Comparison of Open Vs Closed Kinetic Chain Exercises in Genu Recurvatum Among Stroke Patients

NCT07670728 | Enrolling By Invitation DMC

• 1 other identifier: 4536
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

Brief Summary The goal of this clinical trial is to learn which type of exercise is more effective for reducing knee hyperextension in people who have had a stroke. Knee hyperextension, also called genu recurvatum, occurs when the knee bends too far backward while standing or walking. This problem is common after a stroke and can make walking difficult, reduce balance, increase the risk of falls, and place extra stress on the knee joint. Over time, it may also lead to pain, joint damage, and reduced independence in daily activities. Stroke is one of the leading causes of long-term disability. Many people who survive a stroke experience weakness, muscle stiffness, balance problems, and difficulty controlling movement on one side of the body. These changes can affect the way a person walks. One common walking problem after stroke is knee hyperextension during the part of walking when the foot is on the ground. This may happen because of muscle weakness, poor balance, reduced body awareness, or difficulty controlling movement. As a result, people may walk more slowly, feel less confident when moving, and have difficulty performing everyday tasks. Physical therapy plays an important role in helping people recover after a stroke. Exercise programs are commonly used to improve strength, balance, walking ability, and overall function. Two types of exercises frequently used in rehabilitation are Open Kinetic Chain (OKC) exercises and Closed Kinetic Chain (CKC) exercises. However, there is limited research directly comparing these exercise approaches for treating knee hyperextension after stroke. Open Kinetic Chain exercises involve moving the leg freely while the foot is not fixed to the ground. Examples include straight leg raises, knee extensions while sitting, hip abduction, hip adduction, and hamstring curls. These exercises are often used to strengthen specific muscles and improve movement control. Closed Kinetic Chain exercises involve movements performed with the foot fixed on the ground or another stable surface. Examples include squats, lunges, step-ups, and side step exercises. These exercises require several joints and muscle groups to work together and may better reflect movements used in everyday activities such as standing, walking, and climbing stairs. They may also improve balance and body awareness. The main questions this study aims to answer are:

• Does Closed Kinetic Chain exercise reduce knee hyperextension more effectively than Open Kinetic Chain exercise?
• Does Open Kinetic Chain exercise improve knee control and walking ability after stroke?
• Which exercise program leads to greater improvements in muscle strength, balance, mobility, and independence in daily activities?
• Can these exercise programs be safely used as part of stroke rehabilitation? Researchers will compare the effects of these two exercise programs in adults who have experienced a stroke and have weakness on one side of the body. Participants must be able to walk with at least minimal assistance and meet other study requirements. People with certain musculoskeletal conditions, severe communication or cognitive difficulties, or other conditions that may interfere with participation will not be eligible to take part. A total of 60 participants will be enrolled in the study. Participants will be assigned by chance, similar to flipping a coin, to one of two treatment groups. Thirty participants will receive Closed Kinetic Chain exercises, and thirty participants will receive Open Kinetic Chain exercises. Neither participants nor researchers can choose which group a participant joins. Both groups will continue to receive standard rehabilitation care throughout the study. Participants will:
• Attend supervised physical therapy sessions three times per week for four weeks.
• Complete a total of 12 treatment sessions.
• Perform exercises designed to improve lower limb strength and movement control.
• Receive either Open Kinetic Chain or Closed Kinetic Chain exercises based on random assignment.
• Continue their routine rehabilitation program alongside the study exercises.
• Complete assessments before starting treatment and again after completing the intervention period. Participants assigned to the Open Kinetic Chain exercise group may perform activities such as:
• Straight leg raises while lying down.
• Knee extensions while sitting.
• Hip abduction exercises.
• Hip adduction exercises.
• Hamstring curl exercises. Participants assigned to the Closed Kinetic Chain exercise group may perform activities such as:
• Lunges.
• Semi-squats.
• Forward step-up and step-down exercises.
• Side step-up and step-down exercises. Researchers will measure several outcomes before and after the treatment period. These measurements will help determine whether either exercise program improves movement and function.

Conditions

Cerebrovascular Accident (Stroke); Knee Hyperextension; Genu Recurvatum

Keywords

Stroke; Genu Recurvatum; Knee Hyperextension; Open Kinetic Chain Exercises; Closed Kinetic Chain Exercises

Outcome Measures

Primary Outcomes (2)

• Knee hyperextension with Goniometer

  Knee hyperextension is measured using a universal goniometer to determine the degree to which the knee extends beyond the neutral anatomical position (0°). The patient lies in a supine position with the lower limb fully supported. The fulcrum of the goniometer is placed over the lateral epicondyle of the femur, the stationary arm is aligned with the greater trochanter of the femur, and the movable arm is aligned with the lateral malleolus of the fibula. The patient actively or passively extends the knee to its maximum range. Any extension beyond 0° is recorded as hyperextension (e.g., 5°, 10°, or 15° hyperextension).

  Assessment takes approximately 2-5 minutes per knee and may be performed at baseline and after the intervention period (e.g., 6-8 weeks) to evaluate changes in knee alignment and range of motion.

