PainNCT07137897
Telerehabilitation for Knee Osteoarthritis: Study Protocol
A study testing Telerehabilitation in people with Pain and Stiffness, run by University of Novo Mesto at 1 site in Slovenia.
Trial summary
Patient Recruitment and Enrolment All patients diagnosed with knee OA who present at Artros Medical Center for an orthopaedic specialist consultation will undergo a radiological examination. Read more about this study
- Who is it for?
- Ages 50 to 80 years
- Conditions the study is for
- Pain, Stiffness, Physical Function
- What is being tested?
- Telerehabilitation
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 118 participants
- Where
- 1 siteSlovenia
- Study dates
- 27 Jun 2024to 10 Nov 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 50 to 80 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients with symptomatic OA of the knee joint, graded 1-3 on the Kellgren-Lawrence scale
- Patients older than 50 years
- Patients with access to and proficiency in using a computer,
- Patients with the capability to follow the exercises outlined.
Who cannot join
- Grade 4 cartilage defect (cartilage defect up to the subchondral bone), for which surgical treatment is professionally indicated,
- Planned arthroplasty of the knee joint within the next 6 months,
- Patients who have had a previous TEP arthroplasty or partial knee arthroplasty (hereafter PEP),
- Patients with a history of trauma or surgical treatment of the knee joint (osteotomy or treatment of cartilage lesions) in the last 6 months,
- Patients who have received an intra-articular injection in the knee joint in the last 3 months,
- Patients who have systemic inflammatory arthritis (e.g. rheumatoid arthritis or gout) or those who have concomitant medical conditions that prevent participation in exercise,
Show all 10Show fewer
- Patients who have cognitive impairments or are wheelchair users,
- Who has co-morbidities,
- Those who do not have access to a computer have limited language skills that prevent the correct use of tele-rehabilitation or
- Those who are involved in similar study.
Trial locations and contacts
1 site in 1 country.
Slovenia1 site
University of Novo mesto Faculty of Health Sciences
Novo Mesto
About this study
Official title: Telerehabilitation of Patients With Osteoarthritis of the Knee Joint: Study Protocol for a Randomised Controlled Trial
Patient Recruitment and Enrolment
All patients diagnosed with knee OA who present at Artros Medical Center for an orthopaedic specialist consultation will undergo a radiological examination. Based on the radiographic findings and clinical evaluation, the orthopaedic specialist will refer eligible patients to a physiotherapist, who will assign them to the TG or CG. The physiotherapist will provide both verbal and written explanations of the study procedures. Patients will be included in the study after providing written informed consent.
Read more
Baseline Assessments
The physiotherapist will collect baseline data, including: Sociodemographic characteristics, Anthropometric measurements: height (cm), weight (kg), body mass index (BMI) (kg/m²), Educational background and employment status, Knee joint mobility assessment using a goniometer, Pain intensity measurement using the Numerical Rating Scale (NRS), Physical function, stiffness, and pain assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Physical activity evaluation using the International Physical Activity Questionnaire (IPAQ), Health-related quality of life assessment using the 12-Item Short Form Health Survey (SF-12), OA severity classification based on recent knee radiographs (≤ 4 months old), graded using the Kellgren-Lawrence classification system.
Read the detailed description
Osteoarthritis (OA) of the knee is a chronic degenerative disease that affects the articular cartilage, causing pain, reduced mobility and reduced quality of life. Early detection and appropriate treatment are key to reducing symptoms and slowing disease progression. This study aims to evaluate the effectiveness of therapeutic interventions in patients with knee OA treated at the Artros Medical Centre.
Patients diagnosed with OA of the knee who visit the Artros Medical Centre for a consultation with an orthopaedic specialist will be included in the study. After the visit, they will undergo a radiological examination, based on which the orthopaedic surgeon will assess the severity of the disease. The specialist will then refer suitable patients to a physiotherapist who will further assess them and assign them to a telerehabilitation group (TR) or a control group (TS). The physiotherapist will provide verbal and written explanations of the study procedures to the patients.
Written informed consent will be required from each participant to participate in the study.
After inclusion in the study, the physiotherapist will collect baseline data on the patients, including the following measures:
- Sociodemographic characteristics: age, gender, education, employment status.
