Comparative Effectiveness of Otago and Neuromuscular Exercise Programs in Knee Osteoarthritis

NCT07078526 | Not Yet Recruiting

• 1 other identifier: REC/RCR & AHS/24/0163
• Study Type: interventional
• Target: 58
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to compare the effects of the Otago Exercise Program (OEP) and neuromuscular exercises on pain, functional status, postural control, and balance in patients with knee osteoarthritis (KOA). A total of 58 participants with X-ray confirmed Grade 2-3 KOA will be enrolled from clinical centers in Lahore, Pakistan. Eligible participants will be randomly assigned to either the OEP group or the neuromuscular exercise group. Both groups will receive standardized physiotherapy alongside their respective interventions twice weekly for six weeks. Outcomes including pain (NPRS), functional status (WOMAC), dynamic mobility (TUG), and postural control (mCTSIB) will be measured at baseline, week 3, and week 6. Data will be analyzed to determine which intervention provides greater improvements in pain reduction, functional capacity, mobility, and balance. This study is expected to inform clinical practice by identifying a more effective exercise approach for managing KOA symptoms and enhancing patients' quality of life.

Conditions

Knee Osteoarthritis

Keywords

Otago Exercise Program; Neuromuscular Exercises; Knee Osteoarthritis; Pain Management; Functional Status; Postural Control; Balance

Outcome Measures

Primary Outcomes (1)

• Numeric Pain Rating Scale (NPRS)

  Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), a validated 0-10 scale where higher scores indicate greater pain. Change from baseline to 6 weeks will be analyzed.

  Baseline, Week 3, Week 6

Secondary Outcomes (3)

• Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

  Baseline, Week 3, Week 6

• Timed Up and Go (TUG)

  Baseline, Week 3, Week 6

• Modified Clinical Test of Sensory Interaction in Balance (mCTSIB)

  Baseline, Week 3, Week 6

Study Arms (2)

Otago Exercise Program

EXPERIMENTAL

Participants in this arm will receive the Otago Exercise Program (OEP) consisting of 17 structured exercises (5 strengthening and 12 balance/proprioception exercises). Each session includes warm-up and cool-down, and lasts approximately 40 minutes. Sessions will be supervised twice weekly for a total duration of six weeks, in addition to standard physiotherapy (hot pack and gentle stretching).

Other: Otago Exercise Program

Neuromuscular Exercise

ACTIVE COMPARATOR

Participants in this arm will receive a structured neuromuscular exercise protocol including functional, proprioceptive, and balance exercises such as side stepping, high knees march, pelvic lifts, bridging with marching, lateral leg step, sit to stand, single leg clock reach, and single leg stand. Each session includes warm-up and cool-down, lasts approximately 40 minutes, and will be supervised twice weekly for six weeks, alongside standard physiotherapy (hot pack and gentle stretching).

Other: Neuromuscular Exercise

Interventions

Otago Exercise Program OTHER

The Otago Exercise Program is a structured, progressive exercise regimen focusing on lower limb strengthening and balance retraining. It is performed twice weekly for six weeks under physiotherapist supervision, complementing standard physiotherapy care.

Also known as: OEP

Otago Exercise Program

Neuromuscular Exercise OTHER

The neuromuscular exercise intervention involves functional, proprioceptive, and balance exercises delivered twice weekly for six weeks under supervision, in addition to standard physiotherapy care.

Also known as: NME

Neuromuscular Exercise

Eligibility Criteria

• Age: 45 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 45 to 65 years
• X-ray confirmed Grade 2-3 knee osteoarthritis (Kellgren-Lawrence scale)
• NPRS pain score between 3 and 8
• TUG score ≥ 14 seconds
• Able and willing to participate in twice-weekly sessions for six weeks
• Signed informed consent

You may not qualify if:

• History of heart attack or stroke within the past year
• Knee or hip surgery within the past 6 months
• Resting systolic blood pressure \>160 mmHg or \<100 mmHg
• Resting diastolic blood pressure \>100 mmHg or \<60 mmHg
• Neurological disorders affecting balance
• Current participation in another exercise program
• Recent fractures, cancer, or vascular diseases

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Kulsoom Sultan Medical centre

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (6)

• .KATRE KA, PUSHPARAJ V, PAUL J. Effect of Otago Exercise Program (OEP) and Strength Training Program (STP) on leg strength and risk of fall among bilateral knee osteoarthritis patients. IJMAES. 2019;5(1):536-51.

  BACKGROUND

• Tauqeer S, Shakeel H, Ikram A, Kafeel F, ul Ain N, Farooq N. Frequency of Grade (III) Knee Osteoarthritis (OA) Among Women in Lahore Pakistan: Grade (III) Knee Osteoarthritis (OA) Among Women. Pakistan BioMedical Journal. 2021;4(2):258-62.

  BACKGROUND

• Rao RDM, Methe AD, Patil H, Prabhakar R. Effect of Otago exercise versus dual task net step exercise on balance and functional mobility in community dwelling elderly person with knee osteoarthritis-a randomised control trial. International Journal of Health Sciences and Research. 2021;11:179-87

  BACKGROUND

• Malik FB, Memon AG, Shah S, Latif D, Afzal MF, Memon SA. PREVALENCE OF KNEE OSTEOARTHRITIS AND QUALITY OF LIFE AMONG MIDDLE AGED ADULTS OF PAKISTAN: soi: 21-2017/re-trjvol06iss01p280. The Rehabilitation Journal. 2022;6(01):280-3

  BACKGROUND

• National Library of Medicine (U.S.). Exercise for osteoarthritis of the knee (NCT06329128). ClinicalTrials.gov. 2024. Available from: https://clinicaltrials.gov/ct2/show/NCT0632912

  BACKGROUND

• Yang Y, Wang K, Liu H, Qu J, Wang Y, Chen P, Zhang T, Luo J. The impact of Otago exercise programme on the prevention of falls in older adult: A systematic review. Front Public Health. 2022 Oct 20;10:953593. doi: 10.3389/fpubh.2022.953593. eCollection 2022.

  PMID: 36339194 BACKGROUND

MeSH Terms

Conditions

Osteoarthritis, Knee; Agnosia

Interventions

Muscle Stretching Exercises

Condition Hierarchy (Ancestors)

Osteoarthritis; Arthritis; Joint Diseases; Musculoskeletal Diseases; Rheumatic Diseases; Perceptual Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Exercise Therapy; Rehabilitation; Aftercare; Continuity of Patient Care; Patient Care; Therapeutics; Physical Therapy Modalities; Exercise; Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Mahnoor Butt, MSc OMPT

  Riphah International University

  PRINCIPAL INVESTIGATOR

• Amna Zia, Phd Scholar

  Mayo Hospital/ Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Samrood Akram, Phd Scholar

CONTACT

03324806143; samood.akram@riphah.edu.pk

Amna Zia, Phd Scholar

CONTACT

03244686993; amna_zia_17@live.com

Study Design

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

Model Details: Participants will be randomly assigned in a parallel manner to either the Otago Exercise Program group or the neuromuscular exercise group, receiving their assigned intervention concurrently over six weeks.

Study Record Dates

• First Submitted: July 14, 2025
• First Posted: July 22, 2025
• Study Start: July 15, 2025
• Primary Completion: November 15, 2025
• Study Completion: November 30, 2025
• Last Updated: July 22, 2025

Record last verified: 2025-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)