Examining the Effect of Neuromuscular Exercises on Movement Control in Hip & Knee Osteoarthritis: A Randomised Proof of Concept and Feasibility Study

NCT06963892 | Completed

• 2 other identifiers: 71072.A1306886
• Study Type: interventional
• Target: 90
• Locations: 1 country
• Sites: 1

Brief Summary

This completed study evaluated the effects of a six-week neuromuscular exercise programme on movement control in individuals with hip and/or knee osteoarthritis (OA). The trial also assessed the feasibility of conducting a future definitive randomised controlled trial. A total of 90 participants with symptomatic hip or knee OA were recruited from NHS outpatient physiotherapy clinics and cluster-randomised to either an intervention group or a control group. The intervention group received a structured neuromuscular exercise programme based on the GLA:D® approach, delivered once weekly for six weeks. The control group received usual care, including general physiotherapy advice and standard exercises. The primary outcome was change in movement control, assessed using the Short Hip and Lower Limb Movement Screen (Short-HLLMS) at baseline and six weeks. Secondary outcomes included joint-specific function measured by KOOS-12 and HOOS-12 questionnaires, and pain intensity assessed using the Numeric Pain Rating Scale (NPRS). Feasibility measures included recruitment rate, participant adherence, and study retention. The study was completed successfully and demonstrated that neuromuscular exercise may improve short-term movement control and functional outcomes in individuals with OA. Feasibility outcomes supported the acceptability of the intervention and the procedures for conducting a future large-scale trial.

Conditions

Osteoarthritis; Hip; Knee OA; Motor Control

Keywords

Hip and Knee Osteoarthritis; Movement Control; Movement Screening Tools; Neuromuscular Exercise; Feasibility Study; Proof of Concept

Outcome Measures

Primary Outcomes (1)

• Change in movement control measured by the Short Hip and Lower Limb Movement Screen (Short-HLLMS)

  The Short Hip and Lower Limb Movement Screen (Short-HLLMS) was used to objectively assess participants' movement control, alignment, and joint stability. The screen evaluated three functional tasks: small knee bend, standing hip flexion, and deep squat. Lower scores indicate better movement quality and control. Assessments were performed at baseline (pre-intervention) and immediately following the six-week intervention period (post-intervention). The primary outcome measure was the change in Short-HLLMS scores from baseline to six weeks.

  Baseline (pre-intervention) and at 6 weeks (post-intervention)

Secondary Outcomes (4)

• Change in Knee-specific Function (KOOS-12)

  Baseline (pre-intervention) and at 6 weeks (post-intervention)

• Change in Hip-specific Function (HOOS-12)

  Baseline (pre-intervention) and at 6 weeks (post-intervention)

• Change in Pain Intensity (Numeric Pain Rating Scale)

  Baseline (pre-intervention) and at 6 weeks (post-intervention)

• Feasibility of the Intervention (Recruitment and Retention Rates)

  Measured continuously during recruitment and across the 6-week intervention period

Study Arms (2)

Neuromuscular Exercise Intervention

EXPERIMENTAL

Participants attended six supervised group exercise sessions over six weeks. Each session (\~60 min) included structured neuromuscular exercises focusing on joint stability, functional movement retraining, balance, proprioception, and muscle strengthening, following principles from the Good Life with osteoArthritis in Denmark (GLA:D®) programme. Exercises were progressed based on individual capability and pain tolerance.

Behavioral: Neuromuscular Exercise Programme (GLA:D®-based

Usual Physiotherapy Care

ACTIVE COMPARATOR

Participants received usual care provided by NHS physiotherapy outpatient services. This involved standard joint mobility exercises, strengthening activities, general advice, and education typically offered to patients with hip or knee osteoarthritis, without specific emphasis on structured neuromuscular control training.

Behavioral: Usual Physiotherapy Care (NHS Standard)

Interventions

Neuromuscular Exercise Programme (GLA:D®-based BEHAVIORAL

Participants underwent supervised neuromuscular exercise sessions based on the Good Life with osteoArthritis in Denmark (GLA:D®) programme. Exercises targeted dynamic joint stability, balance, proprioception, functional movements, and muscle strengthening. Sessions were held once weekly, lasting approximately 60 minutes each, over six consecutive weeks. The intervention was tailored progressively to each participant's capabilities, symptoms, and pain tolerance.