- Anthropometric measurements: height (cm), weight (kg), body mass index (BMI) (kg/m²).
- Assessment of knee joint mobility: measurement of range of movement with a goniometer.
- Pain intensity: Use the Numerical Rating Scale (NRS) to measure subjective pain.
Assessment of physical function, stiffness, and pain: The validated Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire is used.
- Physical activity assessment: performed using the International Physical Activity Questionnaire (IPAQ).
- Assessment of health-related quality of life: administered by the 12-item Short Form Health Survey (SF-12).
- Osteoarthritis severity classification: based on knee radiographs (≤ 4 months old) and will be performed according to the Kellgren-Lawrence classification system.
Patients will be randomly assigned to one of two groups:
- telerehabilitation group (TR): They will be enrolled in a tailored physiotherapy programme, including individually tailored exercises to strengthen, stretch, and improve the functionality of the knee joint.
- control group (CG): patients will continue with standard care without additional therapeutic interventions.
Patient measurements and assessments will be carried out at the start of the study and at specific time points (after 12 weeks). All data will be recorded and analysed to identify changes in pain, mobility, functionality, and quality of life.
Statistical analysis Data will be analysed using appropriate statistical methods (e.g., t-test, ANOVA, regression analysis). The main outcome parameters will be changes in WOMAC, NRS, IPAQ, and SF-12, where the statistical significance and clinical relevance of differences between groups will be assessed.
The Declaration of Helsinki will conduct the study, which will be subject to ethics committee approval. Before participation, all participants will be informed in detail about the nature of the study and the potential risks and benefits, and their inclusion will be voluntary.
This study will provide valuable data on the effectiveness of therapeutic interventions in patients with knee OA and will contribute to a better understanding of optimal approaches to treating this disease.
- Conditions
- Pain, Stiffness, Physical Function
- Being tested
- Telerehabilitation, Control group
- Keywords
- Telerehabilitation, knee, osteoarthritis, RCT, Physical Activity
- Medical subject headings
- Pain, Osteoarthritis, Motor Activity
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
TelerehabilitationOther
Telerehabilitation involves a physiotherapy program delivered remotely using digital tools. Participants perform exercises independently with remote support from a physiotherapist, including:
Weekly scheduled phone consultations
Live virtual consultations via MS Teams, Zoom, or Skype
Text messages and emails for personalized guidance, motivation, and ongoing problem-solving
The intervention includes targeted exercises for:
Core muscle strength
Strengthening of lower extremity muscles
Mobility exercises for the hip, knee, and ankle joints
Balance and stabilization exercises
Each session lasts approximately 20-25 minutes, performed three times per week. Patients can choose the days for their sessions, with the requirement of a minimum of 24 hours and a maximum of 72 hours of rest between sessions.
The intervention will last for at least three months.
Control groupOther
Patients in the control group will receive written instructions for a home exercise program. They will independently perform the rehabilitation program at home without remote supervision.
The intervention includes targeted exercises for:
Core muscle strength
Strengthening of lower extremity muscles
Mobility exercises for the hip, knee, and ankle joints
Balance and stabilization exercises
Each session lasts approximately 20-25 minutes, performed three times per week. Patients can choose the days for their sessions, with the requirement of a minimum of 24 hours and a maximum of 72 hours of rest between sessions.
The intervention will last for at least three months.
| Study group | Role | What they receive |
|---|---|---|
| Telerehabilitation Group | Experimental | Patients in the Telerehabilitation group will receive instructions on physiotherapy intervention. They will independently perform the exercise for at least three months. During this time, they will have access to continuous remote support from the physiotherapist, including: • Weekly scheduled phone consultations • Live virtual consultations via MS Teams, Zoom, or Skype • Text messages and emails for personalised guidance, motivation, and ongoing problem solving. Receives: Other: Control group |
| Control group | Active comparator | Patients in the control group will receive only written exercise instructions and perform the rehabilitation program independently at home without additional remote supervision. Receives: Other: Telerehabilitation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Pain Intensity
Measured using the Numeric Rating Scale (NRS), where the scale ranges from 0 to 10, with 0 representing 'no pain' and 10 representing 'worst possible pain'. Higher scores indicate a higher level of pain.
