Discussion
KOA, pain, disability, KOA pain, knee pain
 The study aimed to evaluate the effects of a structured HBE + EDU program as an adjunct treatment to the usual physiotherapy care on KOA-related clinical outcomes (pain, functional mobility, and disability level). The study findings revealed that following an eight-week intervention, participants in the experimental group demonstrated significant improvements in all investigated outcomes (KOOS, pain VAS, and TUG) compared to baseline. In addition, group effects were observed for KOOS (22.2%), pain VAS (44.1%), and TUG (15.7%). It seems that the integration of a structured HBE + EDU program as an adjunct treatment to individualized KOA rehabilitation is effective in reducing knee pain and disability while increasing functional mobility. Based on the VAS assessment, the prescribed HBE + EDU program in this study improved KOA pain. Typically, a reduction in pain is often associated with an increase in strength, as reported by Chen et al, Furthermore, higher performance in functional mobility and lower fall risk were recorded in the HBE + EDU group compared to the control based on TUG assessments. These can be attributed to various included exercises, Meanwhile, a significant decrease in the disability level measured using KOOS (as indicated by reduced knee symptoms and improvements in ADL, sports, and QOL) was also observed in the experimental group compared to the control. Generally, disability in KOA is affected by complex interactions between pain, physical capacity. Some limitations should be considered in this study. First, given the short study duration (our intervention lasted only eight weeks), we could not determine the long-term effects of the HBE + EDU intervention. Further, the rehabilitation exercises were tailored to individual needs based on physiotherapist assessments, and variations in the usual care received between participants may have also influenced our findings. Furthermore, considering that the KOOS and VAS outcomes were assessed based on self-reported methods, the findings could potentially be confounded by the differences in the subject’s perception (risk of method bias).