Knee OsteoarthristisNCT07396233
Effects of Diagonal Proprioceptive Neuromuscular Facilitation Patterns on Pain and Functional Outcomes in Patients With Knee Osteoarthritis
A study testing Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises, Conventional Strength Training Exercises and Heat Therapy in people with Knee Osteoarthristis and Osteearthritis, run by University of Karachi at 2 sites in Pakistan.
Trial 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. Read more about this study
- Who is it for?
- Ages 40 to 60 years
- Conditions the study is for
- Knee Osteoarthristis, Osteearthritis, Knee Pain Arthritis
- What is being tested?
- Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises, Conventional Strength Training Exercises and Heat Therapy
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 150 participants
- Where
- 2 sitesPakistan
- Study dates
- 7 Feb 2026to 22 Feb 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 40 to 60 years
- All sexes
- No healthy volunteers
- Adult
Who may be able to join
- 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).
Who cannot join
- 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.
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan2 sites, 2 recruiting
- Recruiting
Al-Rayaz Hospital
Karachi, Sindh, 74600
Rabia Hassan, MSAPT, 03345448859, rabiahassan096@gmail.com
- Recruiting
Dr. Ziauddin Hospital
Karachi, Sindh, 74600
Rabia Hassan, MSAPT, 03345448859, rabiahassan096@gmail.com
About this study
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.
Read the detailed description
The Statistical Package for the Social Sciences (SPSS) version 23 will be used for data analysis. Mean and standard deviation will be calculated for quantitative variables such as age. Qualitative variables will be presented as frequencies and percentages. Outcome measures (decrease pain intensity, improve functional disability, increase knee range of motion, improve hamstring flexibility, dynamic balance, and fatigue level) recorded at baseline and after 18th session of intervention will be compared and analyzed. Repeated measures ANOVA will be applied for statistical analysis. A p-value of less than 0.05 will be considered as the level of statistical significance.
- Conditions
- Knee Osteoarthristis, Osteearthritis, Knee Pain Arthritis
- Being tested
- Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises, Conventional Strength Training Exercises, Heat Therapy
- Keywords
- Knee Osteoarthritis, Functional Disability, Knee Pain, Conventional Training, Osteoarthritis, Arthritis, Musculoskeletal Disease, Joint Disease
- Medical subject headings
- Osteoarthritis, Knee, Osteoarthritis, Arthritis, Musculoskeletal Diseases, Joint Diseases
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern ExercisesOther
Diagonal PNF pattern exercises include Diagonal 1 and Diagonal 2 lower limb pattern movements performed against resistance to improve strength, flexibility, and functional performance.
Conventional Strength Training ExercisesOther
The conventional strength training exercises include quadriceps and hip abductor strengthening performed using resisted active movements to improve muscle strength and functional ability.
Heat TherapyOther
Heat therapy will be given for 10 minutes by the help of electric heating pad.
| Study group | Role | What they receive |
|---|---|---|
| Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises + Heat Therapy. | Experimental | This arm will receive PNF pattern exercises using Diagonal 1 and Diagonal 2 Lower Limb Patterns of PNF and the heat therapy Receives: Other: Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises; Other: Heat Therapy |
| Conventional Strength Training Exercises + Heat Therapy | Active comparator | This arm will receive evidence based treatment of Quadripceps and Hip Abductor Strengthening exercises and the heat therapy. Receives: Other: Conventional Strength Training Exercises; Other: Heat Therapy |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 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.
Measured: 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)
The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific instrument, developed to assess the patients' opinion about their knee and associated problems regarding functional disability. It consists of total 100 scores. Increase in scores suggests better function and decrease in scores suggests increased functional disability.
Measured: Baseline and after 6 weeks of intervention.
Change in hamstring flexibility will be assessed with Active Knee Extension test.
The Active Knee Extension (AKE) test will be used to assess hamstring muscle length using a goniometer with the hip flexion position at 90°. A greater knee extension angle indicates greater hamstring muscle length.
Measured: Baseline and after 6 weeks of intervention.
Change in dynamic balance will be assessed with Four Step Square Test (FSST)
The Four Square Step Test will be used to assess dynamic balance. It is measured in seconds. A higher completion times indicate poorer dynamic balance and a greater risk of falls.
Measured: Baseline and after 6 weeks of intervention.
Change in fatigue level will be assessed with Multidimensional Fatigue Inventory questionnaire.
The multidimensional fatigue inventory is a 20-item scale designed to evaluate five dimensions of fatigue: general fatigue, physical fatigue, reduced motivation, reduced activity, and mental fatigue. Higher total scores correspond with more acute levels of fatigue.
