An Evaluation of the Graded Weight-bearing Exercise on Pain, Function, Proprioception, and Muscle Strengths in Patients With Knee Osteoarthritis.

Study design: This study is a single-blinded randomized controlled trial. after baseline assessment, the participants will be assigned randomly into three groups, the graded weight-bearing exercise group, the closed kinetic chain exercise group, and the control group. First, randomization will be performed by allocating a specific number for each participant. Then, Online GraphPad will be applied to randomize these numbers into three groups. The participants' allocation will be conducted by a person who is not in contact with the participants or involved in any testing. The allocation sequence will be saved on that person's computer. Following randomization, the participant will be notified by phone about which group they will be assigned to.

Study setting: The current study will be held at the laboratory at Umm Al-Qura University, Faculty of Applied Medical Sciences, Makkah, Saudi Arabia Recruitment and study population Patients will be recruited from the physical therapy outpatient clinic, Umm Al-Qura university medical centre, and other physical therapy outpatient clinic in Makkah.

Intervention group:

The intervention will be constructed based on recent clinical exercise guidelines for people with knee osteoarthritis. These guidelines mainly recommend weight-bearing exercises, progressive resistance training for lower limb major muscle groups, and aerobic exercise. The exercise regimen will be applied at two sessions per week for six weeks. The intervention is designed as the group I will perform progressive weight-bearing using an anti-gravity treadmill, the loading starts with patient tolerance - pain-free range and increases gradually, combined with open kinetic chain exercises. Group II will perform closed kinetic chain exercises with open kinetic chain exercises. Most of the exercises in these groups will be achieved in a weight-bearing position, with or without support, besides other exercises to improve knee flexors and extensors strength. An experienced physiotherapist will observe the intervention. Participants who have a higher risk of falling, restricted weight-bearing activities, or movement during training and activities will be given extra attention to avoid injuries. The physiotherapists will be trained to deliver the weight-bearing exercise program and ensure that participants have access to support devices. The session will last one hour and be repeated twice a week for six weeks. Participants' customizing, appropriate dosage, and progression of the exercises will be the responsibility of the physiotherapist supervising the exercise session. The exercise regimen will begin with a 10-minute warm-up that includes stretching, flexibility, and dynamic balance exercises. The warm-up will be followed by a graded weight-bearing exercise for group I and a closed kinetic chain exercise for group II with a short break for 30 seconds. Each session will end with 10 min cooling down and stretching. Participants are encouraged to report any significant side effects from the exercise, such as muscular soreness, joint tenderness, or increased pain level.

Control group: