Effect of PNF + Core Strengthening Exercise in Sub-acute Guillain Barre Syndrome ( PNF-CORE-GBS ) (PNF-CORE-GBS)

November 7, 2026 updated by: University of Lahore

Proprioceptive Neuromuscular Facilitation Combined With Core Strengthening Exercise in Guillain Barre Syndrome Patients

This randomized controlled trial will evaluate the effectiveness of proprioceptive neuromuscular facilitation combined with core strengthening exercises in Guillain barre syndrome patients .A total of 32 participants aged 18-45 years with clinically diagnosed sub-acute GBS will be allocated into two groups. The intervention group will receive PNF techniques combined with core strengthening exercises, while the control group will receive conventional physiotherapy. Both groups will participate in rehabilitation sessions four times per week for eight weeks.The primary outcomes include balance, muscle strength, and functional independence, assessed using the Berg Balance Scale (BBS), Manual Muscle Testing (MMT), and Barthel Index (BI), respectively. Assessments will be conducted at baseline, the fourth week, and the eighth week.The study purpose to determine whether combining PNF with core strengthening exercises provides additional benefits in improving rehabilitation outcomes in patients with sub-acute Guillain-Barré Syndrome.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Guillain-Barré Syndrome (GBS) is an acute immune-mediated inflammatory polyneuropathy characterized by rapidly progressive muscle weakness, diminished or absent deep tendon reflexes, sensory disturbances, impaired balance, and functional limitations in activities of daily living (ADLs). Although most patients recover gradually following the acute phase, many continue to experience persistent muscle weakness, impaired postural control, reduced trunk stability, and decreased functional independence during the subacute stage. Early rehabilitation plays a vital role in maximizing neurological recovery and improving functional outcomes. Conventional physiotherapy is considered a standard rehabilitation approach for patients with subacute GBS and typically includes range of motion exercises, muscle strengthening, balance training, gait training, and functional mobility exercises. However, there is limited evidence regarding the additional benefits of combining Proprioceptive Neuromuscular Facilitation (PNF) with core strengthening exercises in this population. Proprioceptive Neuromuscular Facilitation (PNF) is a therapeutic approach that uses proprioceptive stimulation, resistance, stretching, and coordinated movement patterns to facilitate neuromuscular activation and functional movement. Core strengthening exercises focus on improving trunk stability, pelvic control, postural alignment, and balance.

Although both interventions are used in neurological rehabilitation, evidence regarding the combined application of PNF and core strengthening exercises in patients with sub-acute GBS remains limited. Therefore, this study is designed to evaluate the effectiveness of combining these interventions compared with conventional physiotherapy.

This study is a randomized controlled trial involving 32 participants with clinically diagnosed sub-acute Guillain-Barré Syndrome. Participants will be recruited through non-probability purposive sampling from the Neuro-Medicine Ward and Physiotherapy Outpatient Department of Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.

Eligible participants will be adults aged 18-45 years, of either gender, diagnosed with GBS and clinically stable for participation in physiotherapy rehabilitation. Participants will be randomly allocated into two groups using the sealed-envelope method. The outcome assessor will be blinded to group allocation.

Participants assigned to Group A will receive Proprioceptive Neuromuscular Facilitation (PNF) combined with core strengthening exercises.

The PNF intervention will include Contract-Relax (CR) and Contract-Relax-Antagonist-Contract (CRAC) techniques applied to the upper and lower extremities. The techniques will involve an initial stretch of approximately 10-20 seconds, followed by resisted muscle contraction lasting 3-6 seconds, with a relaxation period of approximately 2-3 seconds before further stretching.

Core strengthening exercises will include:

  • Pelvic control exercises.
  • Bridging exercises.
  • Curl-up exercises.
  • Curl-ups with diagonal reaching.
  • Bridging with crossed legs.
  • Single-leg bridging.
  • Side-bridging exercises. These exercises will target trunk and pelvic stability, neuromuscular control, and postural function.

*Control Group (Group B)*

Participants assigned to Group B will receive conventional physiotherapy, including:

  • Upper and lower extremity stretching and strengthening exercises.
  • Techniques for normalization of muscle tone.
  • Weight-bearing exercises.
  • Active functional training.
  • Postural control exercises.
  • Conventional balance training. Both groups will receive physiotherapy rehabilitation four times per week over eight weeks.

