing (Tecnobody ProKin)
Description: Measured in millimeters per second (mm/sec) using the Tecnobody ProKin platform. Reflects the average velocity of CoP movement in the medio-lateral direction during eyes-open static standing. Reduced values suggest enhanced lateral stability and balance control.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average sway velocity in the medio-lateral direction during eyes-closed static standing (Tecnobody ProKin)
Description: Measured in millimeters per second (mm/sec) using the Tecnobody ProKin platform. Reflects the average velocity of CoP movement in the medio-lateral direction during eyes-closed static standing. Reduced values suggest enhanced lateral stability and balance control.
Time frame: Baseline, immediately after the 3-week intervention, and 6 weeks after the end of the intervention (follow-up at week 9)
Change in dynamic balance performance assessed by the Angular Target Evaluation test - Right Foot (Tecnobody ProKin)
Assessed using the A.T.E. (Angular Target Evaluation)test on the Tecnobody ProKin platform with the right foot. This dynamic balance test measures the ability to control the center of pressure (CoP) to reach visual targets on a moving platform. Metrics include time to target, accuracy, path efficiency, and postural stability. Improved performance indicates enhanced proprioceptive control, coordination, and dynamic balance of the right lower limb.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in knee flexion range of motion (ROM)
Knee flexion range of motion (ROM) will be measured using a standard goniometer with the participant in a supine position. The angle between the thigh and lower leg during active knee flexion will be recorded in degrees. Increases in ROM indicate improved joint mobility and functional recovery after total knee arthroplasty.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in knee extension range of motion (ROM)
Knee extension range of motion (ROM) will be measured using a standard goniometer with the participant in a supine position. The angle between the thigh and lower leg during active knee extension will be recorded in degrees. Decreases in extension deficit (i.e., movement closer to full extension) indicate improved joint mobility and functional recovery following total knee arthroplasty.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in single-leg stance time on the operated limb with eyes closed
Balance will be assessed using the Single-Leg Stance Test. The participant is asked to stand on the operated limb with eyes closed, and the time they can maintain the position without losing balance is recorded in seconds. Longer durations indicate better static balance and postural control.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in single-leg stance time on the non-operated limb with eyes open
Balance will be assessed using the Single-Leg Stance Test. The participant is asked to stand on the non-operated limb with eyes open, and the time they can maintain the position without losing balance is recorded in seconds. Longer durations indicate better static balance and postural control.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in single-leg stance time on the non-operated limb with eyes closed
Balance will be assessed using the Single-Leg Stance Test. The participant is asked to stand on the non-operated limb with eyes closed, and the time they can maintain the position without losing balance is recorded in seconds. Longer durations indicate better static balance and postural control.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in dynamic balance performance assessed by the Angular Target Evaluation test - Left Foot (Tecnobody ProKin)
Assessed using the A.T.E. (Angular Target Evaluation)test on the Tecnobody ProKin platform with the left foot. This dynamic balance test measures the ability to control the center of pressure (CoP) to reach visual targets on a moving platform. Metrics include time to target, accuracy, path efficiency, and postural stability. Improved performance indicates enhanced proprioceptive control, coordination, and dynamic balance of the left lower limb.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in KOOS (Knee injury and Osteoarthritis Outcome Score) Pain Subscale Score
The KOOS (Knee injury and Osteoarthritis Outcome Score) Pain subscale will be used to evaluate knee-related pain. Scores range from 0 (extreme problems) to 100 (no problems), with higher scores indicating better outcomes.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Health-Related Quality of Life
The 12-Item Short Form Health Survey (SF-12) is a patient-reported measure evaluating physical and mental components of health-related quality of life. Scores range from 0 to 100, with higher scores indicating better health status.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Anxiety Levels
The Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A) is a validated tool specifically designed to assess symptoms of anxiety in hospital settings. It includes 7 items, each scored from 0 to 3, yielding a total score ranging from 0 to 21. Lower scores indicate fewer anxiety symptoms, while higher scores reflect greater levels of anxiety.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Kinesiophobia
The Tampa Scale for Kinesiophobia (TSK) is a questionnaire that measures fear of movement or re-injury. Scores range from 17 to 68, with higher scores indicating greater fear.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in Functional Reach Distance
The Functional Reach Test (FRT) is a clinical measure used to assess dynamic balance and stability. It quantifies the maximum distance an individual can reach forward beyond arm's length while standing in a fixed position without losing balance. The outcome is measured in centimeters. An increase in reach distance from baseline to post-intervention indicates improvement in dynamic balance and postural control.
