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NCT Number: NCT07261540

Bilateral Knee Strength Asymmetry and Functional Performance in Older Women With Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease that primarily affects the knees and becomes more prevalent with age. In individuals over 50, particularly those with bilateral knee osteoarthritis, it leads to chronic pain, limited mobility, and functional decline. This condition worsens due to muscle strength imbalances, especially in the quadriceps and hamstrings. These imbalances are triggered by pain, joint instability, and cartilage damage, which negatively impact muscle strength and coordination. In women, these asymmetries are more pronounced, increasing the risk of functional decline.

Recent studies highlight the significant role of strength asymmetry in functional limitations, affecting balance, gait, and daily activities. This study aims to investigate the impact of bilateral quadriceps and hamstring strength asymmetries on dynamic balance, gait efficiency, and functional mobility in older women with bilateral knee osteoarthritis.

The study aims to examine the effects of bilateral strength asymmetries in the knee extensors and flexors on dynamic balance, gait efficiency, and overall mobility in older women with bilateral knee osteoarthritis. We hypothesize that greater strength asymmetry will be associated with impaired dynamic balance, reduced gait efficiency, and decreased functional mobility.

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Key information

Conditions

Knee Osteoarthristis Functional Performance Isokinetic Test Muscle Strenght Postmenopausal Women

Age range

50 year and older

Sex eligibility

Female

Study type

Observational

Primary location

Kocaeli Health and Technology University

Kocaeli, Turkey (Türkiye)

About this study

Osteoarthritis (OA) is a degenerative joint disease that commonly affects the knee, especially in individuals over 50. It leads to pain, reduced mobility, and functional decline. In bilateral knee OA, muscle imbalances, especially in the quadriceps and hamstrings, worsen functional limitations and increase the risk of falls. These imbalances are caused by pain, joint instability, and cartilage damage, affecting muscle strength and coordination. In older women, these issues are more pronounced, increasing their risk of functional decline compared to men.

Emerging research highlights the role of muscle strength asymmetry (differences between the left and right leg) in functional difficulties, such as poor balance, walking issues, and difficulty with daily tasks. This study aims to explore how these muscle imbalances in knee extensors and flexors impact overall functional abilities, such as balance and walking efficiency in women with bilateral knee OA.

The study seeks to examine how bilateral strength asymmetry in the knee muscles affects dynamic balance, gait efficiency, and mobility in older women with knee osteoarthritis. The hypothesis is that greater muscle imbalance will lead to worse balance, slower walking, and reduced mobility.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • women gender
  • aged 50 years or older
  • diagnosed with bilateral knee osteoarthritis (Kellgren-Lawrence grade II-III),
  • capable of independent walking without assistive devices.

Exclusion criteria

  • severe knee osteoarthritis requiring total knee arthroplasty
  • neurological conditions affecting gait or balance
  • severe musculoskeletal disorders
  • uncontrolled systemic diseases
  • cognitive impairments (Mini-Mental State Examination < 24)

Treatment and study plan

Isokinetic Strength Testing

Other

Bilateral knee strength asymmetry was assessed using a Biodex System 4 Pro isokinetic dynamometer (Biodex Medical Systems, USA). Participants were securely positioned, and knee extensor and flexor strength were measured at angular velocities of 120°/s and 180°/s. Each participant performed five maximal concentric contractions per limb, with the highest peak torque values recorded.

Other names: Pain Assessment, Dynamic Balance Measurement, Functional Mobility, Gait Speed

Primary outcomes

  1. Isokinetic Strength Testing

    Time frame: From enrollment to the end of evaluation in 1 hour

    Bilateral knee strength asymmetry was assessed using a Biodex System 4 Pro isokinetic dynamometer (Biodex Medical Systems, USA). Participants were securely positioned, and knee extensor and flexor strength were measured at angular velocities of 120°/s and 180°/s. Each participant performed five maximal concentric contractions per limb, with the highest peak torque values recorded. Higher asymmetry values indicated greater strength imbalances between limbs

  2. Functional Mobility

    Time frame: From enrollment to the end of evaluation in 1 hour

    The 30-second Sit-to-Stand test was used to assess lower limb functional strength and endurance. Participants were instructed to stand up and sit down as many times as possible in 30 seconds from a standard chair (seat height: 46 cm) without using their arms. The total number of completed repetitions was recorded. A lower Sit-to-Stand score indicates reduced quadriceps endurance, decreased functional independence, and a higher fall risk in older adults.

Secondary outcomes

  1. Pain Assessment

    Time frame: From enrollment to the end of evaluation in 1 hour

    Knee pain intensity during daily activities and strength testing was evaluated using the 10-cm Visual Analog Scale, a widely validated tool for assessing subjective pain perception in bilateral knee osteoarthritis patients

  2. Dynamic Balance Measurement

    Time frame: From enrollment to the end of evaluation in 1 hour

    Dynamic balance was assessed using the Biodex Balance System (Biodex Medical Systems, Shirley, NY, USA), a validated system for evaluating postural control and stability. Participants performed the Limits of Stability (LOS) test, which measures movement control in eight directions, quantifying reaction time, movement velocity, endpoint excursion, and directional control

  3. Gait Speed

    Time frame: From enrollment to the end of evaluation in 1 hour

    Gait speed was assessed using a 4-meter walk test, a reliable measure of functional mobility and fall risk in older adults. Participants were instructed to walk at their usual pace, and the time (s) was recorded. Slower gait speed is associated with higher fall risk, reduced mobility, and lower physical function in knee osteoarthritis patients

Sponsors and collaborators

Lead sponsor

Kocaeli Sağlık ve Teknoloji Üniversitesi

Other

Registry information

Acronym: STASFP-OA

Important dates

Study start
2025
Primary completion
2025
Study completion
2025
First posted
Dec 3, 2025
Registry last updated
Dec 3, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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