Effects of Diagonal Proprioceptive Neuromuscular Facilitation Patterns on Pain and Functional Outcomes in Patients With Knee Osteoarthritis

February 7, 2026 updated by: Rabia Hassan, University of Karachi
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.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

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 Type

Interventional

Enrollment (Estimated)

150

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 Contact

Study Contact Backup

Study Locations

  • Pakistan
    • Sindh
      • Karachi, Sindh, Pakistan, 74600
      • Karachi, Sindh, Pakistan, 74600
        • Recruiting
        • Dr. Ziauddin Hospital
        • Contact:

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

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 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).

Exclusion Criteria:

  • 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.

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
Intervention / Treatment
Experimental: Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises + Heat Therapy.
This arm will receive PNF pattern exercises using Diagonal 1 and Diagonal 2 Lower Limb Patterns of PNF and the heat therapy
Other: Diagonal Proprioceptive Neuromuscular Facilitation (PNF) Pattern Exercises
Diagonal PNF pattern exercises include Diagonal 1 and Diagonal 2 lower limb pattern movements performed against resistance to improve strength, flexibility, and functional performance.
Other: Heat Therapy
Heat therapy will be given for 10 minutes by the help of electric heating pad.
Active Comparator: Conventional Strength Training Exercises + Heat Therapy
This arm will receive evidence based treatment of Quadripceps and Hip Abductor Strengthening exercises and the heat therapy.
Other: Heat Therapy
Heat therapy will be given for 10 minutes by the help of electric heating pad.
Other: Conventional Strength Training Exercises
The conventional strength training exercises include quadriceps and hip abductor strengthening performed using resisted active movements to improve muscle strength and functional ability.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
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.
Baseline and after 6 weeks of intervention
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.
Baseline and after 6 weeks of intervention.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in functional disability will be assessed with Knee Injury and Osteoarthritis Outcome Score (KOOS)
Time Frame: Baseline and after 6 weeks of intervention.
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.
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.
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.
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.
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.
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.
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.
Baseline and after 6 weeks of intervention.

Collaborators and Investigators

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

Sponsor

University of Karachi

Investigators

  • Study Chair: Basit Ansari, PhD, University of Karachi
  • Study Director: Aftab Ahmed Mirza Baig, PhD, IQRA University
  • Principal Investigator: Rabia Hassan, MSAPT, Ziauddin University

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)

February 7, 2026

Primary Completion (Estimated)

January 19, 2027

Study Completion (Estimated)

February 22, 2027

Study Registration Dates

First Submitted

February 1, 2026

First Submitted That Met QC Criteria

February 1, 2026

First Posted (Actual)

February 9, 2026

Study Record Updates

Last Update Posted (Actual)

February 11, 2026

Last Update Submitted That Met QC Criteria

February 7, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • IBC KU-549/2025

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

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.

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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