Osteoarthritis (OA) of the Knee
Conditions
Keywords
osteoarthritis, knee, Stanley Paris
Brief summary
This study aims to compare two different physiotherapy approaches for people suffering from Grade II Knee Osteoarthritis (OA) - a condition that causes knee pain, stiffness, and difficulty in walking. The first approach is the Stanley Paris Manual Therapy Concept, which involves hands-on treatment techniques such as joint mobilization, soft tissue massage, and movement correction. The second is Conventional Physiotherapy, which uses traditional exercises and electrotherapy (like heat, ultrasound, or TENS) to reduce pain and improve strength. The study will include 50 patients aged 40-60 years who have moderate knee osteoarthritis. They will be randomly divided into two groups - one receiving manual therapy and the other receiving conventional physiotherapy - for 6 to 8 weeks. Researchers will measure pain, knee function, range of motion, balance, and quality of life before and after treatment to see which method gives better results. By identifying which therapy works more effectively, this study will help patients, families, and healthcare providers choose the most beneficial and evidence-based treatment for improving movement, reducing pain, and enhancing daily living activities in people with knee osteoarthritis.
Detailed description
Knee osteoarthritis (OA) is a common degenerative joint disorder that causes pain, stiffness, and loss of mobility, often leading to functional limitations and reduced quality of life. In Grade II OA, cartilage damage is moderate and potentially reversible through appropriate rehabilitation strategies. This stage offers an important opportunity for physiotherapy interventions to restore function and delay further joint deterioration. The Stanley Paris Manual Therapy Concept emphasizes a biomechanical and hands-on approach to rehabilitation. It includes joint mobilization, soft tissue manipulation, neural mobilization, and correction of faulty movement patterns to restore normal joint motion and neuromuscular control. In contrast, Conventional Physiotherapy typically focuses on pain management using electrotherapy modalities, strengthening exercises, and general mobility training. This randomized controlled trial (RCT) is designed to compare the effectiveness of these two treatment approaches in individuals with Grade II knee osteoarthritis. Fifty participants will be randomly allocated into two equal groups: one receiving the Stanley Paris manual therapy and the other receiving conventional physiotherapy, for a period of 6-8 weeks. Standardized assessment tools - including the Visual Analog Scale (VAS) for pain, the Knee Injury and Osteoarthritis Outcome Score (KOOS) for function and quality of life, and the Berg Balance Scale for proprioception and stability - will be used to evaluate outcomes at baseline, mid-intervention, and post-intervention. The study will generate clinical evidence on whether manual therapy provides superior outcomes in terms of pain relief, functional improvement, and patient satisfaction compared to conventional physiotherapy. Results are expected to assist clinicians in developing more effective rehabilitation protocols for managing knee osteoarthritis and improving patients' independence and overall well-being.
Interventions
OTHERHands-on manual therapy including joint mobilization, soft tissue and neural mobilization, and movement retraining based on the Stanley Paris Concept.
This intervention follows the Stanley Paris Manual Therapy Concept, a hands-on approach emphasizing biomechanical correction and functional movement restoration. Treatment will include Maitland and Kaltenborn joint mobilization (Grades II-IV), patellar glides, soft tissue and myofascial release, neural mobilization, and movement pattern retraining. Sessions will also include proprioceptive and balance exercises, functional strengthening, and patient education on posture and joint protection. Each participant will receive 4 sessions per week for 6 weeks, lasting approximately 45-60 minutes each, delivered by trained manual therapists using a standardized protocol.
OTHERConventional Physiotherapy Standard physiotherapy care including electrotherapy modalities (TENS, ultrasound), strengthening, flexibility, and balance training exercises.
This intervention consists of standard physiotherapy treatment commonly used for Grade II Knee Osteoarthritis. It includes electrotherapy modalities such as TENS, ultrasound, and hot/cold therapy, along with therapeutic exercises for strengthening, flexibility, and balance. Exercises include open-chain and closed-chain strengthening, range-of-motion activities, and static stretching. Participants will receive 4 supervised sessions per week for 6 weeks, each lasting 45-60 minutes, administered by qualified physiotherapists following evidence-based clinical practice guidelines.
Sponsors
Ibadat International University, Islamabad
Helping Hand Institute of Rehabilitation Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Caregiver, Investigator, Outcomes Assessor)
Masking description
This study will use a quadruple-blind design in which the participants, care providers, investigators, and outcomes assessors will all be masked to group allocation. Randomization will be conducted using a coded allocation system managed by an independent coordinator. Intervention protocols will be standardized and labeled by code to ensure blinding of treatment identity. Data collection and analysis will be performed without revealing group assignments to maintain objectivity and reduce bias.
Intervention model description
This study is a randomized controlled trial with a parallel-group design involving 50 participants diagnosed with Grade II Knee Osteoarthritis. Participants will be randomly assigned into two groups: Group A will receive the Stanley Paris Manual Therapy Concept, and Group B will receive Conventional Physiotherapy. Both groups will undergo supervised sessions 2-3 times per week for 6-8 weeks. Randomization will be computer-generated, and outcome assessors will be blinded to group allocation. The study follows a prospective, single-blinded, two-arm model, comparing manual therapy-based rehabilitation with traditional physiotherapy for pain reduction, functional improvement, and enhanced quality of life in knee osteoarthritis patients.
Eligibility
Sex/Gender
FEMALE
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* diagnosed with Grade II knee osteoarthritis based on radiographic and clinical criteria. * Participants experiencing knee pain for at least three months. * Ability to walk independently without assistive devices. * Willingness to participate in a structured physiotherapy program.
Exclusion criteria
* Presence of Grade III or IV knee osteoarthritis. * History of knee surgery or joint replacement. * Rheumatoid arthritis or other inflammatory joint diseases. * Neurological conditions affecting lower limb function. * Contraindications to manual therapy or exercise interventions.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pain Reduction Measured by Visual Analog Scale (VAS) | Change in pain intensity from baseline to 4th week and 8 weeks | The Visual Analog Scale (VAS) will be used to assess the intensity of knee pain. Participants will mark their pain level on a 10 cm line ranging from 0 ("no pain") to 10 ("worst imaginable pain"). Pain scores will be recorded at baseline, after 4 weeks, after 8 weeks of treatment. |
| Functional Improvement Measured by Knee Injury and Osteoarthritis Outcome Score (KOOS) | Change in KOOS scores from baseline to 4th weeks and 8 weeks. | The KOOS questionnaire will assess knee function, daily living activities, sports and recreation function, and knee-related quality of life. Each subscale is scored from 0 (extreme problems) to 100 (no problems). |
| Knee Range of Motion Measured by Goniometer | Change from baseline to 4th weeks and 8 weeks post-intervention. | Active knee flexion and extension will be measured using a standard universal goniometer to assess joint mobility. |
| Balance and Proprioception Measured by Berg Balance Scale | Change from baseline to 4th week and 8 weeks post-intervention. | The Berg Balance Scale (14 items, score range 0-56) will assess participants' static and dynamic balance. Higher scores indicate better balance and lower fall risk. |
Countries
Pakistan
Contacts
STUDY_DIRECTORProf. Dr. Muhammad Nazim Farooq, Ph.D.
Ibadat International University, Islamabad
Outcome results
None listed