Rehabilitation across the Spectrum: A Case Series Evaluating a Structured Program for Knee Osteoarthritis and Musculoskeletal Impairments

Abstract

Knee osteoarthritis and related musculoskeletal conditions significantly impact mobility and independence in older adults. This prospective case series evaluated a 12-week structured physiotherapy program in five elderly women with diverse knee impairments. The program included six weeks of supervised rehabilitation followed by six weeks of home-based exercises. Key outcomes assessed were pain (VAS), quadriceps strength, active range of motion (AROM), ambulation, and balance (Tinetti score). All participants showed functional improvements across multiple domains, including reduced pain, increased strength, improved mobility, and enhanced balance. These findings support the role of structured physiotherapy in managing geriatric knee conditions.

INTRODUCTION

Knee osteoarthritis (OA) is a leading cause of disability worldwide, particularly among aging and sedentary populations.[1] It commonly presents with pain, joint stiffness, quadriceps weakness, and reduced mobility, which can significantly impair daily activities such as walking and stair climbing.[2] In India, symptomatic knee OA affects approximately 5.8% of adults over 50, with higher prevalence in women and those with obesity or joint trauma.[3] These impairments increase dependence on assistive devices and heighten the risk of falls and fractures in older adults. Although surgical interventions like total knee arthroplasty are effective, many elderly patients require or prefer conservative approaches. Structured physiotherapy—including strengthening, mobility training, and balance exercises—has been shown to alleviate symptoms, improve function, and delay disease progression.[4] Despite this, there is a lack of real-world case-based data on individualized responses to rehabilitation. This study examines the impact of a 12-week physiotherapy program in five elderly women with diverse knee impairments.

Case presentation

This prospective case series included five elderly female patients aged 64 to 81 years (mean age: 73.6 ± 6.4 years), each presenting with distinct knee-related musculoskeletal impairments. Diagnoses ranged from degenerative joint disease and post-fracture stiffness to chronic pain syndrome and ligamentous laxity. Patients were recruited from a rehabilitation center in New York, USA, following ethical approval and informed consent.

All participants underwent a 12-week structured rehabilitation protocol. The initial 6 weeks involved supervised physiotherapy sessions (3–5 times per week), focusing on static quadriceps contractions, straight leg raises, joint mobilization, balance training, gait retraining, and pain relief modalities such as cryotherapy and TENS. The subsequent 6 weeks consisted of a home-based exercise program, with progress monitored via logs and weekly check-ins. A detailed overview of patient demographics and clinical backgrounds is summarized in Table 1, while the individual rehabilitation outcomes across key functional domains over the 12-week period are presented in Table 2.

Table 1.

Patient demographic and clinical overview

Case No	Age (Years)	Sex	Primary Diagnosis	Rehabilitation Focus	Key Comorbidities
1	75	F	Degenerative Joint Disease	Knee OA, strength and mobility	HTN, Osteoarthritis
2	64	F	Post-Fracture Rehabilitation	Stiffness post immobilization	DM, HTN, Asthma, OA
3	78	F	Muscle Atrophy	Quadriceps weakness	DM, HTN, Hypercholesterolemia
4	70	F	Ligamentous Laxity	Instability due to laxity	HTN, Obesity
5	81	F	Chronic Pain Syndrome	Pain and poor balance	Dementia, HTN, DM, Vertigo

HTN=Hypertension, DM=Diabetes Mellitus, OA=Osteoarthritis

Table 2.

Patient rehabilitation outcomes over 12 weeks

Case No	Pain (VAS) Baseline →Final	AROM (°) Baseline→Final	Strength (N) Baseline →Final	MMT Baseline →Final	Ambulation (ft) Baseline →Final	Tinetti Score Baseline →Final	Assistive Device	Discharge Status
1	6→3	Limited →Improved	120→180	3-/5→4/5	20→150	Not Applicable	RW→RW	HEP, all goals met
2	6→4	0–45° → 0–60°	100→140	3+/5→4/5	40→200	13→18	RW→RW	Discharged with HEP
3	6→5	0–80° → 0–100°	130→175	3/5→4/5	50→100	10→15	RW→RW	Discharged with supervision
4	6→5	10–90° → Improved	110→165	2+/5→4/5	60→80	13→16	RW→RW	Outpatient referral
5	6→5	Restricted →Improved	105→150	3+/5→4/5	30→100	11→14	Walker→Walker	Discharged with supervision

VAS=Visual Analog Scale, AROM=Active range of motion, MMT=Manual muscle testing, RW=Rolling walker, HEP=Home exercise program

Individual Outcomes:

• Case 1 (75 years): Diagnosed with advanced knee osteoarthritis, this patient exhibited marked improvement in quadriceps strength (120 N to 180 N) and ambulation (20 ft to 150 ft), alongside pain reduction (VAS 6 to 3). All discharge goals were met with continued walker use.

