Objective The objective of this randomized controlled trial (RCT) was to investigate the effectiveness of the lower limb rehabilitation protocol (LLRP) combined with mobile health (mHealth) applications on knee pain, mobility, functional activity and activities of daily living (ADL) among knee osteoarthritis (OA) patients who were overweight and obese. Methods This study was a single-blind, RCT conducted at Teaching Bay of Rehmatul-Lil-Alameen Post Graduate Institute of Cardiology between February and November 2020. 114 knee OA patients who were overweight and obese were randomly divided by a computer-generated number into the rehabilitation group with mHealth (RGw-mHealth) to receive LLRP + instructions of daily care (IDC) combined with mHealth intervention, rehabilitation group without mHealth (RGwo-mHealth) to receive LLRP + IDC intervention and control group (CG) to receive IDC intervention. All three groups were also provided leaflets explaining about their intervention. The primary outcome measure was knee pain measured by the Western Ontario and McMaster Universities Osteoarthritis Index score. The secondary outcome measures were mobility measured by the Timed up and go (TUG) test, functional activity measured by the patient-specific functional scale (PSFS), and ADL measured by the Katz Index of independence in ADL scores. Results Among the 114 patients who were randomized (mean age, 53 years), 96 (84%) completed the trial. After 3-months of intervention, patients in all three groups had statistically significant knee pain reduction (RGw-mHealth: 2.54; RGwo-mHealth: 1.47; and CG: 0.37) within groups (P < 0.05). Furthermore, patients in the RGw-mHealth and RGwo-mHealth had statistically significant improvement in mobility, functional activity, and ADL within groups (P < 0.05), but no improvement was noted in the CG (p > 0.05). As indicated in the overall analysis of covariance, there were statistically significant differences in the mean knee pain, mobility, functional activity, and ADL changes between groups after 3-months (p < 0.001). The pairwise between-group comparisons (Bonferroni post hoc analysis) of the knee pain, mobility, functional activity, and ADL scores at 3-months revealed that patients in the RGw-mHealth had significantly higher mean change in the knee pain, TUG test, functional activity, and ADL scores compared to patients in the RGwo-mHealth or CG. Conclusion Reduction in knee pain, improvement in mobility, functional activity, and ADL were more among patients in the RGw-mHealth compared with the RGwo-mHealth or CG. Trial registration National Medical Research Registry: NMRR-20-1094-52911. Date of registration: 05–05-2020. URL: https://www.nmrr.gov.my.

Background. Osteoarthritis (OA) of the knee is defined as a progressive disease of the synovial joints and is characterized by wear and tear of the cartilage and underlying bone. This study aimed to determine the short-term effects of the lower limb rehabilitation protocol (LLRP) on pain, stiffness, physical function, and body mass index (BMI) among knee OA participants who were overweight or obese. Methodology. A single-blinded randomized controlled trial of one-month duration was conducted at Rehmatul-Lil-Alameen Postgraduate Institute, Lahore, Pakistan. Fifty overweight or obese participants with knee OA were randomly divided into two groups by a computer-generated number. Participants in the rehabilitation protocol group (RPG) were provided with leaflets explaining the strengthening exercises of the LLRP and instruction of daily care (IDC), while the participants in the control group (CG) were provided with leaflets explaining the IDC only for a duration of four weeks. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function. The secondary outcome measures were BMI, exercise adherence, and patients’ satisfaction assessed by using the numeric rating scale ranging from 0 to 10. The paired-sample t-test was used to analyze the differences within groups from baseline to posttest evaluations. The analysis of variance 2 × 2 factor was used to analyze the differences in BMI, knee pain, stiffness, and physical function between the groups. Results. Participants in the RPG and CG reported a statistically significant reduction in knee pain and stiffness ( p ≤ 0.05 ) within the group. The reduction in the scores of knee pain was higher in participants in the RPG than that in participants in the CG ( p = 0.001 ). Additionally, participants in the RPG reported greater satisfaction ( p = 0.001 ) and higher self-reported exercise adherence ( p = 0.010 ) and coordinator-reported exercise adherence ( p = 0.046 ) than the participants in the CG. Conclusion. Short-term effects of the LLRP appear to reduce knee pain and stiffness only, but not physical function and BMI.

