Clinical trial NCT06954363: Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients
Official title: Effectiveness of Muscle Energy Techniques and Mulligan Mobilization Along With Conventional Physical Therapy in Knee Joint Osteoarthritis Patients: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Knee Osteoarthritis
Keywords: Knee Osteoarthritis
Muscle Stretching Exercises
Range of Motion, Articular
Lead sponsor: Khyber Medical University Peshawar
Sponsor class: OTHER
First posted: 2025-05-01
Enrollment: 24
Sex: ALL
Minimum age (years): 40
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Participants will be randomly assigned to one of two parallel treatment groups that includes experimental Group (Mulligan Mobilization + Conventional Physical Therapy) and Control Group (Muscle Energy Technique + Conventional Physical Therapy).
Primary purpose: TREATMENT

Brief summary: This study aims to evaluate the effectiveness of integrating Muscle Energy Technique (MET) and Mulligan Mobilization with conventional physical therapy in the management of knee osteoarthritis (OA), with a specific focus on improving hamstring flexibility and reducing functional limitations. The findings will help inform clinical decision-making and enhance patient outcomes in OA rehabilitation.

Detailed description: Osteoarthritis (OA) is a progressive degenerative joint disease characterized by the destruction of articular cartilage and the formation of bone spurs, leading to pain, joint stiffness, and decreased functional mobility. While its exact cause remains unknown, factors such as age, sex, obesity, sedentary lifestyle, genetics, bone density, smoking, and joint location contribute significantly to its development. As patients experience pain and reduced joint mobility, they often limit movement, particularly of the knee, resulting in muscular tightness-most notably in the hamstring, a two-joint muscle.

Globally, OA is a major public health concern, with knee OA affecting approximately 250 million people in 2010, including 18% of women and 9.6% of men over 60. It has substantial economic impacts, such as costing the United States 1-2.5% of its GDP and Spain €4.7 billion in 2007. Regional data from South Asia show higher prevalence in rural populations, emphasizing the disease's widespread burden.

Physical therapy has been shown to be highly effective in managing knee OA symptoms. Several randomized controlled trials support the use of techniques like Muscle Energy Technique (MET) and Mulligan Mobilization. MET has demonstrated superior efficacy compared to static stretching and whole-body vibration in improving hamstring flexibility and reducing stiffness. Similarly, Mulligan Mobilization, particularly when combined with supervised exercises, has shown better outcomes than Maitland mobilization in improving flexibility and function in OA patients.

However, current literature presents conflicting evidence regarding the individual efficacy of MET and Mulligan Mobilization. This study seeks to address these inconsistencies by investigating the effectiveness of integrating both MET and Mulligan Mobilization with conventional physical therapy in treating knee OA. The goal is to provide evidence-based insights that can guide clinicians in optimizing therapeutic strategies for better functional outcomes and enhanced quality of life for patients with knee osteoarthritis.

Eligibility criteria: Inclusion Criteria:

* Diagnosed cases of osteoarthritis (Grade 1 to 3)
* X-ray showing Grades I to III on Kellgren Lawrence scale of Osteoarthritis.
* Residents of Peshawar verified via NADRA CNIC
* Both genders will be included with unilateral or bilateral knee involvement.
* Age group 40 and above.
* Duration of Knee pain for more than 3 months.

Exclusion Criteria:

* History of any previously known neurological conditions i.e. stroke, peripheral neuropathy
* Fractures in treatment limb.
* Suspicious of malignancy around the knee joint.
* Recent under gone surgery
* Recent Intra-articular injection.
* Significant comorbid diseases and disabilities are excluded from the study

Primary outcomes:
measure: Hamstring Flexibility Measured by Goniometer
timeFrame: Baseline (Day 1) and Post-treatment (End of Week 3)
measure: Change in Pain Score Using Knee Osteoarthritis Outcome Score-12 questionnaire Questionnaire
timeFrame: Baseline (Day 1) and Post-treatment (End of Week 3)
measure: Change in Knee-Related Quality of Life Using Knee Osteoarthritis Outcome Score-12 questionnaire
timeFrame: Baseline (Day 1) and Post-treatment (End of Week 3)
measure: Change in Activity of Daily Living Function Using KOOS-12
timeFrame: Baseline (Day 1) and Post-treatment (End of Week 3)
Secondary outcomes:
Other outcomes:
Locations:
city: Peshawar
country: Pakistan
facility: Hayatabad Medical Complex Peshawar
state: KPK
city: Peshawar
country: Pakistan
facility: Alkhidmat Hospital Peshawar
state: KPK
city: Peshawar
country: Pakistan
facility: Bibi Zahida Memorial Hospital, NCS University System
state: KPK
Study officials:
affiliation: Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar
name: Babar Israr, MSPT
role: PRINCIPAL_INVESTIGATOR
affiliation: Institute of Physical Medicine and Rehabilitation, Khyber Medical University Peshawar
name: Shakir Ullah, PhD
role: STUDY_DIRECTOR
affiliation: Alkhidmat Hospital Peshawar
name: Samra Farid, MSPT
role: PRINCIPAL_INVESTIGATOR
References:
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citation: Ceballos-Laita L, Jimenez-Del-Barrio S, Marin-Zurdo J, Moreno-Calvo A, Marin-Bone J, Albarova-Corral MI, Estebanez-de-Miguel E. Effects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trial. Complement Ther Med. 2020 Jun;51:102443. doi: 10.1016/j.ctim.2020.102443. Epub 2020 May 18.
citation: Ashraf F, Anwar K, Arshad H. Effects of muscle energy technique along conventional physical therapy after mesenchymal stem cell transplantation in knee osteoarthritis patients. Pak J Med Sci. 2024 Dec;40(11):2558-2564. doi: 10.12669/pjms.40.11.9605.
citation: Goksen A, Can F, Yilmaz S, Korkusuz F. Comparison of different neuromuscular facilitation techniques and conventional physiotherapy in knee osteoarthritis. Turk J Med Sci. 2021 Dec 13;51(6):3089-3097. doi: 10.3906/sag-2101-298.
citation: Sanchez-Romero EA, Pecos-Martin D, Calvo-Lobo C, Ochoa-Saez V, Burgos-Caballero V, Fernandez-Carnero J. Effects of dry needling in an exercise program for older adults with knee osteoarthritis: A pilot clinical trial. Medicine (Baltimore). 2018 Jun;97(26):e11255. doi: 10.1097/MD.0000000000011255.