"Bimodal vs Unimodal High-Intensity Pulsed Electromagnetic Field Therapy in Older Adults With Knee Osteoarthritis" (HIPEMF-OAK)

September 22, 2025 updated by: Ana Lilia Villagrana Rodríguez, Hospital Civil de Guadalajara

Effect of High-Intensity Pulsed Electromagnetic Field Therapy as a Bimodal Intervention for Analgesia and Strengthening in Older Adults With Knee Osteoarthritis: A Randomized Double-Blind Controlled Clinical Trial

This randomized, double-blind clinical trial aims to evaluate the effect of high-intensity pulsed electromagnetic field therapy (HI-PEMF) applied either exclusively on the knee joint or bimodally on the knee and quadriceps, in older adults with knee osteoarthritis. Both groups will also receive a structured home-based exercise program. The primary outcome is pain reduction, and secondary outcomes include functional performance.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Knee osteoarthritis (OA) is a highly prevalent and disabling condition in older adults. It often coexists with quadriceps muscle weakness, sarcopenia, and frailty, all of which contribute to pain, functional decline, and loss of independence. Pulsed electromagnetic field therapy (PEMF) has emerged as a non-invasive alternative for pain relief in OA, with growing interest in its application at both articular and muscular levels.

High-intensity pulsed electromagnetic field (HI-PEMF) therapy-also known as the super inductive system-generates magnetic fields up to 2.5 Tesla, capable of stimulating both joint structures and skeletal muscle via deep tissue electric induction. HI-PEMF has shown promising results for pain reduction, anti-inflammatory modulation, and muscle bioactivation, particularly when applied over the quadriceps.

This randomized, double-blind, parallel-assignment clinical trial aims to compare the effects of two HI-PEMF treatment modalities in older adults with moderate to severe knee OA (Kellgren-Lawrence grade II-IV):

  • Group A: HI-PEMF applied exclusively over the symptomatic knee.
  • Group 2: HI-PEMF applied both over the knee and the quadriceps (bimodal). Both groups will also perform a standardized home-based strengthening and mobility exercise program.

A total of 64 participants (32 per group) will receive 9 sessions of HI-PEMF (2 per week for 5 weeks), using the BTL-6000 Super Inductive System. Outcomes will be assessed at baseline and post-intervention. The primary outcome is change in pain intensity using the Numeric Analog Scale (NAS). Secondary outcomes include functional tests (Timed Up and Go and 5-times Sit-to-Stand), and paracetamol use. Exploratory subgroup analyses will assess associations with frailty status (FRAIL), probable sarcopenia (SARC-F), and radiological OA grade.

This study seeks to generate evidence on the potential synergistic benefits of combining articular and muscular HI-PEMF therapy in geriatric rehabilitation. It is designed for implementation in a public hospital setting in Mexico, with minimal risk and high feasibility. All procedures follow ethical guidelines and have received institutional review board approval.

Study Type

Interventional

Enrollment (Estimated)

64

Phase

  • 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 Locations

  • Mexico
    • Jalisco
      • Guadalajara, Jalisco, Mexico, 44280
        • Recruiting
        • Hospital Civil de Guadalajara "Fray Antonio Alcalde"
        • Contact:
        • Contact:
        • Principal Investigator:
          • Ana L Villagrana Rodríguez, MD
        • Sub-Investigator:
          • Armando T Ávila García, MD, MSc
        • Sub-Investigator:
          • Ileana Díaz Solís, MD
        • Sub-Investigator:
          • Sara L Sáenz Guzmán, MD
        • Sub-Investigator:
          • Samuel J Gaspar Rodríguez, MD
        • Sub-Investigator:
          • Diana H Araiza Quintana, MD

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

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age ≥ 60
  • Clinical and radiological diagnosis of knee OA grade I-IV
  • Pain ≥ 3 on Numeric Analog Scale for >6 months
  • Can walk (with/without aid)
  • Cognitive ability to follow instructions
  • Signed informed consent
  • Availability for 9 treatment sessions and home exercise Exclusion Criteria
  • Prior total knee arthroplasty (unilateral or bilateral)
  • Neurological disorders affecting motor function or cognition (e.g., Parkinson's disease, stroke, moderate to severe dementia)
  • Active inflammatory rheumatic diseases (e.g., rheumatoid arthritis, lupus)
  • Presence of pacemakers, implantable defibrillators, or metallic implants near the treatment area
  • Current use of other physical therapy modalities for pain (e.g., electrotherapy, ultrasound, TENS) outside the study protocol
  • Participation in another clinical trial within the past 3 months
  • Current use of NSAIDs or systemic/local corticosteroids (including intra-articular injections)
  • Open wounds or active infections at the treatment site
  • Decompensated cardiac conditions or medical contraindication to exercise
  • Vestibular disorders that affect balance and interfere with functional assessments
  • Uncorrected visual impairment interfering with gait or balance (visual acuity worse than 20/60 in the better eye, assessed by Snellen chart)

Withdrawal Criteria:

  • Participants who complete fewer than 7 out of the 9 planned intervention sessions (i.e., less than 80% adherence)
  • Occurrence of serious adverse events related to the intervention that contraindicate continuation
  • Repeated non-compliance with the home exercise program, documented in at least two consecutive weekly follow-up reports
  • Voluntary withdrawal of consent at any time during the study