Measured: Baseline and after 6 weeks of intervention.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Feb 2026
- Study start7 Feb 2026
- Primary completion19 Jan 2027 (estimated)
- Study completion22 Feb 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Knee OsteoarthristisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 150 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Karachi
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Rabia Hassan, University of Karachi
- Investigators
- Rabia Hassan, MSAPT, Principal investigator, Ziauddin UniversityBasit Ansari, PhD, Study chair, University of KarachiAftab Ahmed Mirza Baig, PhD, Study director, IQRA University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07396233
- Sponsor's protocol ID
- IBC KU-549/2025
- Status last verified
- Feb 2026
- First submitted
- 1 Feb 2026
- Last updated
- 11 Feb 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: 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.
Publications
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.
PubMed 37268961Gao 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.
PubMed 36780435Geng 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.
PubMed 37745043Song 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.
PubMed 32407583
Study at a glance
From the registry record, last updated by the sponsor on 11 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Diagonal Proprioceptive Neuromuscular Facilitation Patterns on Pain and Functional Outcomes in Patients With Knee Osteoarthritis
- ClinicalTrials.gov ID
- NCT07396233
- Acronym / sponsor ID
- IBC KU-549/2025
- Conditions
- Knee Osteoarthristis, Osteearthritis, Knee Pain Arthritis
- Keywords
- Knee Osteoarthritis, Functional Disability, Knee Pain, Conventional Training, Osteoarthritis, Arthritis, Musculoskeletal Disease, Joint Disease
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 150 participants (estimated)
- Lead sponsor
- University of KarachiUniversity, hospital or other
- Study start
- 7 Feb 2026 (actual)
- Primary completion
- 19 Jan 2027 (estimated)
- Study completion
- 22 Feb 2027 (estimated)
- First posted
- 9 Feb 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Detailed description
The Statistical Package for the Social Sciences (SPSS) version 23 will be used for data analysis. Mean and standard deviation will be calculated for quantitative variables such as age. Qualitative variables will be presented as frequencies and percentages. Outcome measures (decrease pain intensity, improve functional disability, increase knee range of motion, improve hamstring flexibility, dynamic balance, and fatigue level) recorded at baseline and after 18th session of intervention will be compared and analyzed. Repeated measures ANOVA will be applied for statistical analysis. A p-value of less than 0.05 will be considered as the level of statistical significance.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises + Heat Therapy. | Experimental | Other: Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises, Other: Heat TherapyThis 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 comparator | Other: Conventional Strength Training Exercises, Other: Heat TherapyThis arm will receive evidence based treatment of Quadripceps and Hip Abductor Strengthening exercises and the heat therapy. |
Who may qualify
- Ages
- 40 to 60 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- 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).
Key exclusion criteria (7 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern ExercisesDiagonal PNF pattern exercises include Diagonal 1 and Diagonal 2 lower limb pattern movements performed against resistance to improve strength, flexibility, and functional performance. | Other | Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises + Heat Therapy. |
| Conventional Strength Training ExercisesThe conventional strength training exercises include quadriceps and hip abductor strengthening performed using resisted active movements to improve muscle strength and functional ability. | Other | Conventional Strength Training Exercises + Heat Therapy |
| Heat TherapyHeat therapy will be given for 10 minutes by the help of electric heating pad. | Other | Conventional Strength Training Exercises + Heat Therapy, Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises + Heat Therapy. |
Primary outcome
Change in pain intensity will be assessed with Visual Analogue Scale
Time frame: Baseline and after 6 weeks of intervention
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.
Change in range of motion will be assessed with Universal Goniometer
Time frame: Baseline and after 6 weeks of intervention.
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.
4 secondary outcomes
Change in functional disability will be assessed with Knee Injury and Osteoarthritis Outcome Score (KOOS)
Time frame: Baseline and after 6 weeks of intervention.
Change in hamstring flexibility will be assessed with Active Knee Extension test.
Time frame: Baseline and after 6 weeks of intervention.
Change in dynamic balance will be assessed with Four Step Square Test (FSST)
Time frame: Baseline and after 6 weeks of intervention.
Change in fatigue level will be assessed with Multidimensional Fatigue Inventory questionnaire.
Time frame: Baseline and after 6 weeks of intervention.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 11 Feb 2026.
- Background: PubMed 37268961Nafees 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.
- Background: PubMed 36780435Gao 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.
- Background: PubMed 37745043Geng 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.
- Background: PubMed 32407583Song 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.
- Individual participant dataSharing planned: No. 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.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Rabia Hassan, MSAPT principal investigator
Ziauddin University
Basit Ansari, PhD study chair
University of Karachi
Aftab Ahmed Mirza Baig, PhD study director
IQRA University
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises, Conventional Strength Training Exercises and Heat Therapy in people with Knee Osteoarthristis and Osteearthritis, run by University of Karachi at 2 sites in Pakistan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 11 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Pakistan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Rabia Hassan, MSAPT (+923345448859, rabiahassan096@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in pain intensity will be assessed with Visual Analogue Scale (time frame: Baseline and after 6 weeks of intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07396233, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Feb 2026.