Measured: Day 1
Knee Function (WOMAC)
Evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which measures joint function, stiffness, and pain related explicitly to knee osteoarthritis.
Measured: Day 1
Joint Mobility
Joint mobility will be assessed using a goniometer to measure any improvements or changes in the range of motion of the knee joint.
Measured: Day 1
Physical Activity
Assessed using the International Physical Activity Questionnaire (IPAQ), gauges the level of physical activity and sedentary behaviour in daily life. Health-Related
Measured: Day 1
Quality of Life ( SF-12)
Measured by the SF-12, a 12-item questionnaire that evaluates the patient's perceived quality of life, focusing on physical and mental health.
Measured: Day 1
Secondary outcomes (8)
Pain Intensity
Measured using the Numeric Rating Scale (NRS) to assess changes in pain levels experienced by patients during rehabilitation and following the intervention.
Measured: up to 12 weeks
Knee Function (WOMAC)
Evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which measures joint function, stiffness, and pain related explicitly to knee osteoarthritis.
Measured: up to 12 weeks
Physical Activity
Assessed using the International Physical Activity Questionnaire (IPAQ), gauges the level of physical activity and sedentary behaviour in daily life.
Measured: up to 12 weeks
Quality of Life ( SF-12)
Measured by the SF-12, a 12-item questionnaire that evaluates the patient's perceived quality of life, focusing on physical and mental health.
Measured: up to 12 weeks
Exercise Adherence and Frequency
Monitoring the regularity and consistency with which patients in both TG and CG complete the prescribed exercises, along with any challenges encountered that may influence adherence.
Measured: up to 12 weeks
Patient Satisfaction with telerehabilitation
Following the intervention, patients will provide feedback on their overall satisfaction with the telerehabilitation approach, including perceived benefits and limitations.
Measured: up to 12 weeks
Reasons for Reduced Exercise Engagement or Discontinuation
Patients will report any factors contributing to decreased exercise frequency or halting the rehabilitation program, particularly in the TG.
Measured: up to 12 weeks
Joint Mobility
Joint mobility will be reassessed using a goniometer to measure any improvements or changes in the range of motion of the knee joint.
Measured: up to 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Aug 2025
- Study start27 Jun 2024
- Primary completion30 Oct 2025
- Study completion10 Nov 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for PainStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 118 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Novo Mesto
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Karmen Erjavec, University of Novo Mesto
- Investigators
- Karmen Erjavec, prof. dr., Study director, University of Novo Mesto
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07137897
- Sponsor's protocol ID
- L7-50184
- Status last verified
- Mar 2025
- First submitted
- 24 Mar 2025
- Last updated
- 2 Jan 2026
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 2 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Telerehabilitation of Patients With Osteoarthritis of the Knee Joint: Study Protocol for a Randomised Controlled Trial
- ClinicalTrials.gov ID
- NCT07137897
- Acronym / sponsor ID
- L7-50184
- Conditions
- Pain, Stiffness, Physical Function
- Keywords
- Telerehabilitation, knee, osteoarthritis, RCT, Physical Activity
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 118 participants (actual)
- Lead sponsor
- University of Novo MestoUniversity, hospital or other
- Study start
- 27 Jun 2024 (actual)
- Primary completion
- 30 Oct 2025 (actual)
- Study completion
- 10 Nov 2025 (actual)
- First posted
- 22 Aug 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Patient Recruitment and Enrolment
All patients diagnosed with knee OA who present at Artros Medical Center for an orthopaedic specialist consultation will undergo a radiological examination. Based on the radiographic findings and clinical evaluation, the orthopaedic specialist will refer eligible patients to a physiotherapist, who will assign them to the TG or CG. The physiotherapist will provide both verbal and written explanations of the study procedures. Patients will be included in the study after providing written informed consent.
Baseline Assessments
The physiotherapist will collect baseline data, including: Sociodemographic characteristics, Anthropometric measurements: height (cm), weight (kg), body mass index (BMI) (kg/m²), Educational background and employment status, Knee joint mobility assessment using a goniometer, Pain intensity measurement using the Numerical Rating Scale (NRS), Physical function, stiffness, and pain assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Physical activity evaluation using the International Physical Activity Questionnaire (IPAQ), Health-related quality of life assessment using the 12-Item Short Form Health Survey (SF-12), OA severity classification based on recent knee radiographs (≤ 4 months old), graded using the Kellgren-Lawrence classification system.
