Effects of Feldenkrais Exercises in Knee Osteoarthritis Patients

Effects of Feldenkrais Exercises on Pain, Range of Motion, and Disability in Patients With Knee Osteoarthritis

The primary objective of the study is to determine the effects of Feldenkrais Exercises on Pain, Range of Motion, and Disability in Patients with Knee osteoarthritis. Knee osteoarthritis poses significant challenges in pain management, mobility improvement, and disability reduction among middle-aged to older adults. Feldenkrais Method offers benefits comparable to back school lessons or core stability exercises. This study, conducted as a Randomized Controlled Trial at RIPHAH Rehabilitation Clinic, aims to assess the efficacy of Feldenkrais exercises compared to conventional physical therapy in addressing pain, range of motion, and disability in knee osteoarthritis patients aged 40-60 years. A non-probability convenience sampling method will recruit 32 participants meeting specific criteria for osteoarthritis severity and functional ability. Participants will be randomly assigned to Group A (Feldenkrais exercises) or Group B (conventional therapy), with interventions delivered over four weeks. Group A will engage in Feldenkrais exercises targeting pelvic and lower limb mobility, while Group B will receive standard treatments including knee isometrics, mobilization, transcutaneous electric nerve stimulation, and heating pad applications. Pain severity will be measured using the Numeric Pain Rating Scale, Range of Motion assessed via goniometry, and disability evaluated using the Western Ontario McMaster Universities Osteoarthritis Index. Statistical analysis using SPSS will compare outcomes between groups at baseline, post-treatment, and follow-up assessments.

Study Overview

• Status: Recruiting
• Conditions: Knee Osteoarthritis (Knee OA)
• Intervention / Treatment: Other: Feldenkrais exercises; Other: Standard physical therapy interventions

Detailed Description

Osteoarthritis (OA) is one of the most prevalent rheumatic diseases in the elderly, being a frequent cause of incapacity among this population. It is more common in the knee and is characterized by pain, stiffness, and function loss. OA is a major public health problem. The prevalence of knee OA is 34-45% in the Indian population with clinical symptoms of pain, reduced muscle strength, and knee function. That is the most common form of degenerative joint disease affecting 15 to 40% of people aged 40 and above. One hundred fifty-one million people worldwide experienced OA, and it was ranked sixth as a leading cause of moderate and severe disability. The knee is the joint most frequently affected by osteoarthritis. The Feldenkrais Method has the potential to help older people with OA. Developed by Dr. Moshe Feldenkrais, the method is a gentle form of exercise which has been shown to be acceptable for older people who have limited movement. The Feldenkrais Method is taught in two parallel forms, Awareness Through Movement (conducted as a group exercise) and Functional Integration (one-on one approach). This study explores the effectiveness of Awareness Through Movement lessons in helping older people with OA. The method aims for improved functioning, where the entire body cooperates efficiently with minimal effort. This study aims to explore the potential benefits of Feldenkrais exercises as an alternative, non-invasive treatment for knee osteoarthritis. Medical conventional treatments for knee OA, such as pharmacotherapy and surgical interventions, often come with limitations including potential side effects, high costs, and sometimes limited long-term effectiveness. These constraints necessitate the exploration of alternative, non-invasive treatment options that can be both effective and accessible. Feldenkrais exercises focus on improving movement patterns and body awareness, which may help reduce pain, enhance range of motion, and decrease disability.

• Study Type: Interventional
• Enrollment (Estimated): 32
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: imran amjad, PhD*; Phone Number: 03324390125; Email: imran.amjad@riphah.edu.pk
• Study Contact Backup: Name: Imran Amjad, PHD*; Phone Number: 051-5481826; Email: imran.amjad@riphah.edu.pk

Study Locations

• Pakistan
  • Punjab
    • Lahore, Punjab, Pakistan
      • Recruiting
      • RIPHAH Rehabilitation Clinic, Punjab, Pakistan
      • Contact: Ghulam Fatima, PhD; Phone Number: 03034073057; Email: ghulam.fatima@riphah.edu.pk
      • Principal Investigator: saliha Farooq, MS*

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age between 40 to 60 years of patients.
• Both female and male
• Able to walk for 6 minutes (Timed up-and-go test)
• Able to rise from floor
• Grade 2 and 3 of osteoarthritis diagnosed with radiograph (Kellgren and Lawrence classification system)
• Pain reported on VAS score ˃6/10 in knee region for more than 3 months

Exclusion Criteria:

