Secondary outcome measures
WOMAC stiffness, pain, knee flexion, KOA
Active range of motion (ROM) of knee flexion was recorded using a long-arm goniometer. The participant was placed in the prone position and was asked to bring the heel of the tested leg as close as possible to the buttock with the contralateral lower limb in extension. The goniometer’s pivot tip was placed on the femur’s lateral epicondyle of the tested knee with one arm in line with the lateral malleolus and the other arm in line with the greater trochanter, The fully extended knee was considered to be the zero position, and the degree of maximum flexion was recorded. The degree of maximum flexion recorded has been shown to be a reliable and valid measure in clinical practice [The WOMAC is the most widely used instrument to evaluate the symptomatology and function in KOA. It contains 24 questions: 5 questions about pain (0–20 points), 2 questions about stiffness (0–8 points), and 17 questions about physical function difficulty (0–68 points), which can be completed in less than 5 min. Higher WOMAC scores (WOMAC pain, WOMAC stiffness, and WOMAC physical function) indicate a greater degree of deterioration [