Feasibility of a Group-based Programme Combining Vestibular Rehabilitation and Lower-limb Strengthening in Older Women with Bilateral Knee Osteoarthritis: A Single-arm Pilot Study with Exploratory Clinical, Functional and Electromyographic Outcomes

Abstract

Aims: This study assessed the feasibility of a group-based programme combining vestibular rehabilitation and muscle strengthening in women with bilateral knee osteoarthritis and, as exploratory objectives, estimated pre- to post-intervention changes in pain, isometric muscle strength, electromyographic activity, proprioception, postural instability and overall functionality, so as to generate parameters for sizing a definitive trial. Study Design: Non-randomised, single-arm feasibility pilot study with pre- and post-intervention assessments, reported in accordance with TREND and CONSORT guidance for pilot trials. Place and Duration of Study: Physiotherapy Teaching Clinic, University of Ribeirão Preto (UNAERP), Brazil; 25 sessions, twice weekly. Methodology: Seven older women (74.29 ± 6.10 years) completed 25 sessions of lower-limb elastic resistance plus vestibular rehabilitation. Assessments comprised Timed Up and Go (TUG), hand-held dynamometry, Dizziness Handicap Inventory (DHI), Fukuda stepping test, algometry and electromyography during the sharpened Romberg test. Results: All seven participants completed the programme and both assessments (100% retention, no adverse events). In exploratory, uncorrected pre- to post-intervention comparisons, TUG time decreased from 13.34 ± 3.17 to 10.30 ± 2.07 s and left knee extensor strength increased from 11.46 to 14.51 kgf (both P = .01). Left medial gastrocnemius activation fell 30.8% with eyes open (P = .03). DHI, Fukuda, and algometry outcomes were unchanged (P > .05). All comparisons were uncorrected for multiplicity and are reported as exploratory pre- to post-intervention changes rather than as evidence of efficacy. Limitations: The single-arm design, seven participants and the absence of randomisation and of a control group preclude causal inference. Multiple comparisons were uncorrected, strengthening cannot be separated from the vestibular exercises, and the lack of objective vestibular testing limits interpretation. Conclusion: The protocol proved feasible in a teaching-clinic setting. Because the design was single-arm and included no control group, the observed changes cannot be attributed to the programme; the exploratory findings are hypothesis-generating and suggest a possible contribution of peripheral musculoskeletal pathways. Definitive trials require objective vestibular screening, a control group, and an adequate sample.