Clinical Pilates in Hip Osteoarthritis: A Randomised Controlled Trial

Pain intensity will be evaluated using the Visual Analog Scale (VAS). During the assessment, patients will be asked to mark the degree of pain they feel on a 100-mm horizontal line. The distance from the starting point to the marked point will be measured with a ruler, and the pain intensity will be recorded in millimeters.

The VAS, developed by Vas Price et al. (1983), is a validated and reliable tool for determining the perceived intensity of pain. It is simple to administer and widely used in clinical practice.

Lumbopelvic stabilization will be assessed using the "Stabilizer Pressure Biofeedback Unit". Prior to the measurement, each participant will be instructed in the corset technique for contracting the Transversus Abdominis muscle while lying in a supine position. Participants will be asked to lie on their back with their knees bent (hook-lying position), maintaining a neutral and relaxed spinal alignment.

A pressure cell, inflated with air and connected to a stabilizer, will be placed under the lumbar spine. The manometer's baseline pressure will be inflated to 40 mmHg. Participants will then be instructed to contract their Transversus Abdominis muscle using the abdominal corset technique without moving the spine or pelvis and without holding their breath. They will be required to maintain this contraction for 5 seconds.

After three practice trials to ensure learning, participants will rest for 30 seconds. The actual measurement will consist of three repetitions of 10 seconds each.

Static balance assessment was performed using a proprioceptive-stabilometric assessment machine (ProKin 252; TecnoBody, Prokin, Italy). The device consists of a force platform with a 55 cm diameter surface, a sampling rate of 20 Hz, and a sensitivity of 0.1.

For all participants, anterior-posterior stability, medial-lateral stability index, and total stability index were measured under two conditions: with eyes open and eyes closed. Participants were instructed to stand motionless on the fixed platform surface for 30 seconds with their eyes open. During this time, the minimal postural sway of the body was recorded by the device, and a report was generated. The same measurement was then repeated with eyes closed.

Higher scores indicate impaired postural stability, while lower scores represent normal postural stability

The Active Normal Range of Motion (ANROM) of the participants will be evaluated in appropriate positions. If necessary, measurements will be taken using a universal goniometer, and the degree of limitation will be recorded.

In the supine position, hip flexion, abduction, and adduction ANROM will be assessed, while hip extension ANROM will be evaluated in the prone position.

The physical function levels of the participants will be measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). This assessment tool consists of three subscales: Section A evaluates pain severity, Section B assesses joint stiffness, and Section C measures physical function.

The scale includes 5 questions for pain, 2 questions for joint stiffness, and 17 questions for physical function. Each question is scored on a scale from 1 to 5, where:

• = None
• = Mild
• = Moderate
• = Severe
• = Very Severe

Each subscale generates a total score independently. A lower score indicates better health status, while a higher score reflects worse health status. The scoring ranges are as follows:

Section A (pain): 5-25 Section B (joint stiffness): 2-10 Section C (physical function): 17-85

The disability levels of participants will be assessed using the Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (HOOS-PS). HOOS-PS is a 5-item scale designed to evaluate symptoms and functional status related to hip osteoarthritis. This questionnaire was developed by OMERACT/OARSI.

Each question is scored on a scale of 0 to 4 based on the degree of difficulty, with a maximum possible score of 20. However, the scores are normalized to a range of 0-100, where 0 indicates the best functional status.

The self-efficacy levels of participants will be assessed using the Arthritis Self-Efficacy Scale. This scale consists of 20 items evaluated on a 10-point visual scale and includes three subdimensions: self-efficacy for pain, self-efficacy for function, and self-efficacy for other symptoms.

Self-efficacy for pain involves the perception of the ability to reduce pain and maintain it at a low level. The first 5 items of the scale belong to this subdimension.

Self-efficacy for function measures the ability to perform functions affected by arthritis, particularly in the hand and foot joints. The next 9 items following the first 5 are included in this subdimension.

Self-efficacy for other symptoms evaluates the ability of individuals with arthritis to cope with existing symptoms. The final 6 items fall under this subdimension.

Each item is scored on a 10-point scale, ranging from "Not at all confident = 1" to "Very confident = 10." The total score can range from 20 (minimu

The quality of life levels of the participants will be evaluated with SF-12. SF-12 consists of 8 sub-dimensions and 12 items including physical functioning (2 items), physical role (2 items), body pain (1 item), general health (1 item), energy (1 item), social functioning (1 item), emotional role (2 items) and mental health (2 items). The items related to physical and emotional role are answered as 'yes or no', while the other items have Likert-type options ranging between 3 and 6. Physical component summary (PCS)-12 score is obtained from general health, physical functioning, physical role and body pain sub-dimensions, while mental component summary (MCS)-12 score is obtained from social functioning, emotional role, mental health and energy sub-dimensions. Both FCI-12 and MCI-12 scores ranged from 0 to 100, with higher scores representing better health.

The participant is asked to sit upright on a standard 43 cm high chair with their arms crossed over their shoulders. They are then instructed to stand up and sit down as many times as possible in 30 seconds, at the fastest pace they can. They are told that they can rest if they get tired. The number of stand-ups is recorded.

The participant is asked to walk as fast as they can, but not run, for a distance of 40 meters. The time taken to complete the test is recorded.

The participant is asked to climb up a 9-step stair, turn around, and climb back down. The time taken is recorded, and their ability to perform the functional task is observed.

The participant is asked to stand up from a chair, walk 3 meters, turn around, walk back to the chair, and sit down. The time taken to complete the test is recorded.