Before each treatment session, a hot pack (thermotherapy) will be applied to the knee, calf, and thigh muscles for 20 minutes, followed by therapeutic ultrasound administered to the periarticular knee region for 10 minutes in pulsed mode, with a frequency of 1.0 MHz, an intensity of <1 W/cm², and a total dose of <150 J/cm². Exercises and recommendations identical to those prescribed for the home exercise group will be explained to the patients, and they will be instructed to perform these exercises in addition to the treatment, for 8 weeks, at least 3 days per week, in 2 sets per session. An exercise diary will be provided to monitor adherence. Prior to treatment, participants will be informed about the importance and content of the exercise program.

Based on the guidelines published by the American College of Sports Medicine (ACSM), Osteoarthritis Research Society International (OARSI), American Academy of Orthopaedic Surgeons (AAOS), European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the European Alliance of Associations for Rheumatology (EULAR), participants will be prescribed a total of 12 home-based exercises to be performed over 8 weeks, at least 3 days per week, in 2 sets per session, with the number of repetitions progressively increased .

These exercises and recommendations will be categorized under the subheadings of aerobic exercise, muscle strengthening, flexibility, neuromotor performance, and patient education. To enhance exercise adherence and facilitate follow-up, participants will be provided with an exercise diary. The diary will include a 3-month calendar schedule, illustrations of the exercises, and coded numerical markers correspo

Knee Injury and Osteoarthritis Outcome Score (KOOS): Developed to assess knee injury and OA symptoms. It includes 42 items in 5 subscales: Pain, Symptoms, ADL, Sport/Rec, and QoL. Items are scored on a 0-4 Likert scale based on the past week. Each subscale is normalized to a 0-100 range.

Timed Up and Go (TUG) Test: TUG assesses independent mobility and functional ability. Participants rise from a chair, walk 3 meters at a safe pace, turn, walk back, and sit down. The duration is recorded in seconds.

Results are interpreted as follows: ≤10 seconds indicates good balance and gait speed; 10-20 seconds indicates independence in outdoor mobility without aids; ≥20 seconds signifies impaired mobility, poor balance, and increased fall risk. The test provides a reliable measure of dynamic balance and functional performance in clinical populations. All procedures will be timed using a digital stopwatch and recorded.

Measurements will be performed while the participant is in the supine and prone positions using a pressure algometer. In the supine position, measurements will be taken from the distal 1/3 of the iliopsoas muscle, the proximal and distal (suprapatellar) portions of the rectus femoris muscle, the infrapatellar tendon, the medial and lateral fat pads, the distal 1/3 of the iliotibial band, the adductor tendons, and the medial retinaculum. In the prone position, measurements will be obtained from the sacroiliac joint, the muscle bellies of the gluteus medius and piriformis, the proximal 1/3 of the medial and lateral heads of the gastrocnemius, and the popliteus muscle belly. The probe of the algometer will be applied perpendicularly to the designated area, and the pressure will be increased gradually at a rate of 1 kg/s. The value at which the mechanical stimulus first transitions into a sensation of pain will be recorded. Three measurements will be taken at 30-second intervals.

Pain Catastrophizing Scale (PCS): A 13-item self-report tool used to measure exaggerated negative thoughts about actual or anticipated pain. It assesses three dimensions: Rumination (items 8-11), Magnification (items 6, 7, 13), and Helplessness (items 1-5, 12). Rumination reflects preoccupation with pain, helplessness denotes an inability to cope, and magnification represents an intensified perception of pain threat.

Each item is rated on a 5-point Likert scale (0=not at all, 4=all the time). Total scores range from 0 to 52, where higher scores indicate greater catastrophizing. A total score of ≥30 is identified as the clinical cutoff point for significant pain catastrophizing. This scale is vital for evaluating the psychological impact of pain and its influence on recovery and movement-related fear in clinical research and rehabilitation settings.

Lysholm Knee Scoring Scale: Revised in 1985, it assesses 8 domains: limp, support, locking, instability, pain, swelling, stair climbing, and squatting. Total score (0-100) is categorized as Excellent (95-100), Good (84-94), Fair (65-83), or Poor (0-64).

Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC): A valid index for OA, recommended by OMERACT. It comprises 24 items across 3 sections: Pain (max 20), Stiffness (max 8), and Physical Function (max 68). Higher scores indicate increased pain, stiffness, and functional impairment. All scales will be administered by a physiotherapist to evaluate functional status and quality of life.

