This randomized controlled trial aims to investigate the effects of motivational interviewing added to a neuromuscular exercise and home exercise program on pain self-efficacy, exercise behavior, pain intensity, physical performance, and functional status in individuals with knee osteoarthritis. Sixty individuals diagnosed with knee osteoarthritis will be randomly allocated to either an intervention group or a control group. The intervention group will receive motivational interviewing in addition to neuromuscular exercise and a home exercise program, whereas the control group will receive neuromuscular exercise and the same home exercise program. Outcomes will be assessed at baseline, immediately after the intervention, and six weeks after the intervention.
Diagnosis of knee osteoarthritis according to American College of Rheumatology (ACR) criteria
Kellgren-Lawrence radiographic grade ≥2
Knee pain lasting longer than 3 months
History of joint arthroplasty
Body mass index >40 kg/m²
Neuromuscular or neurological diseases such as stroke, Parkinson's disease, or multiple sclerosis
History of lower-extremity joint fracture
Parallel
Motivational Interviewing
BehavioralMotivational interviewing will be delivered individually in face-to-face sessions by a researcher trained and certified in motivational interviewing. Sessions will focus on identifying individual barriers and goals, strengthening motivation and commitment to exercise, supporting self-efficacy, and preventing relapse. The intervention will incorporate three stages: increasing exercise motivation, strengthening commitment to exercise, and relapse prevention.
Neuromuscular Exercise Program
Other interventionParticipants will perform neuromuscular exercise sessions five times per week for four weeks. Each 60-minute session will consist of approximately 10 minutes of warm-up, 40 minutes of exercise, and 10 minutes of cool-down. Exercises will include core stabilization and postural control, postural orientation, lower-extremity strengthening, functional exercises, and balance and proprioception exercises. Exercises will be progressed according to participant tolerance and functional performance.
Home Exercise Program
Other interventionThe home exercise program will include isometric strengthening exercises for the quadriceps and hip adductor muscles, straight leg raising, assisted hip and knee flexion, and active knee flexion exercises. Participants will perform the program five days per week, twice daily, for three weeks, with 10 repetitions of each exercise. The program will be explained and demonstrated by a physiotherapist during the first session, and adherence will be followed by telephone contact.
The Exercise Self-Efficacy Scale (ESE)
The Exercise Self-Efficacy Scale (ESE) measures a person's confidence in their ability to maintain regular physical activity or exercise when facing various internal and external barriers. Different validated versions exist, including Albert Bandura's 18-item scale, an older adult 9-item scale, and a 10-item spinal cord injury adaptation.
Pain Self-Efficacy Questionnaire (PSEQ)
The Pain Self-Efficacy Questionnaire (PSEQ) is a 10-item self-report tool designed to measure a person's confidence in performing daily activities and functioning normally despite ongoing chronic pain. It uses a 7-point scale from 0 to 6, yielding total scores between 0 and 60, where higher scores reflect stronger coping confidence.
Numerical Pain Rating Scale
The Numeric Pain Rating Scale (NPRs) is a fast, 11-point tool used to measure pain intensity. Patients select a whole number from 0 (no pain) to 10 (worst pain imaginable) to rate their discomfort verbally or in writing.
The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
The WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) is a widely used, self-administered 24-item questionnaire that evaluates pain (5 items), stiffness (2 items), and physical function (17 items) in patients with knee or hip osteoarthritis.
Physical Performance 30-Second Sit-to-Stand Test (30s STS)
The 30s STS measures lower-extremity functional strength by recording the total number of complete sit-to-stand repetitions performed within 30 seconds, with a higher number of repetitions indicating better performance.
Physical performance timed up and go test (TUG)
The TUG measures functional mobility as the time, in seconds, required to stand up from a chair, walk 3 meters, turn, walk back, and sit down, with a shorter completion time indicating better performance.
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