Knee osteoarthritis (OA) is a common degenerative joint disease in middle-aged and older adults and is frequently associated with pain, quadriceps weakness, reduced mobility, impaired proprioception, balance deficits, and limitations in daily functional activities. Exercise therapy is recommended as a first-line conservative treatment for early to moderate knee OA; however, conventional rehabilitation programs often rely on therapist supervision and lack objective, quantitative movement monitoring, real-time feedback, and personalized adjustment for home-based training. These limitations may reduce exercise adherence and make it difficult to ensure correct movement execution outside the clinical setting. The overall aim of this study is to develop and evaluate a digital rehabilitation exercise program and user interface for individuals with arthritis, using a smart elastic knee brace integrated with wearable sensing technology, surface electromyography biofeedback, joint-angle monitoring, multisensory stimulation, and artificial intelligence-based musculoskeletal monitoring. The proposed system is designed to provide personalized digital rehabilitation courses, real-time visual and auditory feedback, and objective assessment of movement performance to support knee joint motor control, gait retraining, and individualized rehabilitation planning for patients with knee OA. The investigators hypothesize that digital rehabilitation courses combined with multisensory stimulation, including neuromuscular electrical stimulation and vibration, will improve functional performance, movement quality, muscle activation, proprioception, and knee-related symptoms in patients with knee OA compared with conventional home exercise or gait retraining alone. The expected outcome of this study is to establish the feasibility, reliability, and clinical utility of a smart knee brace-based digital rehabilitation system for personalized knee OA management. This study will achieve the following four specific aims: Aim 1: To determine the feasibility of home-based exercise combined with electrical stimulation and the reliability of digital assessment for tracking exercise performance. Patients with knee OA and healthy adults will be recruited to complete selected quadriceps strengthening exercises based on exercise difficulty levels. Participants will perform a two-week home-based training program using exercise combined with electrical stimulation. Feasibility will be assessed using questionnaires, and movement performance will be tracked using inertial sensors during functional tasks. This aim will provide evidence regarding the practicality of integrating electrical stimulation into home-based rehabilitation and the reliability of digital monitoring for exercise performance. Aim 2: To evaluate the effects of digital rehabilitation exercise courses combined with multisensory stimulation in patients with knee OA and healthy adults. Participants will be randomly assigned to an experimental group or a control group. Both groups will complete a twelve-week home exercise program, three times per week for 40 minutes per session. The experimental group will follow the digital rehabilitation exercise course combined with electrical stimulation or vibration, whereas the control group will perform home exercises based on therapist education. Outcomes will be assessed at four time points: before training, after eight weeks of training, after twelve weeks of training, and six weeks after the intervention. Assessments will include pain, WOMAC scores, hemodynamic responses, muscle strength, electromyographic activity, proprioception, functional performance, body composition, knee structure, and biomechanical parameters. Aim 3: To determine the immediate effects of gait retraining combined with neuromuscular electrical stimulation in patients with knee OA. Patients with knee OA will be randomly assigned to either a gait retraining group or a gait retraining combined with neuromuscular electrical stimulation group. Both groups will receive a single 15-minute gait retraining intervention focused on modifying the foot progression angle. The experimental group will receive synchronized quadriceps electrical stimulation during gait training, while the control group will receive gait retraining alone. Pre- and post-intervention assessments will be performed to examine the immediate effects on gait parameters and functional movement performance. Aim 4: To develop and validate a personalized knee joint digital twin model using artificial intelligence, multisensory stimulation, and wearable sensing technology. This aim will develop an AI-based musculoskeletal monitoring system that integrates wearable sensor data, functional movement analysis, and personalized knee joint modeling. Patients with knee OA and healthy adults will perform functional tasks such as squatting, stair stepping, and walking under different stimulation conditions, including conti
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
100
Aim2: The experimental group will follow the digital rehabilitation exercise course combined with electrical stimulation or vibration for 12 weeks.
Aim2: The control group will perform home exercises based on therapist education for 12 weeks.
Aim3: The experimental group will receive synchronized quadriceps electrical stimulation during gait training for 15 minutes.
Aim3: The the control group will receive gait retraining alone for 15 minutes.
