Effectiveness of core exercises on knee pain and physical function in individuals diagnosed with knee osteoarthritis: A 12-week randomized controlled trial

Abstract This assessor-blinded, single-center randomized controlled trial aimed to determine whether adding the Core Activation and Rehabilitation Exercises for Knee Osteoarthritis (CARE-KOA©) program to conventional knee-focused rehabilitation improves clinical and functional outcomes in adults with mild-to-moderate knee osteoarthritis (KOA). One hundred participants with Kellgren–Lawrence grade 1–3 were randomized to CARE-KOA© rehabilitation ( n = 51) or conventional knee-based rehabilitation ( n = 49) for 12 weeks. Pain, patient-reported outcomes, physical function tests, isometric knee strength, and core endurance were evaluated at baseline and at 4, 8, and 12 weeks. Baseline imbalances in VAS-Activity, KOOS-ADL, and Timed Up-and-Go (TUG) were addressed using analysis of covariance. CARE-KOA© produced greater improvements in activity-related pain, patient-reported outcomes, transitional physical function, and core endurance ( p < 0.05), whereas improvements in isometric knee muscle strength were comparable between groups. Adjusted between-group differences remained statistically significant for VAS-Activity (− 2.27 cm; 95% CI − 2.65 to − 1.88), KOOS-ADL (5.45 points; 95% CI 2.62 to 8.28), and TUG (− 5.49 s; 95% CI − 6.16 to − 4.81). These findings support the incorporation of structured core-stabilization training as an adjunct to conventional knee rehabilitation to improve clinical and functional outcomes in individuals with mild-to-moderate KOA. CTRI Registration: The trial was prospectively registered in the Clinical Trials Registry of India (CTRI) under CTRI no. CTRI/2023/07/054805 in July 2023.