• Case 2 (64 years): Presented with stiffness following fracture immobilization. The patient achieved greater knee flexion (AROM 45° to 60°), improved strength (100 N to 140 N), and a Tinetti balance score increase from 13 to 18. She was discharged with a home exercise plan.

• Case 3 (78 years): With underlying quadriceps atrophy, she gained strength (130 N to 175 N), doubled her ambulation distance (50 ft to 100 ft), and showed reduced fall risk (Tinetti score: 10 to 15). Discharged with minimal supervision.

• Case 4 (70 years): Suffering from ligamentous laxity, she showed enhanced joint stability with strength gains (110 N to 165 N), improved balance (Tinetti: 13 to 16), and was referred for outpatient therapy.

• Case 5 (81 years): Managing chronic pain, dementia, and vertigo, she progressed from minimal mobility to walking 100 ft, with pain reduced (VAS 6 to 5) and improved balance (Tinetti: 11 to 14). Continued supervised support was advised.

All patients demonstrated functional improvements in at least four domains. The intervention led to meaningful gains in pain relief, mobility, balance, and independence, reinforcing the role of structured rehabilitation in managing complex geriatric knee condition

Patient seriation score progression

To track recovery trajectories, a composite seriation score was developed, integrating pain (VAS), quadriceps strength, range of motion (AROM), and balance (Tinetti score). Each domain was normalized to a 0–100 scale and averaged per patient at three time points: Baseline (Week 0), Post-Supervision (Week 6), and Post-Intervention (Week 12).

All five patients showed steady improvement across the 12 weeks. Case 2 demonstrated the greatest progress, improving from a score of 50 to 90, likely due to enhanced mobility following post-fracture rehabilitation. Cases 1 and 4 also reached final scores above 80, reflecting improved pain, gait, and strength.

Despite starting at the lowest baseline due to cognitive impairment and chronic pain, Case 5 achieved a score of 78 by Week 12, indicating meaningful functional gains. These upward trends underscore the effectiveness of the structured rehabilitation protocol in achieving multidimensional recovery [Figure 1].

Figure 1.

Progression of Pain, Quadriceps Strength, and Balance over 12 Weeks

DISCUSSION

All participants demonstrated consistent improvements in pain, quadriceps strength, joint mobility, balance, and ambulation, highlighting the clinical relevance of individualized rehabilitation in geriatric musculoskeletal care.

Pain reduction was evident, with mean Visual Analog Scale (VAS) scores dropping from 6.0 to 4.2—exceeding the minimal clinically important difference (MCID) for chronic musculoskeletal pain. Improvements in quadriceps strength (mean gain ~50 N) supported better knee stability and confidence in weight-bearing, aligning with previous findings identifying strength as a key determinant of function in knee osteoarthritis.

Gains in active range of motion and ambulation distance reflected enhanced neuromuscular coordination. For example, Case 2 gained 15° in knee flexion after targeted rehabilitation, while Case 4 benefited from improved balance and gait stability. These outcomes support evidence favoring early ROM exercises to prevent contractures and maintain mobility in older adults.[5]

Tinetti Balance and Gait scores improved by 3–5 points, reflecting reduced fall risk—a vital outcome in elderly women, who are disproportionately affected by fall-related injuries. This suggests that structured physiotherapy can effectively address diverse geriatric knee impairments, not just conventional osteoarthritis.[6]

The home-based phase (Weeks 7–12) supported sustained progress, consistent with evidence for ongoing care. Despite limitations like small sample size and one cognitively impaired patient, the study supports a phased physiotherapy model as a safe, effective approach for elderly knee dysfunction.

CONCLUSION

This case series underscores the effectiveness of a structured 12-week physiotherapy program in improving functional outcomes in elderly women with diverse knee impairments.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.