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in KOOS (Knee injury and Osteoarthritis Outcome Score) Symptoms Subscale Score
The KOOS Symptoms subscale assesses joint stiffness, swelling, and mechanical symptoms in the knee. Scores range from 0 (extreme problems) to 100 (no problems), with higher scores indicating better knee function.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in KOOS (Knee injury and Osteoarthritis Outcome Score) Activities of Daily Living (ADL) Subscale Score
This subscale evaluates difficulty with performing daily activities such as walking, climbing stairs, and standing. Scores range from 0 to 100, where higher scores reflect better functional ability in daily life.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in KOOS (Knee injury and Osteoarthritis Outcome Score) Sport and Recreation Subscale Score
This subscale measures the participant's ability to perform sport and recreational activities such as squatting, running, and jumping. Scores range from 0 (severe difficulty) to 100 (no difficulty).
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in KOOS (Knee injury and Osteoarthritis Outcome Score) Quality of Life (QOL) Subscale Score
This subscale captures the impact of knee problems on the participant's overall quality of life, including mental and social aspects. Scores range from 0 (very poor knee-related QOL) to 100 (no impact). Change in scores will indicate perceived recovery and satisfaction.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque of knee extensors at 180°/s
Assessed using an isokinetic dynamometer (Computer Sports Medicine Inc., Stoughton, MA, USA). Peak torque represents the maximum torque output of the knee extensor muscles during concentric contraction at an angular velocity of 180 degrees per second. Higher values indicate greater muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque of knee extensors at 60°/s
Assessed using an isokinetic dynamometer (Computer Sports Medicine Inc., Stoughton, MA, USA). Peak torque represents the maximum torque output of the knee extensor muscles during concentric contraction at an angular velocity of 60 degrees per second. Higher values indicate greater muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque of knee flexors at 180°/s
Assessed using an isokinetic dynamometer (Computer Sports Medicine Inc., Stoughton, MA, USA). Peak torque represents the maximum torque output of the knee flexor muscles during concentric contraction at an angular velocity of 180 degrees per second. Higher values indicate greater muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque of knee flexors strength at 60°/s
Assessed using an isokinetic dynamometer (Computer Sports Medicine Inc., Stoughton, MA, USA). Peak torque represents the maximum torque output of the knee flexor muscles during concentric contraction at an angular velocity of 60 degrees per second. Higher values indicate greater muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque to body weight ratio of knee extensors at 180°/s
Measured using an isokinetic dynamometer at 180°/s. This parameter expresses peak torque of the knee extensors relative to body weight (%), allowing comparison across individuals and limbs. Higher values indicate improved relative muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque to body weight ratio of knee extensors at 60°/s
Measured using an isokinetic dynamometer at 60°/s. This parameter expresses peak torque of the knee extensors relative to body weight (%), allowing comparison across individuals and limbs. Higher values indicate improved relative muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque to body weight ratio of knee flexor at 180°/s
Measured using an isokinetic dynamometer at an angular velocity of 180°/s. This parameter expresses peak torque of the knee flexors relative to body weight (%), allowing comparison across individuals and limbs. Higher values indicate improved relative muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque to body weight ratio of knee flexor at 60°/s
Measured using an isokinetic dynamometer at 60°/s. This parameter expresses peak torque of the knee flexors relative to body weight (%), allowing comparison across individuals and limbs. Higher values indicate improved relative muscle strength.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque ratio of knee flexor to extensor muscles at 60°/s
Measured using an isokinetic dynamometer. This outcome reflects the agonist/antagonist strength balance between the knee flexor (hamstring) and extensor (quadriceps) muscles. The ratio is calculated by dividing peak torque of the flexors by that of the extensors, measured at 60°/s. Balanced ratios are important for joint stability and injury prevention.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in peak torque ratio of knee flexor to extensor muscles at 180°/s
Measured using an isokinetic dynamometer. This outcome reflects the agonist/antagonist strength balance between the knee flexor (hamstring) and extensor (quadriceps) muscles. The ratio is calculated by dividing peak torque of the flexors by that of the extensors, measured at 180°/s. Balanced ratios are important for joint stability and injury prevention.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).