• Muscle Strength with dynamometer

  The dynamometer is an objective and reliable tool used to measure muscle strength by quantifying the force generated during a muscle contraction. During testing, the participant performs a maximal voluntary isometric contraction against the dynamometer. Dynamometers are commonly used to assess the strength of various muscle groups, including the quadriceps, hamstrings, hip muscles, and upper limb muscles. Higher values indicate greater muscle strength. Dynamometry is widely used in clinical practice and research to evaluate baseline strength, monitor rehabilitation progress, and assess treatment outcomes.

  The assessment requires approximately 5-10 minutes to complete and can be performed at baseline and after the intervention period (e.g., 6-8 weeks) to evaluate changes in muscle strength.

Secondary Outcomes (3)

• Barthel Index (BI)

  The Barthel Index will be assessed at baseline and after 4 weeks of intervention to measure changes in activities of daily living and functional independence

• Gait Dynamic Index

  The Dynamic Gait Index takes approximately 10-15 minutes to administer and can be assessed at baseline and after the intervention period (4 weeks) to evaluate changes in dynamic balance and gait performance.

• Berg Balance Scale

  he Berg Balance Scale takes approximately 15-20 minutes to administer and can be assessed at baseline and after the intervention period (4 weeks) to evaluate changes in balance performance

Study Arms (2)

Open Kinetic Chain Exercises

EXPERIMENTAL

1. Straight leg raising in lying position 2. Knee extension in sitting position 3. Hip abduction in lying position 4. Hip adduction in lying position 5. Prone Hamstring Curl

Other: Open and closed kinetic chain exercises

Closed Kinetic Chain Exercises

EXPERIMENTAL

1. Lunges 2. Semi Squat 3. Forward step up and down 4. Side step up and down

Other: Open and closed kinetic chain exercises

Interventions

Open and closed kinetic chain exercises OTHER

Open Kinetic Chain (OKC): The hand or foot is free to move. These exercises usually involve one joint and target specific muscles. Examples: Leg extension, hamstring curl, biceps curl, straight leg raise. Closed Kinetic Chain (CKC): The hand or foot is fixed on a surface. These exercises involve multiple joints and muscle groups, improving stability and functional movement. Examples: Squats, lunges, push-ups, step-ups.

Closed Kinetic Chain Exercises; Open Kinetic Chain Exercises

Eligibility Criteria

• Age: 30 Weeks - 65 Weeks
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Male and female participants
• Age between 30 and 65 years
• Referred by a neurologist
• Diagnosed case of stroke with one-sided hemiparesis
• Functional ambulatory capacity (Functional Ambulation Category ≥ 2)
• Muscle strength of at least grade 3+ on the Manual Muscle Testing (MMT) scale in the affected lower limb
• No participation in other rehabilitation programs during the study period

You may not qualify if:

• Participants with any musculoskeletal condition such as osteoarthritis or ligament laxity
• Significant cognitive, communicative, perceptual, or sensory problems that hinder understanding and/or following verbal commands
• Pregnant individuals

Sponsors & Collaborators

• Dow University of Health Sciences: lead

Study Sites (1)

Dow University of Health Sciences Ojha Campus

Karachi, Sindh, 75280, Pakistan

Location

Related Publications (5)

• Lobo AA, Joshua AM, Nayak A, Mithra P P, Misri Z, Pai S. Effect of Compelled Body Weight Shift (CBWS) Therapy in Comparison to ProprioceptiveTraining on Functional Balance, Gait, andMuscle Strength Among Acute Stroke Subjects. Ann Neurosci. 2021 Jul;28(3-4):162-169. doi: 10.1177/09727531211063132. Epub 2022 Jan 28.

  PMID: 35341230 BACKGROUND

• Ain QU, Imran M, Bashir A, Malik AN. Progressive resistance training improving gait performance and mobility in acute and chronic stroke patients. J Pak Med Assoc. 2021 Jan;71(1(A)):140-142. doi: 10.47391/JPMA.612.

  PMID: 33484541 BACKGROUND

• Geerars M, Minnaar-van der Feen N, Huisstede BMA. Treatment of knee hyperextension in post-stroke gait. A systematic review. Gait Posture. 2022 Jan;91:137-148. doi: 10.1016/j.gaitpost.2021.08.016. Epub 2021 Aug 24.

  PMID: 34695721 BACKGROUND

• Okada K, Haruyama K, Okuyama K, Tsuzuki K, Nakamura T, Kawakami M. Categorizing knee hyperextension patterns in hemiparetic gait and examining associated impairments in patients with chronic stroke. Gait Posture. 2024 Sep;113:18-25. doi: 10.1016/j.gaitpost.2024.05.025. Epub 2024 May 23.

  PMID: 38820765 BACKGROUND

• Salaudeen MA, Bello N, Danraka RN, Ammani ML. Understanding the Pathophysiology of Ischemic Stroke: The Basis of Current Therapies and Opportunity for New Ones. Biomolecules. 2024 Mar 4;14(3):305. doi: 10.3390/biom14030305.

  PMID: 38540725 BACKGROUND

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

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: PRINCIPAL INVESTIGATOR
• PI Title: P.G Trainee

Study Record Dates

• First Submitted: June 22, 2026
• First Posted: June 26, 2026
• Study Start: June 8, 2026
• Primary Completion (Estimated): October 8, 2026
• Study Completion (Estimated): October 30, 2026
• Last Updated: July 2, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)