Also known as: Neuromuscular training; sensorimotor exercise

Neuromuscular Exercise Intervention

Usual Physiotherapy Care (NHS Standard) BEHAVIORAL

Participants received standard NHS physiotherapy care for hip or knee osteoarthritis. This included routine joint mobility exercises, strengthening activities, general education, and advice. Sessions were delivered in outpatient clinics following standard practice without specific emphasis on neuromuscular control training. Frequency and duration-matched usual clinical care.

Also known as: Routine physiotherapy, Standard OA physiotherapy

Usual Physiotherapy Care

Eligibility Criteria

• Age: 30 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 30 years or older.
• Clinically diagnosed symptomatic hip and/or knee osteoarthritis (unilateral or bilateral).
• Meeting the American College of Rheumatology (ACR) clinical criteria for osteoarthritis.
• Able to safely participate in neuromuscular exercises and movement screening tests.

You may not qualify if:

• Acute septic arthritis.
• Inflammatory arthritis (e.g., rheumatoid arthritis).
• Avascular necrosis of the hip or knee.
• Recent steroid injections (within the past 3 months).
• Knee or hip surgery within the previous 12 months.
• Significant cardiorespiratory or systemic disorders limiting exercise participation.
• Neurological conditions (e.g., stroke, Parkinson's disease, multiple sclerosis).
• Body mass index (BMI) greater than 35 kg/m².
• Severe low back pain restricting activity.
• Cognitive impairment affecting ability to follow study instructions.
• Skin conditions affecting lower limbs, preventing safe participation in exercises.
• Inability to communicate effectively in English or understand the consent information.

Sponsors & Collaborators

• University of Southampton: lead
• Ashford and St. Peter's Hospitals NHS Trust: collaborator

Study Sites (1)

Ashford & St Peters NHS Hospital

Chertsey, Surrey, TW15 3AA, United Kingdom

Location

Related Publications (1)

• Abramoff B, Caldera FE. Osteoarthritis: Pathology, diagnosis, and treatment options. Med Clin North Am. 2020;104(2):293-311. Ageberg E, Roos EM. Neuromuscular exercise as treatment of degenerative knee disease. Exerc Sport Sci Rev. 2015;43(1):14-22. Ageberg E, Link A, Roos EM. Feasibility of neuromuscular training in patients with severe hip or knee OA: the individualised goal-based NEMEX-TJR training programme. BMC Musculoskelet Disord. 2010;11(1):126. Ageberg E, Nilsdotter A, Kosek E, Roos EM. Effects of neuromuscular training (NEMEX-TJR) on function and quality of life in individuals with hip and knee osteoarthritis: A randomised controlled trial. Osteoarthritis Cartilage. 2010;18(8):971-6. Atkinson G, Nevill AM. Selected issues in the design and analysis of sport performance research. J Sports Sci. 2001;19(10):811-27. Booysen N, Wilson DA, Lewis CL, Warner MB, Gimpel M, Mottram S, et al. Assessing movement quality using the hip and lower limb movement screen: development, reliability and potential applications. J Musculoskelet Res. 2019;22(3-4):1950008. King LK, Birmingham TB, Callaghan JP, et al. Personalised neuromuscular interventions in osteoarthritis rehabilitation: A step toward precision medicine. J Orthop Res. 2023;41(5):789-804. Skou ST, Roos EM. Good Life with osteoArthritis in Denmark (GLA:D®): Evidence-based education and supervised neuromuscular exercise for patients with knee and hip osteoarthritis. BMC Musculoskelet Disord. 2017;18(1):72. Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthritis Cartilage. 2007;15(9):981-1000. Gandek B, Roos EM, Franklin PD, Ware JE. A 12-item short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-12): tests of reliability, validity and responsiveness. Osteoarthritis Cartilage. 2019;27(5):762-70. Gandek B, Roos EM, Franklin PD, Ware JE. A 12-item short form of the Hip disability and Osteoarthritis Outcome Score (HOOS-12): tests of reliability, validity and responsiveness. Osteoarthritis Cartilage. 2019;27(5):754-61.

  BACKGROUND

MeSH Terms

Conditions

Osteoarthritis; Osteoarthritis, Knee

Condition Hierarchy (Ancestors)

Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases

Study Officials

• Umer Umer Sheikh, MSc

  University of Southampton, School of Health Sciences

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: August 24, 2023
• First Posted: May 9, 2025
• Study Start: July 18, 2023
• Primary Completion: March 7, 2025
• Study Completion: March 7, 2025
• Last Updated: May 9, 2025

Record last verified: 2023-08

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)