Knee osteoarthritis is a common degenerative joint disorder characterized by joint pain, stiffness, limited mobility, and reduced quality of life. It primarily affects the elderly population and poses a major burden on functional independence and healthcare resources. While various physiotherapy approaches have shown benefits in managing KOA symptoms, Mulligan's Mobilization with Movement is a manual therapy technique that has gained clinical attention for improving pain and joint mechanics. Similarly, Egoscue postural alignment exercises, which focus on restoring musculoskeletal balance through corrective movement patterns, have shown potential in addressing chronic pain and postural dysfunction, though evidence remains limited in knee osteoarthritis populations. This study aims to evaluate the effects of Egoscue exercises with and without MWM on pain, range of motion, balance, and quality of life in patients with knee osteoarthritis
This single-blinded randomized clinical trial will be conducted at Riphah Clinic and Sir Ganga Ram Hospital, Lahore, over 10 months following ethical approval. A total of 56 participants, diagnosed with KOA based on clinical criteria, will be recruited using non probability purposive sampling and randomly assigned to two groups. Group A will receive Egoscue exercises, MWM, and conventional physiotherapy exercises, while Group B will receive Egoscue exercises and conventional physiotherapy only. Each group will undergo treatment five times per week for 3 weeks, with each session lasting 45 minutes. Pre- and post-intervention assessments will include pain (NPRS), range of motion (Goniometry), balance (Timed Up and Go Test), and quality of life (EQ-5D-5L). Data will be analyzed using SPSS to determine the comparative effectiveness of the interventions in improving functional and clinical outcomes among KOA.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
56
The exercises will consist of: knee drops, standing knee pillow squeezer, hook-lying knee pillow squeezer, floor/knee block, kneeling groin stretch, assisted runners stretch, sitting double, sitting single switch, counter stretch (wall) and supine foot circles. Mobilization with Movement (MWM) will be implemented after completing the Egoscue routine. This will include a medial tibial glide that is done in a non-weight bearing (NWB) position.
The exercises will consist of: knee drops, standing knee pillow squeezer, hook-lying knee pillow squeezer, floor/knee block, kneeling groin stretch, assisted runners stretch, sitting double, sitting single switch, counter stretch (wall) and supine foot circles. The exercises will be done with great caution of body alignment and posture
Acme Medical Center
Lahore, Punjab Province, Pakistan
Numeric Pain Rating Scale for pain
The Numerical Pain Rating Scale (NPRS) is an 11-point scale, in which patients rate their pain in levels ranging between 0 (no pain) and 10 (worst imaginable pain). It is common because it is simple, has high test-retest reliability (ICC = 0.95) and responsiveness in musculoskeletal disorders, such as in knee osteoarthritis. A minimum of 2 points on NPRS is termed the minimal clinically important difference (MCID) on patients with musculoskeletal pain even with KOA.
Time frame: upto 4 weeks
Goniometer for ROM
Goniometry is a clinical instrument that can be used to evaluate the joint angles both in active and passive range of motion. It is said to be valid in knee flexion and extension (ICC values range between 0.85 and 0.99 with respect to experience of examiners), with a standard error of measurement of approximately 3-5 degrees. The MCID of range of motion may depend on the improvement in the range of motion; the range of improvement of at least 5-10 degrees in the knee flexion or extension is usually regarded as clinically significant in patients with KOA
Time frame: Upto 4 weeks
Timed Up and Go - TUG Test
Timed Up and Go (TUG) test refers to the time that the person requires to be seated on a chair, stand up, walk three meters, turn around, walk back, and reseat. It is a valid and reliable (ICC = 0.99) indicator of dynamic balance and functional mobility, with a sensitivity of 87% and specificity of 87% of predicting fall risk in older people. TUG is frequently employed to evaluate the improvement of balance and fall prevention in KOA patients. A difference of about 0.8 to 1.4 seconds is reported to be an MCID in older adults and KOA populations, which is a significant reduction in mobility and risk of falls
Time frame: Upto 4 weeks
Euro Qol-5D-5L
The EQ-5D is a standardized instrument that assesses the quality of life related to health in five dimensions which are mobility, self-care, normal activities, pain/discomfort and anxiety/depression. It is well-construct valid and test-retest reliable (ICC = 0.86 -0.90), and sensitive to clinical changes in chronic arthritis such as osteoarthritis. In the case of musculoskeletal and osteoarthritis patients, the EQ-5D index score should be changed by at least 0.074, which is the minimal rate of improvement in the health-related quality of life
Time frame: Upto 4 weeks
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