Background:Sahrmann five-level core stability test protocol has been used to evaluate the ability of the core muscles to stabilize the spine. However, validation studies on the Sahrmann protocol are limited. Objective:The purpose of this study was to compare the different levels of Sahrmann five-level core stability (levels 1–5) on the muscle activity of rectus abdominis (RA), external oblique (EO), and transverse abdominis/internal oblique (TrA/IO). Methods:Twenty-two asymptomatic male participants aged 21.3[Formula: see text].59 years were recruited. Participants were instructed to perform maximum voluntary contraction (MVC) and five levels of Sahrmann five-level core stability test guided with a pressure biofeedback unit (PBU). The surface electromyography (EMG) data of each muscle during five levels of Sahrmann five-level core stability test were normalized as a percentage of MVC. Results:Results showed significant differences in the normalized EMGs of RA [[Formula: see text](4) = 64.80, [Formula: see text].001], EO [[Formula: see text](4) = 58.11, [Formula: see text].001], and TrA/IO [[Formula: see text](4) = 56.00, [Formula: see text].001] between the five levels of Sahrmann five-level core stability test. Post-hoc analysis revealed Sahrmann levels 5 and 3 have significantly higher abdominal EMG signals than levels 4, 2, and 1 ([Formula: see text].001). Conclusion:In conclusion, the Sahrmann five-level core stability test differs according to the level of Sahrmann tests. Significantly higher abdominal muscle activities were observed during levels 3 and 5. Therefore, the classification exchange in levels 3 and 4 of the Sahrmann five-level core stability test should be reconsidered in the future.

Purpose This study aimed to investigate the effectiveness of progressive resistance strength training of the lower limb rehabilitation protocol (LLRP) on body mass index (BMI), quality of life, and functional capacity in patients with knee osteoarthritis (OA) who were overweight and obese. Patients and Methods Fifty-six patients were allocated into either the Rehabilitation Protocol Group (RPG) or the Control Group (CG) by a computer-generated random number. The patients in the RPG performed the strengthening exercises of the LLRP and followed the instruction of daily care (IDC). The patients in the CG only followed the IDC as a usual care. Gait Speed Test, quality of life, and BMI were taken at pre-test and post-test measurements. Paired samples t -test and two way mixed analysis of variance were used to analyze the change of BMI within and compare the difference of BMI between the groups, respectively. Wilcoxon signed ranked test and Mann–Whitney U -test were used to analyze the changes of quality of life and functional capacity within and compare the differences of quality of life and functional capacity between the groups, respectively. Results The patients in the RPG reported a significant reduction in BMI (p = 0.025), improvement in quality of life (p ≤ 0.001), and functional capacity (p ≤ 0.001) within group. The patients in the CG also reported a significant improvements in quality of life (p < 0.05). The improvement in quality of life score was greater in the patients with RPG than the CG (p = 0.053). Conclusion The progressive resistance strength training of LLRP is effective in terms of reducing BMI, improving quality of life and functional capacity. Trial Registration Name: Iranian Registry of Clinical Trials. Number: IRCT20191221045846N3. Enrollment of first participant: 27-07-2020.

Knee osteoarthritis (OA) is a degenerative and weight bearing joint disease that resulted from wear and tear of articular cartilage. It is more common in the overweight and obese knee OA patients. The objectives of pilot study were to assess the feasibility, acceptability and challenges of study design, study setting and tools of lower limb rehabilitation protocol among the knee OA patients who are overweight and obese. Twelve overweight and obese knee OA patients attending a Teaching Bay in the Pakistan were enrolled in the study and completed 6 training sessions over 2 weeks. The participants were divided randomly into Intervention Group with Mobile Health (IGW-mH), Intervention Group without Mobile Health (IGWO-mH) and the Control Group (CG). Both intervention groups were provided fifteen days of lower limb rehabilitation protocol but the CG did not. Two text messages per day for three days a week were sent to IGW-mH as a reminder to carry on their training session and instructions of daily care. All participants of intervention groups showed willingness to randomization and adherence to training sessions. The results indicated that eligibility criteria, recruitment rate and randomization procedures were feasible and there were no adverse events from training sessions. The participants demanded Urdu translation and pictures of lower limb rehabilitation protocol.