Detailed description
Osteoarthritis (OA) of the knee is a chronic degenerative disease that affects the articular cartilage, causing pain, reduced mobility and reduced quality of life. Early detection and appropriate treatment are key to reducing symptoms and slowing disease progression. This study aims to evaluate the effectiveness of therapeutic interventions in patients with knee OA treated at the Artros Medical Centre.
Patients diagnosed with OA of the knee who visit the Artros Medical Centre for a consultation with an orthopaedic specialist will be included in the study. After the visit, they will undergo a radiological examination, based on which the orthopaedic surgeon will assess the severity of the disease. The specialist will then refer suitable patients to a physiotherapist who will further assess them and assign them to a telerehabilitation group (TR) or a control group (TS). The physiotherapist will provide verbal and written explanations of the study procedures to the patients.
Written informed consent will be required from each participant to participate in the study.
After inclusion in the study, the physiotherapist will collect baseline data on the patients, including the following measures:
- Sociodemographic characteristics: age, gender, education, employment status.
- Anthropometric measurements: height (cm), weight (kg), body mass index (BMI) (kg/m²).
- Assessment of knee joint mobility: measurement of range of movement with a goniometer.
- Pain intensity: Use the Numerical Rating Scale (NRS) to measure subjective pain.
Assessment of physical function, stiffness, and pain: The validated Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire is used.
- Physical activity assessment: performed using the International Physical Activity Questionnaire (IPAQ).
- Assessment of health-related quality of life: administered by the 12-item Short Form Health Survey (SF-12).
- Osteoarthritis severity classification: based on knee radiographs (≤ 4 months old) and will be performed according to the Kellgren-Lawrence classification system.
Patients will be randomly assigned to one of two groups:
- telerehabilitation group (TR): They will be enrolled in a tailored physiotherapy programme, including individually tailored exercises to strengthen, stretch, and improve the functionality of the knee joint.
- control group (CG): patients will continue with standard care without additional therapeutic interventions.
Patient measurements and assessments will be carried out at the start of the study and at specific time points (after 12 weeks). All data will be recorded and analysed to identify changes in pain, mobility, functionality, and quality of life.
Statistical analysis Data will be analysed using appropriate statistical methods (e.g., t-test, ANOVA, regression analysis). The main outcome parameters will be changes in WOMAC, NRS, IPAQ, and SF-12, where the statistical significance and clinical relevance of differences between groups will be assessed.
The Declaration of Helsinki will conduct the study, which will be subject to ethics committee approval. Before participation, all participants will be informed in detail about the nature of the study and the potential risks and benefits, and their inclusion will be voluntary.
This study will provide valuable data on the effectiveness of therapeutic interventions in patients with knee OA and will contribute to a better understanding of optimal approaches to treating this disease.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Telerehabilitation Group | Experimental | Other: Control groupPatients in the Telerehabilitation group will receive instructions on physiotherapy intervention. They will independently perform the exercise for at least three months. During this time, they will have access to continuous remote support from the physiotherapist, including: • Weekly scheduled phone consultations • Live virtual consultations via MS Teams, Zoom, or Skype • Text messages and emails for personalised guidance, motivation, and ongoing problem solving. |
| Control group | Active comparator | Other: TelerehabilitationPatients in the control group will receive only written exercise instructions and perform the rehabilitation program independently at home without additional remote supervision. |
Who may qualify
- Ages
- 50 to 80 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Patients with symptomatic OA of the knee joint, graded 1-3 on the Kellgren-Lawrence scale
- Patients older than 50 years
- Patients with access to and proficiency in using a computer,
- Patients with the capability to follow the exercises outlined.
