Examining the Effect of Neuromuscular Exercises on Movement Control in Hip & Knee Osteoarthritis: A Randomised Proof of Concept and Feasibility Study

Osteoarthritis (OA) is a chronic joint condition that significantly impacts mobility, function, and quality of life. Although exercise is strongly recommended in clinical guidelines for managing OA, the specific role of neuromuscular training-exercises targeting sensorimotor control, functional movement patterns, and joint stability-has not been thoroughly investigated in terms of improving movement control in this population. Previous research indicates that compromised neuromuscular control may contribute to altered biomechanics, increased joint loading, pain, and functional limitations among people with OA. However, structured neuromuscular interventions aiming explicitly at enhancing movement control remain understudied in clinical practice.

This study addressed this gap by conducting a cluster-randomised, proof-of-concept and feasibility trial designed to evaluate the effects of a structured neuromuscular exercise intervention based on principles from the Good Life with osteoArthritis in Denmark (GLA:D®) programme. This exercise programme has previously shown benefits in reducing OA symptoms and improving function, but its effect on movement control using structured assessments has yet to be explored.

Participants with clinically diagnosed symptomatic hip or knee OA were recruited from NHS physiotherapy outpatient clinics in the United Kingdom. Following recruitment, study sites were cluster-randomised to either the intervention or control group to minimise cross-group contamination. Participants at sites allocated to the intervention group underwent a supervised, structured neuromuscular exercise programme delivered by trained physiotherapists. This programme involved six supervised sessions, conducted once per week, with each session lasting approximately 60 minutes. Each session comprised a brief educational component followed by exercises focusing on dynamic joint stability, functional movement retraining, proprioception, balance, and muscle strengthening.

The neuromuscular exercises were progressively adjusted to individual abilities and pain tolerance, with careful monitoring of participants to ensure exercises were performed safely and correctly. Training intensity and exercise difficulty gradually increased throughout the intervention period, adhering closely to the established protocol from the GLA:D® programme.

Participants at control sites received standard physiotherapy care typically provided to individuals with hip or knee OA within the NHS. This standard care included general joint mobility exercises, strength training, general physiotherapy advice, and education provided during routine outpatient appointments.

To assess the impact of the neuromuscular exercise programme, the study used a novel clinical screening tool known as the Short Hip and Lower Limb Movement Screen (Short-HLLMS). This observational tool evaluates key movement patterns such as squatting and single-leg activities, providing a structured approach to identify movement impairments related to joint stability, coordination, and alignment.

Additionally, feasibility outcomes such as participant recruitment rates, retention, adherence to the intervention, and overall acceptability of the neuromuscular exercises were systematically evaluated to inform the potential for scaling up the intervention in future larger-scale trials or clinical practice implementation. Participant experiences and perceptions of the intervention were collected to understand barriers and facilitators to participation, adherence, and potential clinical translation.

The study aimed primarily to establish proof-of-concept regarding neuromuscular training's potential effectiveness in improving movement control, a crucial outcome associated with joint health and functional independence. This study also aimed to identify practical considerations essential for conducting a definitive randomised controlled trial, such as realistic recruitment timelines, dropout rates, and adherence to structured exercise programmes.

The results of this feasibility study have implications for both clinical practice and future research, providing evidence on whether a neuromuscular exercise approach can meaningfully influence movement quality in patients with hip and knee OA and inform decision-making for subsequent research phases, including larger-scale effectiveness trials.

Inclusion criteria

• Adults aged 30 years or older.
• Clinically diagnosed symptomatic hip and/or knee osteoarthritis (unilateral or bilateral).
• Meeting the American College of Rheumatology (ACR) clinical criteria for osteoarthritis.
• Able to safely participate in neuromuscular exercises and movement screening tests.

Exclusion criteria

• Acute septic arthritis.
• Inflammatory arthritis (e.g., rheumatoid arthritis).
• Avascular necrosis of the hip or knee.
• Recent steroid injections (within the past 3 months).
• Knee or hip surgery within the previous 12 months.
• Significant cardiorespiratory or systemic disorders limiting exercise participation.
• Neurological conditions (e.g., stroke, Parkinson's disease, multiple sclerosis).
• Body mass index (BMI) greater than 35 kg/m².
• Severe low back pain restricting activity.
• Cognitive impairment affecting ability to follow study instructions.
• Skin conditions affecting lower limbs, preventing safe participation in exercises.
• Inability to communicate effectively in English or understand the consent information.