The study will evaluate the following outcome measures:

  1. Balance: Assessed using the Berg Balance Scale (BBS), which evaluates static and dynamic balance through 14 functional tasks. The total score ranges from 0 to 56.
  2. Muscle Strength: Assessed using Manual Muscle Testing (MMT), which evaluates muscle strength on a grading scale from 0 to 5.
  3. Functional Independence: Assessed using the Barthel Index (BI), which evaluates independence in activities of daily living, including feeding, bathing, dressing, transfers, mobility, and stair climbing. The total score ranges from 0 to 100.

Assessments will be performed at baseline, the fourth week, and the eighth week of the intervention.

The primary objective is to determine whether PNF combined with core strengthening exercises is more effective than conventional physiotherapy in improving balance, muscle strength, and functional independence among patients with sub-acute Guillain-Barré Syndrome.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
32

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 54000
        • University of Lahore teaching hospital, Lahore

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 45 years (Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • participants diagnosed with Guillain Barré Syndrome (GBS) based on neurological criteria
  • At the subacute or recovery stage of GBS, meaning within two to 12 weeks from disease onset
  • Age ranges from 18 to 45 years
  • Gender does not matter; both males and females can participate
  • Medical stability of the patient and being medically cleared to engage in intensive rehabilitation by a physical Ability to give informed consent

Exclusion Criteria:•Patients with cognitive disabilities and those who cannot follow commands

  • Patients with unstable heart and breathing rates and other systemic disease
  • Patients refusing to give their informed consent
  • Presence of musculoskeletal problems with balance problems (recent fractures, arthritis)

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: PNF+Core strengthening Group

Participants in the experimental group will receive Proprioceptive Neuromuscular Facilitation (PNF) combined with core strengthening exercises versus conventional physiotherapy. The intervention will be administered according to the study protocol over 4 times in week for 8-week period.
Behavioral: Proprioceptive neuromuscular facilitation

Participants in the experimental group will receive PNF techniques, including Contract-Relax (CR) and Contract-Relax-Antagonist-Contract (CRAC), applied to the upper and lower extremities. The intervention will involve an initial stretch of 10-20 seconds, followed by resisted muscle contraction lasting 3-6 seconds, with approximately 2-3 seconds of rest between contractions and subsequent stretching. PNF will be combined with core strengthening exercises during the 8-week rehabilitation program.

Behavioral: core strengthening exercise

Participants in the experimental group will perform core strengthening exercises targeting trunk and pelvic stability. Exercises will include pelvic control exercises, bridging, curl-ups, curl-ups with diagonal reaching, bridging with crossed legs, single-leg bridging, and side bridging. These exercises will be administered in combination with PNF techniques over an 8-week rehabilitation program.
Active Comparator: conventional physiotheraphy Group

conventional physical therapy Participants in the control group will receive conventional physiotherapy according to the standard rehabilitation protocol for patients with subacute Guillain-Barré Syndrome over 4 time per week for 8 week period
Behavioral: conventional physiotherapy

Participants in the control group will receive conventional physiotherapy, including stretching and strengthening exercises for the upper and lower extremities, muscle tone normalization techniques, weight-bearing exercises, active functional training, postural control exercises, and conventional balance training. Treatment will be provided four times per week for eight weeks.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Balance
Time Frame: Baseline , week 4 and week 8

Balance was assessed using the Berg Balance Scale (BBS) . The Berg Balance Scale is a 14-item clinical scale that measures static and dynamic balance. Scores range from 0 to 56, with higher scores indicating better balance and functional performance
Baseline , week 4 and week 8
muscle strength
Time Frame: Baseline, week 4 and week 8

Muscle strength was assessed using the Medical Research Council (MRC) Manual Muscle Testing scale. Muscle strength is graded from 0 to 5, where 0 indicates no muscle contraction and 5 indicates normal muscle strength. Higher scores indicate better muscle strength.
Baseline, week 4 and week 8
Activities of Daily living (ADL)
Time Frame: Baseline , week 4 and week 8

Activities of daily living were assessed using the Barthel Index (BI). The Barthel Index measures independence in activities of daily living. Scores range from 0 to 100, with higher scores indicating greater functional independence.
Baseline , week 4 and week 8

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Lahore

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
November 30, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 30, 2027

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
May 30, 2027

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
November 7, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 7, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 13, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
November 13, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 7, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
November 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • UOL/IREB/26/19/01/0017

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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