The purpose of the study is to compare the short-term effectiveness of manual therapy
with neuromuscular training and conventional physical therapy with neuromuscular training
in patients with knee osteoarthritis.

Effectiveness of Manual Therapy and Neuromuscular Training in the Management of Knee Osteoarthritis

Knee Osteoarthritis

Knee osteoarthritis (OA) is a major public health problem, characterized by progressive
degeneration and loss of articular cartilage, resulting in pain, limitation of movement,
imbalance, functional disability, and diminished patient quality of life. Regular
participation in physical activity has been recognized for several years as being
beneficial in the management of knee OA. The role and effectiveness of manual therapy
techniques and conventional physical therapy are evident from the existing literature,
but no comparison was found for the combination of neuromuscular training (NMT) in
patients with knee OA. Thus, the aim of this study is to compare the short-term
effectiveness of manual therapy (MT) versus conventional physical therapy (CPT) with NMT
in the management of knee OA after six weeks of treatment.

Manual therapy techniques

Transcutaneous Electrical Nerve Stimulation (TENS)

Effectiveness of Manual Therapy VS Conventional Physical Therapy With Neuromuscular Training in the Management of Knee Osteoarthritis

The average pain intensity over the last week at the time of testing was measured on a
numerical pain rating scale, where 0 represented no pain and 10 represented the worst
pain possible.

To check the range of motion (ROM) of the knee joint, the joint will be extended as far
as it can go while the person is lying on their back three times. The angle at the
maximum flexion position was measured with a goniometer, and the average angle was
recorded.

It is a questionnaire for the evaluation of treatment results in patients with lower
extremity osteoarthritis, and it divides difficulties in daily living into scales. WOMAC
scores are recorded on a five-point Likert scale of 0-4, where 0 = no pain or limitation,
1 = mild pain or limitation, 2 = moderate pain or limitation, 3 = severe pain or
limitation, and 4 = extreme pain or limitation. Maximum scores for pain, stiffness and
physical functions were 20, 8, and 68, respectively, with total scores of 96 indicating
greater disease severities.

This instrument consists of 36 items, grouped into eight domains: functional capacity,
physical aspects, pain, general health, vitality, social aspects, emotional aspects, and
mental health. A measurement scale with values ranging from 0 (the worst health status)
to 100 (the best health status) was used to give each subject and each of the eight
dimensions a score.

This test has been used to assess static standing balance in individuals with knee OA.
The single-leg stance test was measured by recording the time in seconds (30s maximum)
while participants are asked to balance on one leg while keeping their hands on their
hips. The test starts when the free foot lifts off the ground and is stopped if: (1) the
swing limb touches the ground; (2) the stance foot moves on the floor; (3) the swing foot
touches the tested limb; or (4) the hands move away from the hips.

ASSOCIATE PROFESSOR

Manual physical therapy is intended to improve musculoskeletal function and pain by
addressing impaired kinematics of the joint. Passive Joint Mobilization (PJM) was applied
to knee distraction and dorsal glides, ventral glides, and patellar glides in all
directions, which were applied at a rate of two to three oscillations per second for 1-2
min. Each direction was repeated three to six times.

Neuromuscular training (NEMEX-TJR training program):

(2 times per week for 6 weeks) The neuromuscular training program consists of 3 parts:
warming up, a circuit program, and cooling down. The program is performed twice a week
for 6 weeks, with each session lasts for 60 minutes.

Physical therapists use a variety of transcutaneous electrical nerve stimulation (TENS)
applications to reduce or alleviate pain for individuals with Knee OA. TENS (symmetrical
biphasic waveform, frequency 32-50 Hz, pulse width 80 microseconds) for the same amount
of time and the same number of days. The TENS electrodes were applied on the medial and
lateral superior, as well as the medial and lateral inferior, borders of the patella.
Care was taken not to place TENS electrodes on the quadriceps muscles or muscles of the
anterior leg.

Neuromuscular training (NEMEX-TJR training program):

(2 times per week for 6 weeks) The neuromuscular training program consists of 3 parts:
warming up, a circuit program, and cooling down. The program is performed twice a week
for 6 weeks, with each session lasts for 60 minutes.

Effectiveness of Manual Therapy and Neuromuscular Training in the Management of Knee Osteoarthritis

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Not accepting

Trial Timing

What is this trial about?

What are the participation requirements?

Locations

Location

Status