{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:40:58Z","timestamp":1767796858033,"version":"3.49.0"},"reference-count":49,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T00:00:00Z","timestamp":1765324800000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006261","name":"Taif University","doi-asserted-by":"publisher","award":["TU-DSPP-2024-177"],"award-info":[{"award-number":["TU-DSPP-2024-177"]}],"id":[{"id":"10.13039\/501100006261","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,19]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the efficacy of two volumes of acute isometric wall squat exercise on pain sensitivity (primary outcome: pressure pain threshold (PPT)) and intensity (secondary outcome) in adults with knee osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A parallel-group randomised controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Outpatient physiotherapy clinics at hospitals in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants (n = 90; mean (SD) age 49.0 (13.0) years) with chronic knee osteoarthritis, diagnosed by a specialist orthopaedic physician using radiographic evidence and clinical judgement, were recruited via two tertiary hospitals in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Participants were stratified by sex and randomly allocated to one of three groups: isometric single-repetition wall-squat (ISO-SR; one repetition of a 3-min wall squat or to volitional fatigue at a 100\u00b0 knee joint angle), isometric multiple-repetition wall-squat (ISO-MR; three repetitions of the same intervention) and control (quiet sitting for 7 min).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>PPT was measured at the calf (primary site of interest), lumbar spine and forearm using a pressure algometer. Pain intensity was assessed using a visual analogue scale. Primary analyses compared changes between intervention and control groups. All participants were included in the ITT analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The ISO-MR group had higher mean PPT ratings immediately postintervention in the calf (mean difference=9.4 (95% CI 5.6 to 13.2), p&lt;0.001), forearm (4.0 (95% CI 1.2 to 6.9), p=0.006) and lumbar spine (5.4 (95% CI 2.4 to 8.4), p&lt;0.001), compared with control. The ISO-SR group reported a greater increase in PPT when compared with control at the calf (5.8 (95% CI 2.0 to 9.6), p=0.003) and lumbar spine (3.7 (95% CI 0.7 to 6.8), p=0.015). There were no differences in clinical pain intensity between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both the ISO-SR and ISO-MR exercises to volitional fatigue reduced pain sensitivity in patients with knee osteoarthritis. Neither exercise volume changed clinical pain intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov registry (ID:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05605444\">NCT05605444<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-103756","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T11:55:14Z","timestamp":1765454114000},"page":"e103756","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of an acute bout of isometric wall squat exercise on pain sensitivity and clinical pain intensity in adults with knee osteoarthritis: a randomised controlled trial in outpatient physiotherapy clinics in Saudi Arabia"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct05605444","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05605444","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Jamilah","family":"Zabarmawi","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, King Abdulaziz Hospital, Ministry of Health, Makkah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clint T","family":"Miller","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J","family":"Owen","sequence":"additional","affiliation":[{"name":"Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia"},{"name":"Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5406-3216","authenticated-orcid":false,"given":"Niamh L","family":"Mundell","sequence":"additional","affiliation":[{"name":"Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Areej","family":"Meny","sequence":"additional","affiliation":[{"name":"Occupational Therapy Program, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia"},{"name":"King Abdullah International Medical Research Center, Western Region, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sultan","family":"Aldhafri","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, King Abdulaziz Hospital, Ministry of Health, Makkah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riyadh","family":"Banjar","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, King Abdulaziz Hospital, Ministry of Health, Makkah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4383-115X","authenticated-orcid":false,"given":"Hosam","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"2026010703463388000_15.12.e103756.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00163-7"},{"key":"2026010703463388000_15.12.e103756.2","doi-asserted-by":"crossref","first-page":"101825","DOI":"10.1016\/j.berh.2023.101825","article-title":"Pain in osteoarthritis from a symptom to a disease","volume":"37","author":"Perrot","year":"2023","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2026010703463388000_15.12.e103756.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(21)00032-1"},{"key":"2026010703463388000_15.12.e103756.4","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1093\/rheumatology\/ker283","article-title":"What makes osteoarthritis painful? 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