Key exclusion criteria (10 listed)
- Grade 4 cartilage defect (cartilage defect up to the subchondral bone), for which surgical treatment is professionally indicated,
- Planned arthroplasty of the knee joint within the next 6 months,
- Patients who have had a previous TEP arthroplasty or partial knee arthroplasty (hereafter PEP),
- Patients with a history of trauma or surgical treatment of the knee joint (osteotomy or treatment of cartilage lesions) in the last 6 months,
- Patients who have received an intra-articular injection in the knee joint in the last 3 months,
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| TelerehabilitationTelerehabilitation involves a physiotherapy program delivered remotely using digital tools. Participants perform exercises independently with remote support from a physiotherapist, including: Weekly scheduled phone consultations Live virtual consultations via MS Teams, Zoom, or Skype Text messages and emails for personalized guidance, motivation, and ongoing problem-solving The intervention includes targeted exercises for: Core muscle strength Strengthening of lower extremity muscles Mobility exercises for the hip, knee, and ankle joints Balance and stabilization exercises Each session lasts approximately 20-25 minutes, performed three times per week. Patients can choose the days for their sessions, with the requirement of a minimum of 24 hours and a maximum of 72 hours of rest between sessions. The intervention will last for at least three months. | Other | Control group |
| Control groupPatients in the control group will receive written instructions for a home exercise program. They will independently perform the rehabilitation program at home without remote supervision. The intervention includes targeted exercises for: Core muscle strength Strengthening of lower extremity muscles Mobility exercises for the hip, knee, and ankle joints Balance and stabilization exercises Each session lasts approximately 20-25 minutes, performed three times per week. Patients can choose the days for their sessions, with the requirement of a minimum of 24 hours and a maximum of 72 hours of rest between sessions. The intervention will last for at least three months. | Other | Telerehabilitation Group |
Primary outcome
Pain Intensity
Time frame: Day 1
Measured using the Numeric Rating Scale (NRS), where the scale ranges from 0 to 10, with 0 representing 'no pain' and 10 representing 'worst possible pain'. Higher scores indicate a higher level of pain.
Knee Function (WOMAC)
Time frame: Day 1
Evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which measures joint function, stiffness, and pain related explicitly to knee osteoarthritis.
Joint Mobility
Time frame: Day 1
Joint mobility will be assessed using a goniometer to measure any improvements or changes in the range of motion of the knee joint.
Physical Activity
Time frame: Day 1
Assessed using the International Physical Activity Questionnaire (IPAQ), gauges the level of physical activity and sedentary behaviour in daily life. Health-Related
Quality of Life ( SF-12)
Time frame: Day 1
Measured by the SF-12, a 12-item questionnaire that evaluates the patient's perceived quality of life, focusing on physical and mental health.
8 secondary outcomes
Pain Intensity
Time frame: up to 12 weeks
Knee Function (WOMAC)
Time frame: up to 12 weeks
Physical Activity
Time frame: up to 12 weeks
Quality of Life ( SF-12)
Time frame: up to 12 weeks
Exercise Adherence and Frequency
Time frame: up to 12 weeks
Patient Satisfaction with telerehabilitation
Time frame: up to 12 weeks
Reasons for Reduced Exercise Engagement or Discontinuation
Time frame: up to 12 weeks
Joint Mobility
Time frame: up to 12 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Jan 2026.
Related trials for Pain
Not yet recruiting
Digital Use, 24-Hour Movement Behaviors, and Myofascial Release in University Students With Neck Pain
Forward Head Posture, Chronic Nonspecific Neck Pain
Recruiting
Effects of Virtual Reality Exergames Versus Spinal Manipulation in Chronic Nonspecific Low Back Pain
Chronic Nonspecific Low-back Pain, CNSLBP
Recruiting
Dietary Intervention for Migraine Relief
Migraine
RecruitingPhase 4
Anrikefon-based Patient-controlled Intravenous Analgesia Following Laparoscopic Surgery
Laparoscopic Surgery, Visceral Pain, Postoperative
Not yet recruiting
Ultrasound-Guided Radiofrequency Ablation for Focal Adenomyosis
Adenomyosis, Adenomyoma of Uterus
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Karmen Erjavec, prof. dr. study director
University of Novo Mesto
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Telerehabilitation in people with Pain and Stiffness, run by University of Novo Mesto at 1 site in Slovenia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 2 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Slovenia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Pain Intensity (time frame: Day 1). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jan 2026; AzTrials last refreshed its copy on 31 Oct 2026.