R Richards1, J C van den Noort2, M van der Esch3, M J Booij4, J Harlaar5. 1. VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands. Electronic address: r.richards@vumc.nl. 2. VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands; Academic Medical Center, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands. Electronic address: j.vandennoort@vumc.nl. 3. Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands. Electronic address: m.vd.esch@reade.nl. 4. VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands. Electronic address: m.booij1@vumc.nl. 5. VU University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, Netherlands; Delft University of Technology, Delft, Netherlands. Electronic address: j.harlaar@vumc.nl.
Abstract
BACKGROUND: The knee adduction moment (KAM) is often elevated in medial knee osteoarthritis (KOA). The aim of this study was to evaluate effects on KAM and patient-reported outcomes of a six-week gait training program. METHODS: Twenty-one patients (61 ± 6 years) with KOA participated in a six-week biofeedback training program to encourage increased toe-in (all patients) and increased step-width (five patients). Patients received real-time visual feedback while walking on an instrumented treadmill. We analysed the effect of the gait modification(s) on peak KAM in week six and three and six months post-training. We also evaluated the effect on pain and functional ability. RESULTS: Of 21 patients starting the program, 16 completed it with high attendance (15 and 16 respectively) at the three and six month follow-ups. First peak KAM was significantly reduced by up to 14.0% in week six with non-significant reductions of 8.2% and 5.5% at the follow-ups. Functional ability (assessed using the WOMAC questionnaire) improved significantly after the training (eight point reduction, p = 0.04 in week six and nine point reduction, p = 0.04 at six-month follow-up). There was also a trend towards reduction in WOMAC pain (p = 0.06) at follow-up. CONCLUSIONS: Biofeedback training to encourage gait modifications is feasible and leads to short-term benefits. However, at follow-up, reductions in KAM were less pronounced in some participants suggesting that to influence progression of KOA in the longer term, a permanent regime to reinforce the effects of the training program is needed. Trial number: ISRCTN14687588.
BACKGROUND: The knee adduction moment (KAM) is often elevated in medial knee osteoarthritis (KOA). The aim of this study was to evaluate effects on KAM and patient-reported outcomes of a six-week gait training program. METHODS: Twenty-one patients (61 ± 6 years) with KOA participated in a six-week biofeedback training program to encourage increased toe-in (all patients) and increased step-width (five patients). Patients received real-time visual feedback while walking on an instrumented treadmill. We analysed the effect of the gait modification(s) on peak KAM in week six and three and six months post-training. We also evaluated the effect on pain and functional ability. RESULTS: Of 21 patients starting the program, 16 completed it with high attendance (15 and 16 respectively) at the three and six month follow-ups. First peak KAM was significantly reduced by up to 14.0% in week six with non-significant reductions of 8.2% and 5.5% at the follow-ups. Functional ability (assessed using the WOMAC questionnaire) improved significantly after the training (eight point reduction, p = 0.04 in week six and nine point reduction, p = 0.04 at six-month follow-up). There was also a trend towards reduction in WOMAC pain (p = 0.06) at follow-up. CONCLUSIONS: Biofeedback training to encourage gait modifications is feasible and leads to short-term benefits. However, at follow-up, reductions in KAM were less pronounced in some participants suggesting that to influence progression of KOA in the longer term, a permanent regime to reinforce the effects of the training program is needed. Trial number: ISRCTN14687588.
Authors: M Denika C Silva; Diana M Perriman; Angela M Fearon; Daniel Tait; Trevor J Spencer; Dianne Walton-Sonda; Milena Simic; Rana S Hinman; Kim L Bennell; Jennie M Scarvell Journal: PLoS One Date: 2022-09-21 Impact factor: 3.752