The scale consists of 17 items designed to measure the fear of movement and (re)injury. It utilizes a 4-point Likert scale (1: Strongly disagree, 2: Disagree, 3: Agree, 4: Strongly agree). Items 4, 8, 12, and 16 are reverse-scored. Total scores range from 17 to 68, where higher scores indicate a greater degree of kinesiophobia (fear of movement).

A staircase consisting of 9 steps (16-20 cm height) with handrails will be used. Participants will be instructed to ascend and descend as quickly and safely as possible. The total completion time will be recorded in seconds. This test provides data on lower extremity muscle strength and balance.

Edema assessment will be performed using the circumference measurement technique with a foldable, non-elastic, 7-mm wide tape measure. To ensure the measurement is unaffected by tension, the starting end of the tape will be held in the left hand while the other end is wrapped around the limb with the right hand, and the value aligning with the starting point will be recorded. Furthermore, during measurement, the starting point and the corresponding value will be aligned side-by-side rather than overlapping. Participants will wear shorts to facilitate the identification of anatomical landmarks. Since the patella is the reference point for the thigh, measurements will be taken from the mid-patella, as well as 5 and 10 cm superiorly and inferiorly from both legs. To minimize potential errors arising from incorrect positioning or varying tension, all measurements will be performed by the same researcher to ensure inter-rater reliability.

Goniometric Assessment: AROM and PROM of the hip and knee will be measured using standardized protocols. Hip flexion (supine, knee flexed) and extension (prone, knee extended) use the greater trochanter as the fulcrum. Abduction and adduction (supine) align the stationary arm with the ASIS line. Internal and external rotation are assessed in the sitting position with the fulcrum at the tibial tuberosity and the stationary arm perpendicular to the floor. Knee flexion is measured in the prone position with the fulcrum at the lateral femoral condyle. Precautions include maintaining pelvic stability and preventing compensatory movements such as lumbar lordosis or pelvic elevation. All measurements start from a 0° neutral position. This comprehensive 2026 clinical evaluation ensures precise documentation of joint mobility, essential for monitoring rehabilitation progress and functional recovery in musculoskeletal physical therapy.

The FACIT-F is a 13-item self-report scale designed to evaluate fatigue and its impact on daily activities and functions. Originally developed to assess the relationship between anemia and fatigue in cancer patients, its validity and reliability have since been established across more than 70 published studies involving over 20,000 participants. Since 1995, it has been proven effective for various conditions, including Multiple Sclerosis, Rheumatoid Arthritis, Psoriasis, Parkinson's disease, and Paroxysmal Nocturnal Hemoglobinuria. The scale measures the level of fatigue experienced during the past 7 days. Each item is rated on a 5-point Likert scale (0: Not at all, 4: Very much). Total scores range from 0 to 52, where higher scores indicate lower levels of fatigue. Items 1, 2, 3, 4, 5, 6, 9, 10, 11, 12, and 13 are reverse-scored, while items 7 and 8 are scored directly. It is a cross-culturally validated tool approved for use in adults with chronic illnesses.

WHOQOL-OLD: A 24-item module specifically for older adults, consisting of six facets: Sensory Abilities, Autonomy, Past/Present/Future Activities, Social Participation, Death and Dying, and Intimacy. Items use a 5-point Likert scale, with facet scores ranging from 4 to 20. It evaluates the impact of aging on independence, social engagement, and mortality concerns. Increased total scores represent improved quality of life. Both scales provide a multidimensional profile of the participant's subjective well-being and are validated in Turkish. These instruments are essential for evaluating the holistic outcomes of geriatric rehabilitation and 2026 clinical standards in elderly care.

The 6MWT is a submaximal exercise test used to evaluate aerobic capacity and endurance. The distance covered over 6 minutes is recorded. A 30-meter unobstructed corridor, cones, and a stopwatch are required. Participants may rest if needed, but the timer continues. Dyspnea intensity will be assessed using the Modified Borg Scale before and after the test. The Modified Borg Scale is a 0-10 rating scale (0: None, 10: Maximum) used to measure perceived exertion and dyspnea severity. It is highly reliable for determining exercise intensity and monitoring subjective fatigue pre- and post-session.