Knee osteoarthritis is a degenerative joint disease that commonly affects the elderly, characterized by the gradual deterioration of articular cartilage. It can be classified into primary osteoarthritis, which has no identifiable cause, and secondary osteoarthritis, resulting from factors such as abnormal force distribution across the joint (e.g., post-traumatic causes) or conditions affecting cartilage like rheumatoid arthritis (RA). Symptoms include gradually increasing knee pain, stiffness, and swelling, which can significantly impact daily activities and potentially lead to disability over time. Osteoarthritis (OA) affects 7% of the global population, with 73% of those affected being over 55 years old and 60% being female. In India, OA is highly prevalent, affecting 22% to 39% of the population.

Patients with knee OA often experience deficits in proprioception, leading to abnormal joint loading and slow, progressive joint degeneration. Additionally, these patients typically have reduced muscle strength, particularly in the quadriceps, and altered muscle activation patterns, contributing to poor balance. Balance maintenance involves the vestibular system, vision, proprioception, muscle strength, and cognitive functions. Studies show that individuals with knee OA have impaired proprioception compared to peers of similar age, with histological examinations indicating fewer mechanical sensory receptors around the knee ligaments. Since the knee is a frequently injured weight-bearing joint and OA increases fall risk, educating patients on fall prevention and providing balance-specific rehabilitative training is essential.

Patients with chronic pain, including OA, often perform poorly on tests assessing attention and memory, indicating cognitive deficits. Sensory, motor, and cognitive functions in knee OA patients are generally worse than in healthy individuals, which may contribute to balance impairments. The cognitive-motor dual task method, derived from the dual-task paradigm, is used for balance training and hypothesizes that adding a continuous cognitive task to balance exercises enhances performance by promoting task automaticity. Automaticity refers to the execution of a skill with minimal attentional demand, whereas non-automated tasks require significant attention. Logan et al. propose that automaticity exists on a continuum, with tasks varying in their degree of automation.

The constrained-action hypothesis by Wulf et al. suggests that conscious control of movements constrains the motor system, interfering with automatic motor control processes. Focusing on the movement effect, however, may allow the motor system to self-organize more naturally, leading to more effective performance and learning. Previous studies have shown positive effects of cognitive-motor dual tasks on balance in ACL patients. Chronic pain patients, including those with OA, often display cognitive deficits due to pain’s demand on attention, which competes with other cognitive tasks. These patients also show reduced reaction times and compromised perceptual-motor coordination.

This study aims to evaluate the effect of cognitive-motor dual task training on balance in adults with knee osteoarthritis, addressing a gap in the literature regarding this specific patient population. The goal is to assess whether this training improves postural stability in knee OA patients.

Need for the Study: To the best of my knowledge there is a lack of literature on the impact of cognitive-motor dual task training on balance in knee osteoarthritis, despite evidence of its benefits in conditions like ACL injuries and chronic ankle instability. This study seeks to fill that gap and provide insights into improving balance in knee OA patients.

Aim of the Study: To evaluate the effect of cognitive-motor dual task training on balance in individuals with knee osteoarthritis.