National Taiwan University Hospital
Taipei, Taiwan
NOT_YET_RECRUITINGSchool and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University
Taipei, Taiwan
NOT_YET_RECRUITINGTaipei Tzu Chi Hospital International Medical Service Center
Taipei, Taiwan
RECRUITINGPain Visual Analog Scale
Pain intensity will be assessed using the Visual Analog Scale. Participants will be asked to report their knee pain level before and after the intervention to evaluate changes in pain symptoms associated with the digital rehabilitation exercise program, multisensory stimulation, or gait retraining intervention.
Time frame: Pain Visual Analog Scale outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Western Ontario and McMaster Universities Osteoarthritis Index
Knee symptoms and functional limitations will be assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The questionnaire will be used to evaluate knee-related pain, stiffness, and physical function in patients with knee osteoarthritis.
Time frame: WOMAC outcome measure will be assessed before training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Electromyographic Muscle Activity
Muscle activity will be assessed using surface electromyography. Electrodes will be placed on the quadriceps and hamstring muscles to evaluate muscle activation patterns during functional movement tasks and exercise intervention.
Time frame: Electromyographic muscle activity outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Biomechanical Motion Analysis
Biomechanical movement parameters will be assessed using OpenCap markerless motion capture system and inertial measurement sensors. Joint angles, joint velocities, and related kinematic parameters will be analyzed during functional movement tasks. Force plate data will also be used to assess joint moments when applicable.
Time frame: Biomechanical motion analysis outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Feasibility of Home-Based Exercise Combined with Electrical Stimulation
The feasibility of performing home-based exercise combined with electrical stimulation will be assessed using feasibility-related questionnaires. The assessment will focus on participants' experience, acceptability, and practicality of using electrical stimulation during home-based rehabilitation exercise.
Time frame: Feasibility outcome measure will be assessed after completion of the 2-week home-based training program and will be reported through study completion.
Hemodynamics Analysis
Hemodynamic responses will be assessed using functional near-infrared spectroscopy. The analysis will focus on quadriceps muscle hemodynamics and cerebral hemodynamics during functional tasks and multisensory stimulation. Changes in hemodynamic parameters will be used to evaluate physiological responses associated with the intervention.
Time frame: Hemodynamics outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Knee Muscle Strength
Knee extensor and flexor muscle strength will be assessed using maximal voluntary isometric contraction measured by a handheld dynamometer.
Time frame: Knee muscle strength outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Knee Joint Proprioception
Knee joint proprioception will be assessed using inertial measurement sensors during a dynamic joint position sense test performed in a seated position. The assessment will be used to quantify the accuracy of knee joint position control.
Time frame: Knee joint proprioception outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Five-Times Sit-to-Stand Test
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Functional movement performance will be assessed using the Five-Times Sit-to-Stand Test. This test will be used to evaluate lower-extremity functional capacity and sit-to-stand performance.
Time frame: Five-Times Sit-to-Stand Test outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
10-Meter Walk Test
Walking performance will be assessed using the 10-Meter Walk Test. This test will be used to evaluate gait performance and walking ability in patients with knee osteoarthritis and healthy adults.
Time frame: Ten-Meter Walk Test outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Timed Up-and-Go Test
Functional mobility will be assessed using the Timed Up-and-Go Test. This test will be used to evaluate dynamic balance, mobility, and functional movement capacity.
Time frame: Timed Up-and-Go Test outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Weight-Bearing Knee Flexion
Weight-bearing knee flexion will be assessed during functional movement tasks. This outcome will be used to evaluate knee movement control and functional knee flexion capacity under weight-bearing conditions.
Time frame: Weight-bearing knee flexion outcome measure will be assessed before training, after 15 minutes of training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Body Composition
Body composition will be assessed using InBody based on segmental multi-frequency bioelectrical impedance analysis. Outcome variables will include body fat percentage, skeletal muscle mass, body weight, and body mass index.
Time frame: Body composition outcome measure will be assessed before training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.
Ultrasound Assessment of Knee Joint Structure
Knee joint structure will be assessed using ultrasound imaging. The assessment will include femoral cartilage thickness, suprapatellar bursa effusion, and meniscal extrusion, which are structural indicators related to knee osteoarthritis status.
Time frame: Ultrasound assessment outcome measure will be assessed before training, after 8 weeks of training, after 12 weeks of training, and 6 weeks after the intervention, and will be reported through study completion.