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: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Group A - Unimodal HI-PEMF
Participants in Group A will receive high-intensity pulsed electromagnetic field therapy (HI-PEMF) applied exclusively to the symptomatic knee (femorotibial joint) for 10 minutes per session, twice a week over 5 weeks, completing a total of 9 sessions. The intervention will use the "Chronic Pain" protocol of the BTL-6000 Super Inductive System. A standardized home-based exercise program will be provided to all participants.
Device: HI-PEMF - Knee (Chronic Pain Protocol)
High-intensity pulsed electromagnetic field (HI-PEMF) therapy applied to the symptomatic knee using the "Chronic Pain" protocol of the BTL-6000 Super Inductive System, 10-minute duration per session, applied twice per week over 5 weeks (total of 9 sessions). The applicator is positioned 2-3 cm above the patella, without skin contact, with the patient seated or in supine position.
Behavioral: Home-Based Exercise Program
Standardized home-based exercise program prescribed to both groups. It includes five exercises: isometric quadriceps contractions, straight leg raises, seated knee extensions, sit-to-stand from chair, and stationary marching. Participants are instructed to perform the exercises three times per week during the 5-week intervention. Printed instructions and a video guide are provided. Adherence is reinforced via weekly follow-up.
Experimental: Group B - Bimodal HI-PEMF
Participants in Group B will receive high-intensity pulsed electromagnetic field therapy (HI-PEMF) applied to both the symptomatic knee (femorotibial joint) and the quadriceps muscle (rectus femoris), with 10 minutes per site, twice a week over 5 weeks, completing a total of 9 sessions. The knee application will follow the "Chronic Pain" protocol, and the quadriceps application will follow the "Muscle Strengthening" protocol, both using the BTL-6000 Super Inductive System. A standardized home-based exercise program will be provided to all participants.
Behavioral: Home-Based Exercise Program
Standardized home-based exercise program prescribed to both groups. It includes five exercises: isometric quadriceps contractions, straight leg raises, seated knee extensions, sit-to-stand from chair, and stationary marching. Participants are instructed to perform the exercises three times per week during the 5-week intervention. Printed instructions and a video guide are provided. Adherence is reinforced via weekly follow-up.
Device: HI-PEMF - Quadriceps (Muscle Strengthening Protocol)
HI-PEMF therapy will be applied to both the symptomatic knee and the quadriceps muscle (rectus femoris). The knee application will follow the same procedure as in Group A, using the "Chronic Pain" protocol of the BTL-6000 Super Inductive System. In addition, the quadriceps will be treated using the "Muscle Strengthening" protocol. Each site will receive 10 minutes of therapy per session, twice per week over 5 weeks (total of 9 sessions). The applicator for the quadriceps will be positioned perpendicular to the muscle belly, without skin contact, with the patient lying supine and a cushion under the knee for slight flexion.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in pain intensity measured by the Numeric Analog Scale (NAS)
Time Frame: Baseline, end of intervention (week 5), and 2-month follow-up
Pain intensity will be assessed using the 11-point Numeric Analog Scale (0 = no pain, 10 = worst possible pain), reported by the patient at rest and related to the most symptomatic knee. The primary endpoint is the change in NAS score from baseline to end of the 5-week intervention and at 2-month follow-up (approximately week 13). This will allow evaluation of both immediate and sustained effects of the intervention.
Baseline, end of intervention (week 5), and 2-month follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in functional mobility measured by the Timed Up and Go (TUG) test
Time Frame: Baseline, end of intervention (week 5), and 2-month follow-up
Functional mobility will be assessed using the Timed Up and Go (TUG) test. Participants are instructed to stand up from a chair, walk 3 meters, turn around, return, and sit down. The total time (in seconds) will be recorded using a stopwatch. The outcome measure is the change in time from baseline to the end of the 5-week intervention and at 2-month follow-up. This assesses both short-term and sustained improvements in functional mobility.
Baseline, end of intervention (week 5), and 2-month follow-up
Change in lower-limb functional strength measured by the 5-times Sit-to-Stand (5STS) test
Time Frame: Baseline, end of intervention (week 5), and 2-month follow-up
Lower-limb functional strength will be assessed using the 5-times Sit-to-Stand (5STS) test. Participants will be instructed to rise from a standard chair and sit back down five times as quickly as possible without using their arms. The total time (in seconds) to complete the task will be recorded using a stopwatch. The outcome measure is the change in time from baseline to the end of the 5-week intervention and at 2-month follow-up. This evaluates improvements in functional lower-limb strength and endurance over time.
Baseline, end of intervention (week 5), and 2-month follow-up

Collaborators and Investigators

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

Sponsor

Hospital Civil de Guadalajara

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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 (Actual)

September 15, 2025

Primary Completion (Estimated)

February 5, 2026

Study Completion (Estimated)

April 15, 2026

Study Registration Dates

First Submitted

September 22, 2025

First Submitted That Met QC Criteria

September 22, 2025

First Posted (Estimated)

September 30, 2025

Study Record Updates

Last Update Posted (Estimated)

September 30, 2025

Last Update Submitted That Met QC Criteria

September 22, 2025

Last Verified

September 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CEI-151-25

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The individual participant data (IPD) will not be shared because the study is conducted within a public hospital setting without external funding, and there is no current plan or infrastructure to support secondary data sharing. Data will be used exclusively for the primary objectives outlined in the approved protocol.

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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