Effects of Diagonal Proprioceptive Neuromuscular Facilitation Patterns on Pain and Functional Outcomes in Patients With Knee Osteoarthritis
1 other identifier
interventional
150
1 country
2
Brief Summary
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.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable
Started Feb 2026
2 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
February 1, 2026
CompletedStudy Start
First participant enrolled
February 7, 2026
CompletedFirst Posted
Study publicly available on registry
February 9, 2026
CompletedPrimary Completion
Last participant's last visit for primary outcome
January 19, 2027
ExpectedStudy Completion
Last participant's last visit for all outcomes
February 22, 2027
February 11, 2026
February 1, 2026
12 months
February 1, 2026
February 7, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (2)
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.
Baseline and after 6 weeks of intervention
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.
Baseline and after 6 weeks of intervention.
Secondary Outcomes (4)
Change in functional disability will be assessed with Knee Injury and Osteoarthritis Outcome Score (KOOS)
Baseline and after 6 weeks of intervention.
Change in hamstring flexibility will be assessed with Active Knee Extension test.
Baseline and after 6 weeks of intervention.
Change in dynamic balance will be assessed with Four Step Square Test (FSST)
Baseline and after 6 weeks of intervention.
Change in fatigue level will be assessed with Multidimensional Fatigue Inventory questionnaire.
Baseline and after 6 weeks of intervention.
Study Arms (2)
Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises + Heat Therapy.
EXPERIMENTALThis arm will receive PNF pattern exercises using Diagonal 1 and Diagonal 2 Lower Limb Patterns of PNF and the heat therapy
Conventional Strength Training Exercises + Heat Therapy
ACTIVE COMPARATORThis arm will receive evidence based treatment of Quadripceps and Hip Abductor Strengthening exercises and the heat therapy.
Interventions
Diagonal PNF pattern exercises include Diagonal 1 and Diagonal 2 lower limb pattern movements performed against resistance to improve strength, flexibility, and functional performance.
The conventional strength training exercises include quadriceps and hip abductor strengthening performed using resisted active movements to improve muscle strength and functional ability.
Heat therapy will be given for 10 minutes by the help of electric heating pad.
Eligibility Criteria
You may qualify if:
- 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.
- Duration of knee OA more than 3 months (chronic).
You may not qualify if:
- 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.
- Cancer or any other malignancy such as bone tumor.
- Knee deformities such as contracture, genu valgum and genu varum.
- History of ligamentous injury and meniscal tear.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (2)
Al-Rayaz Hospital
Karachi, Sindh, 74600, Pakistan
Dr. Ziauddin Hospital
Karachi, Sindh, 74600, Pakistan
Related Publications (4)
Nafees K, Baig AAM, Ali SS, Ishaque F. Dynamic soft tissue mobilization versus proprioceptive neuromuscular facilitation in reducing hamstring muscle tightness in patients with knee osteoarthritis: a randomized control trial. BMC Musculoskelet Disord. 2023 Jun 2;24(1):447. doi: 10.1186/s12891-023-06571-y.
PMID: 37268961BACKGROUNDGao B, Li L, Shen P, Zhou Z, Xu P, Sun W, Zhang C, Song Q. Effects of proprioceptive neuromuscular facilitation stretching in relieving pain and balancing knee loading during stepping over obstacles among older adults with knee osteoarthritis: A randomized controlled trial. PLoS One. 2023 Feb 13;18(2):e0280941. doi: 10.1371/journal.pone.0280941. eCollection 2023.
PMID: 36780435BACKGROUNDGeng R, Li J, Yu C, Zhang C, Chen F, Chen J, Ni H, Wang J, Kang K, Wei Z, Xu Y, Jin T. Knee osteoarthritis: Current status and research progress in treatment (Review). Exp Ther Med. 2023 Aug 25;26(4):481. doi: 10.3892/etm.2023.12180. eCollection 2023 Oct.
PMID: 37745043BACKGROUNDSong Q, Shen P, Mao M, Sun W, Zhang C, Li L. Proprioceptive neuromuscular facilitation improves pain and descending mechanics among elderly with knee osteoarthritis. Scand J Med Sci Sports. 2020 Sep;30(9):1655-1663. doi: 10.1111/sms.13709. Epub 2020 Jun 1.
PMID: 32407583BACKGROUND
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Rabia Hassan, MSAPT
Ziauddin University
- STUDY CHAIR
Basit Ansari, PhD
University of Karachi
- STUDY DIRECTOR
Aftab Ahmed Mirza Baig, PhD
IQRA University
Central Study Contacts
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- SINGLE
- Who Masked
- OUTCOMES ASSESSOR
- Masking Details
- Data analyst will also be blinded.
- Purpose
- TREATMENT
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Principal Investigator
Study Record Dates
First Submitted
February 1, 2026
First Posted
February 9, 2026
Study Start
February 7, 2026
Primary Completion (Estimated)
January 19, 2027
Study Completion (Estimated)
February 22, 2027
Last Updated
February 11, 2026
Record last verified: 2026-02
Data Sharing
- IPD Sharing
- Will not share
Results will be published by the investigators in academic journals. Sharing of generated study data will be carried out in several different ways. We plan to make our results available to researchers and potential collaborators interested in physical medicine rehabilitation and knee osteoarthritis management.