A randomized controlled trial will be conducted at the Department of Physiotherapy, Dr. Ziauddin Hospital and Al-Rayaz Hospital, Karachi, Pakistan. A total of 150 patients diagnosed with knee osteoarthritis, aged between 40-60 years, will be recruited through a non-probability purposive sampling technique. Written informed consent will be obtained from all eligible participants prior to enrollment. The participants will be randomly allocated by the help of computer generated randomization sheet, into two groups i.e. experimental and the control group, with 75 participants in each group. Group A (experimental group) will receive diagonal proprioceptive neuromuscular facilitation (PNF) pattern exercises, while Group B (control group) will receive conventional strength training exercises. Heat therapy will be administered to both groups. All participants will be assessed using a standardized assessment form. Outcome measures will include pain intensity, knee range of motion, functional disability, hamstring flexibility, dynamic balance, and fatigue level. A single blinded assessor will assess all participants at baseline and at post intervention. Treatment sessions will be given thrice a week on alternate days for 6 weeks.
Both male and females with an age range between 40-60 years.
Patients diagnosed with unilateral or bilateral Knee OA.
Grade-II or grade-III on kellgren and Lawrence classification.
Patients having pain intensity more than 3.4 cm on VAS as minimum cut off value.
Patients with any neurological disorder.
History of lower limb arthroplasty or any other knee surgery.
Septic knee arthritis.
Inflammatory rheumatic disease such as rheumatoid arthritis and gout.
Parallel
Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises
Other interventionDiagonal PNF pattern exercises include Diagonal 1 and Diagonal 2 lower limb pattern movements performed against resistance to improve strength, flexibility, and functional performance.
Conventional Strength Training Exercises
Other interventionThe conventional strength training exercises include quadriceps and hip abductor strengthening performed using resisted active movements to improve muscle strength and functional ability.
Heat Therapy
Other interventionHeat therapy will be given for 10 minutes by the help of electric heating pad.
Change in pain intensity will be assessed with Visual Analogue Scale
The Visual Analogue Scale is a unidimensional measure of pain intensity, used to record patients' pain progression, or assess pain severity in different conditions. It is 0 to 10 cm scale. Patients rate their pain on the scale. Higher the score in centimeter, severe will be the pain experienced.
Change in range of motion will be assessed with Universal Goniometer
The universal goniometer is an instrument for the precise measurement of range of movement angles in degree, especially one used to measure the angles before and after range of motion. Increase in the degree of angle suggests increase in range of movement.
Change in functional disability will be assessed with Knee Injury and Osteoarthritis Outcome Score (KOOS)
The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific instrument, developed to assess the patients' opinion about their knee and associated problems regarding functional disability. It consists of total 100 scores. Increase in scores suggests better function and decrease in scores suggests increased functional disability.
Change in hamstring flexibility will be assessed with Active Knee Extension test.
The Active Knee Extension (AKE) test will be used to assess hamstring muscle length using a goniometer with the hip flexion position at 90°. A greater knee extension angle indicates greater hamstring muscle length.
Change in dynamic balance will be assessed with Four Step Square Test (FSST)
The Four Square Step Test will be used to assess dynamic balance. It is measured in seconds. A higher completion times indicate poorer dynamic balance and a greater risk of falls.
Change in fatigue level will be assessed with Multidimensional Fatigue Inventory questionnaire.
The multidimensional fatigue inventory is a 20-item scale designed to evaluate five dimensions of fatigue: general fatigue, physical fatigue, reduced motivation, reduced activity, and mental fatigue. Higher total scores correspond with more acute levels of fatigue.
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