An interventional study of Sensory-Assisted Neuromuscular Exercise and Electrical stimulation in Knee Arthritis Osteoarthritis and Neuromuscular Adaptations, sponsored by Ziauddin University. Completed at 1 site in Pakistan. Open to participants aged 40 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-10-23.
Sponsored by Ziauddin University · Not applicable, Interventional, and Treatment
This two-arm randomized controlled trial compared Sensory-Assisted Neuromuscular Exercise (Group A) with Electrical Stimulation (Group B) in 40 adults aged 40-65 with Kellgren-Lawrence Grade II-III knee osteoarthritis, recruited from Ziauddin Hospital and Nemat Begum Hamdard Hospital. Both interventions were given three times a week for eight weeks, with outcomes assessed at baseline, week 8, and week 12 across eighteen variables covering pain, stiffness, function, range of motion, muscle activation, strength, alignment, and quality of life. Both groups improved significantly, but the neuromuscular exercise group outperformed electrical stimulation on most outcomes by week 12. Only the HKA alignment angle remained unchanged in both groups, as expected for a fixed skeletal measure. The authors conclude that neuromuscular exercise should be prioritized as a first-line conservative treatment, with electrical stimulation serving as an adjunct.
Background: Knee osteoarthritis (KOA) is the most prevalent form of arthritis worldwide, imposing a substantial and growing burden on physical function and quality of life. While therapeutic exercise and electrical stimulation are both widely used conservative treatments, direct comparative evidence spanning pain, biomechanical, neuromuscular, and quality-of-life outcomes within a single trial remains limited.
Objective: This study compared the effects of Sensory-Assisted Neuromuscular Exercise (Group A) and Electrical Stimulation (Group B) on pain, stiffness, physical function, range of motion, neuromuscular activation, muscular strength, mechanical alignment, and knee-related quality of life in adults with Kellgren-Lawrence Grade II-III knee osteoarthritis.
Methods: A two-arm, parallel-group randomized controlled trial was conducted at Ziauddin Hospital and Nemat Begum Hamdard Hospital. Forty participants (aged 40-65 years) were randomized 1:1 to Group A or Group B (n = 20 each) using a computer-generated sequence with allocation concealment. Both interventions were delivered three times weekly for eight weeks, with outcomes assessed at baseline (T0), post-treatment (T1, week 8), and follow-up (T2, week 12) across eighteen variables, including the Numeric Rating Scale, WOMAC, KOOS, surface electromyography, dynamometry, goniometry, and Hip-Knee-Ankle (HKA) radiographic alignment. Data were analyzed using repeated-measures ANOVA/Friedman tests (within-group) and independent-samples t-tests/Mann-Whitney U tests (between-group).
3,391 studies on the registry are indexed under Osteoarthritis, Knee; 628 are open to participants now.
This study's enrollment of 40 is below the median of 69 across 2,808 interventional studies indexed under Osteoarthritis, Knee.
Browse Osteoarthritis, Knee studies →Ziauddin University is the lead sponsor of 51 studies on the registry; 9 are open to participants now.
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Exclusion Criteria:
Sensory-assisted neuromuscular exercise, three sessions per week for 8 weeks.
Other: Electrical stimulation
Electrical stimulation, three sessions per week for 8 weeks.
Other: Sensory-Assisted Neuromuscular Exercise
Sensory-assisted neuromuscular exercise, three sessions per week for 8 weeks.
Electrical stimulation, three sessions per week for 8 weeks.
Knee Joint Alignment Measured by Hip-Knee-Ankle (HKA) Angle on Full-Leg Standing Radiograph
Frontal-plane mechanical alignment of the affected knee, measured on a full-length standing radiograph. The HKA angle is the angle between the femoral mechanical axis (centre of femoral head to centre of knee) and the tibial mechanical axis (centre of knee to centre of ankle). It is reported in degrees of deviation from neutral (0° = neutral alignment). Higher values indicate greater malalignment.
Time frame: Baseline, Week 8, and Week 12
Knee Pain Intensity Measured by Numeric Rating Scale (NRS)
Knee pain intensity measured on the 11-point Numeric Rating Scale (0 = no pain, 10 = worst imaginable pain). Lower scores indicate less pain.
Time frame: Baseline, Week 8, and Week 12
WOMAC Pain, Stiffness, Physical Function, and Total Scores
Western Ontario and McMaster Universities Osteoarthritis Index, assessing pain (0-20), stiffness (0-8), and physical function (0-68), with a total score of 0-96. Higher scores indicate worse symptoms and function.
Time frame: Baseline, Week 8, and Week 1
Knee Flexion Range of Motion Measured by Digital Goniometer
Active knee flexion range of motion of the affected knee, measured in degrees with a digital goniometer by a blinded physiotherapist. Higher values indicate better mobility.
Time frame: Baseline, Week 8, and Week 12
Knee Extension Deficit Measured by Digital Goniometer
Loss of full knee extension of the affected knee, measured in degrees with a digital goniometer by a blinded physiotherapist (0° = full extension). Lower values indicate a better outcome.
Time frame: Baseline, Week 8, and Week 12
Vastus Medialis Muscle Activation Measured by Surface Electromyography (sEMG)
Muscle activation of the vastus medialis, recorded with surface EMG during a standardized contraction. Reported as amplitude in \[µV / %MVIC\]. Higher values indicate greater activation.
Time frame: Baseline, Week 8, and Week 12
Vastus Lateralis Muscle Activation Activation Measured by Surface Electromyography (sEMG)
Muscle activation of the vastus lateralis, recorded with surface EMG during a standardized contraction. Reported as amplitude in \[µV / %MVIC\]. Higher values indicate greater activation
Time frame: Baseline, Week 8, and Week 12
Hamstring Muscle Strength Measured by Hand-Held Dynamometer
Maximal isometric knee flexor strength of the affected limb, measured with a hand-held dynamometer, in \[N / kg\]. Higher values indicate greater strength.
Time frame: Baseline, Week 8, and Week 12
Quadriceps Muscle Strength Measured by Hand-Held Dynamometer
Maximal isometric knee extensor strength of the affected limb, measured with a hand-held dynamometer, in \[N / kg\]. Higher values indicate greater strength
Time frame: Baseline, Week 8, and Week 12
Knee Injury and Osteoarthritis Outcome Score (KOOS)
KOOS subscales of Pain, Symptoms, Activities of Daily Living, Sport/Recreation, and Knee-Related Quality of Life, each scored 0-100. Higher scores indicate fewer problems and better quality of life.
Time frame: Baseline, Week 8, and Week 12
Plan to share: No
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Ran from Feb 2021 to primary completion in Jan 2026, 59 months.
Of 1,143 non-industry interventional studies with no phase under Osteoarthritis, Knee, half reached primary completion within 18 months of starting (the median), counting those still running; a quarter within 8 and three quarters within 36. This study's 59 months is above that.
Counting every sponsor, half of 1,285 studies reached it within 18 months; a quarter within 8 and three quarters within 36.
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is completed, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
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Ziauddin University