OA & Bone Health Track
GROUND
Graduated Rehabilitation & Optimization of Neuromuscular Dynamics
Duration
24 weeks · 3 progressive phases
Structure
Progressive, 3 phases over 6 months
Delivery
Virtual
About this protocol
GROUND is aligned with the GLA:D / NEMEX framework (warm-up → neuromuscular → strengthening → cool-down) for knee osteoarthritis, preferentially Kellgren-Lawrence Grade I–III, including patients awaiting or not eligible for joint replacement. Three integrated pillars run over six months: progressive quadriceps and lower-limb strengthening (bodyweight → bands → weighted); neuromuscular and balance training emphasizing knee alignment and proprioception; and a graduated walking program with daily step targets. Built on OARSI 2019 Core Treatment recommendations.
Clinical authors
- Angelo Papachristos, PT, ACPAC
- Dr. Dharini Mahendira, MD
Evidence base
GROUND is derived from systematic review and randomized controlled trial evidence in Knee Osteoarthritis. Protocol parameters — phase structure, load progression, and outcome measures — align with EULAR, ACR, and ASAS exercise-therapy recommendations. Outcome tracking favours open-access PROMIS instruments where validated equivalents exist.
View the evidence library →Outcome measures
- PROMIS Physical Function Short Form 10aPROMIS
- NRS Pain (0–10, rest and walking) — every session
- 30-Second Chair Stand
- 5× Timed Sit-to-Stand
- 40-m Walk Test
- Timed Up & Go (TUG)
- Single-Leg Stance (each side)
- Daily Step Count (weekly average)
- BMI / Weight
PROMIS short forms are free, NIH-developed measures used in place of paid legacy instruments.
What's included
- Virtual assessment with a certified exercise therapist
- Personalised programme plan
- Live-virtual group or individual sessions
- Asynchronous guided home programme
- Regular ePRO check-ins with adaptive progression
- Care coordinator support
- Programme completion report
Interested in this protocol?
Speak to us about adding GROUND to your PSP or benefits plan.
Request a pilotFor patients