Change in total work of knee extensors at 180°/s
Total work will be assessed using an isokinetic dynamometer at an angular velocity of 180 degrees per second. It represents the cumulative torque generated by the knee extensor muscles across all repetitions during the test. Higher values indicate improved muscular endurance and sustained force production at higher speeds of movement.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in total work of knee flexors at 180°/s
Total work will be assessed using an isokinetic dynamometer at an angular velocity of 180 degrees per second. It represents the cumulative torque generated by the knee flexor muscles across all repetitions during the test. Higher values indicate improved muscular endurance and sustained force production at higher speeds of movement.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in fatigue index of knee extensors at 180°/s
Fatigue index will be assessed using an isokinetic dynamometer at an angular velocity of 180 degrees per second. It reflects the percentage decline in torque output across repeated maximal knee extension contractions. A lower fatigue index indicates improved muscular endurance and greater resistance to fatigue under high-speed loading conditions.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in fatigue index of knee flexors at 180°/s
Fatigue index will be assessed using an isokinetic dynamometer at an angular velocity of 180 degrees per second. It reflects the percentage decline in torque output across repeated maximal knee flexion contractions. A lower fatigue index indicates improved muscular endurance and greater resistance to fatigue under high-speed loading conditions.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in work per repetition of knee extensors at 60°/s
Work per repetition will be assessed using an isokinetic dynamometer at an angular velocity of 60 degrees per second. This parameter represents the mechanical work produced by the knee extensor muscles during each repetition of concentric contraction. It is calculated as the area under the torque-angle curve for a single repetition. Higher values indicate improved muscular performance and efficiency during isolated strength testing.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in work per repetition of knee flexors at 60°/s
Work per repetition will be assessed using an isokinetic dynamometer at an angular velocity of 60 degrees per second. This parameter represents the mechanical work produced by the knee flexor muscles during each repetition of concentric contraction. It is calculated as the area under the torque-angle curve for a single repetition. Higher values indicate improved muscular performance and efficiency during isolated strength testing.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average power per repetition of knee extensors at 60°/s
Average power per repetition will be measured using an isokinetic dynamometer at 60 degrees per second. It is calculated by dividing the work performed during each repetition by the time taken to complete that repetition. This parameter reflects the ability of the knee extensor muscles to generate force quickly and efficiently. Increased values are associated with enhanced functional performance in tasks requiring speed and strength, such as gait and balance.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average power per repetition of knee flexors at 60°/s
Average power per repetition will be measured using an isokinetic dynamometer at 60 degrees per second. It is calculated by dividing the work performed during each repetition by the time taken to complete that repetition. This parameter reflects the ability of the knee flexor muscles to generate force quickly and efficiently. Increased values are associated with enhanced functional performance in tasks requiring speed and strength, such as gait and balance.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average power per repetition of knee extensors at 180°/s
Average power per repetition will be measured using an isokinetic dynamometer at 180 degrees per second. It is calculated by dividing the work performed during each repetition by the time taken to complete that repetition. This parameter reflects the ability of the knee extensor muscles to generate force quickly and efficiently. Increased values are associated with enhanced functional performance in tasks requiring speed and strength, such as gait and balance.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in average power per repetition of knee flexors at 180°/s
Average power per repetition will be measured using an isokinetic dynamometer at 180 degrees per second. It is calculated by dividing the work performed during each repetition by the time taken to complete that repetition. This parameter reflects the ability of the knee flexor muscles to generate force quickly and efficiently. Increased values are associated with enhanced functional performance in tasks requiring speed and strength, such as gait and balance.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9)
Change in Depression Levels
The Hospital Anxiety and Depression Scale - Depression subscale (HADS-D) is a validated tool specifically designed to assess symptoms of depression in hospital settings. It consists of 7 items, each scored from 0 to 3, resulting in a total score ranging from 0 to 21. Lower scores indicate fewer depressive symptoms, while higher scores suggest greater levels of depression.
Time frame: At baseline (pre-intervention), immediately after the 3-week intervention (post-intervention), and 6 weeks after the end of the intervention (follow-up at week 9).