• • Tuberculosis, carcinoma, heart disease, and osteoporosis

  • Any trauma or localized infection in the knee joint
  • Hyper flexibility
  • Open sores
  • Ongoing radiotherapy, chemotherapy, steroid therapy, or anticoagulants
  • Psychiatric diseases such as phobia/obsession and depression
  • Allergy to hot pack
  • Patients with a history of surgery in the knee region within a year.
  • Severe cognitive impairments
  • Contraindications to physical activity
  • Concurrent participation in other physical therapy programs

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group-A (Feldenkrais exercises); This group of participants will engage in Feldenkrais exercises focused on pain, improved mobility, and disability. Each session will last 30 minutes, conducted twice a week for 4 weeks. The exercises include Pelvic Clock Exercise, Knee Rolling, Ankle Circles, Knee Flexion and Extension and Leg Slides.	Other: Feldenkrais exercises; Feldenkrais exercises focused on pain, improving mobility, and disability.
Active Comparator: Group-B (Standard Physicaltherapy interventions); Participants will receive standard physical therapy interventions for knee osteoarthritis. Protocol: Knee Isometrics: Isometric exercises targeting the quadriceps and hamstrings, performed for 10 minutes, twice a week.; Knee Mobilization; Transcutaneous Electric Nerve Stimulation (TENS).; Heating Pad Duration: 30-minute sessions, conducted twice a week for 4 weeks.	Other: Standard physical therapy interventions; Knee Isometrics: Isometric exercises targeting the quadriceps and hamstrings, performed for 10 minutes, twice a week.; Knee Mobilization; Transcutaneous Electric Nerve Stimulation (TENS).; Heating Pad Duration: 30-minute sessions, conducted twice a week for 4 weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Numeric Pain Rating Scale	The NPRS is a segmented numeric scale in which the respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain. The common format is a horizontal bar or line. NPRS is anchored by terms describing pain severity extremes.	upto 4 weeks
Western Ontario and McMaster Universities Arthritis Index (WOMAC)	WOMAC is a disease-specific measure of health status (pain, stiffness, and function) in OA sufferers. It is widely used for evaluating hip and knee osteoarthritis. It is a self-administered questionnaire consisting of 24 items divided into 3 subscales	upto 4 weeks
Universal Goniometer (UG)	A universal goniometer is a crucial tool in orthopedics used to precisely measure joint angles. It exists in two primary forms: the short-arm version is ideal for smaller joints such as the wrist, elbow, or ankle, while the long-arm version is more accurate for joints with longer levers like the knee and hip. It highlighting its role in quantifying joint mobility and aiding in treatment planning and assessment in medical practice.	upto 4 weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Ghulam Fatima, PHD*, Riphah International University

Publications and helpful links

General Publications

• Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010 Aug;26(3):355-69. doi: 10.1016/j.cger.2010.03.001. Erratum In: Clin Geriatr Med. 2013 May;29(2):ix.
• Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino A, Mont MA. Knee Osteoarthritis: A Primer. Perm J. 2017;21:16-183. doi: 10.7812/TPP/16-183.
• Vincent KR, Vincent HK. Resistance exercise for knee osteoarthritis. PM R. 2012 May;4(5 Suppl):S45-52. doi: 10.1016/j.pmrj.2012.01.019.
• Brooks PM. The burden of musculoskeletal disease--a global perspective. Clin Rheumatol. 2006 Nov;25(6):778-81. doi: 10.1007/s10067-006-0240-3. Epub 2006 Apr 12.
• Salaffi F, Carotti M, Stancati A, Grassi W. Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls. Aging Clin Exp Res. 2005 Aug;17(4):255-63. doi: 10.1007/BF03324607.
• Webb R, Cofre Lizama LE, Galea MP. Moving with ease: feldenkrais method classes for people with osteoarthritis. Evid Based Complement Alternat Med. 2013;2013:479142. doi: 10.1155/2013/479142. Epub 2013 Sep 3.

Study record dates

Study Major Dates

• Study Start (Actual): January 2, 2025
• Primary Completion (Estimated): September 2, 2025
• Study Completion (Estimated): September 15, 2025

Study Registration Dates

• First Submitted: March 10, 2025
• First Submitted That Met QC Criteria: March 10, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 10, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: Goniometry; Knee Osteoarthritis; Range of Motion; Disability; Numeric Pain Rating Scale; Feldenkrais Method
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Arthritis; Joint Diseases; Rheumatic Diseases; Osteoarthritis; Osteoarthritis, Knee
• Other Study ID Numbers: REC/RCR & AHS/24/0150

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No