Effect of Retro walking as an Adjunct to conventional treatment on Pain, Balance, Gait, Muscle strength, Flexibility, Functional disability and Mobility in patients with knee Osteoarthritis

**Aim:**The  Objective of this RCT is to evaluate the effects of retro walking when used as an adjunct to Conventional treatment on pain, balance, gait, functional disability and mobility, muscle strength, and  flexibility,  in patients with OA knee compared to conventional treatment alone

Background and need of study: There is enough evidence demonstrating the effect of retro walking on pain and knee functional disability and mobility in patients with OA knee as it reduces the compressive

load on the knee but studies regarding its effect on gait, balance, muscle strength, and flexibility are inadequate as they involve the measurement of few parameters and use of conventional measuring tools. Considering this, the present study aims to investigate the effect of retro walking on strength, biomechanical gait, and balance parameters using more advanced tools in patients with knee OA.

Methods: An single -blinded randomized control trial on patients with OA knee (age 40 and above, both male and female) will be conducted in CPRS, Jamia Millia Islamia, New Delhi in accordance with the declaration of Helsinki, 1964.  Considering a 12 % drop out 42   eligible patients will be randomly allocated to either group A(n=21) which will receive conventional treatment including IFT for 15 min, a supervised exercise program that includes straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and isotonic quadriceps exercise and home program and group B(n=21) which will receive 15 min of retro walking on the treadmill along with conventional treatment for 3days /week for 6 weeks. Primary outcome measures include balance parameters (cop sway, cop range, reaction time, multidirectional stability, and proprioception), gait parameters (walking velocity, stride length, stride time, step width, step time and cadence), muscle strength (quadriceps to hamstring ratio, hip flexors to hip extensors ratio), pain intensity will be measured using pedalosensa move, kinovea software, Lafayette dynamometer and NPRS. Secondary outcome measures include hamstring flexibility, and knee function score using the KOOS scale and TUG score. Assessment of outcome measures includes pain intensity, muscle strength, flexibility, balance,  kinematic gait parameters, functional disability, and mobility at baseline, after 3rd week, and immediately after post-intervention.

Conclusion and clinical implication: Findings will provide evidence on the effectiveness of retro walking and help to enhance its future implementation to conventional treatment. The study might lead to new scientific insights into the importance of retro walking in the rehabilitation of patients with OA knee. This study will help us to understand the correlation between retro walking and conventional treatment for knee osteoarthritis. It will explore and provide information about retro walking and to which extent it affects balance parameters, gait parameters, strength, flexibility, function and pain. Retro-walking could be a useful technique for improving balance, gait, function, strength of the quadriceps and hip extensors, hamstring flexibility and reduce pain when used as an adjunct to conventional treatment. Since retro-walking prevents overstretching of the ligaments and undue loading of the knee, it may be proved as a good training method for rehabilitation of patients with OA knee. As the prevalence of OA knee is increasing its importance to keep up to date for providing best treatment for reducing pain and improving function through evidence-based practice and this study could provide knowledge of body for the same. To benefit knee OA patients, it is crucial to provide them with adequate rehabilitation training to decrease pain and enhance their strength and balance. This study guides us through the new treatment approach for patients with OA knee. Findings from this study may be relevant for the development of treatment strategies for patient with OA knee.

Ethical approval: The study has been approved by  Institutional Human Ethical Committee, Jamia Millia Islamia, India.