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Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.

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Journal American journal of physical medicine & rehabilitation
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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OBJECTIVE: The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis. DESIGN: Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models. RESULTS: There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 ± 8.2 yrs) and 21 control (57.1% women; age, 68.9 ± 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 ± 1.7; P = 0.0162) and symptoms (8.6 ± 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos. CONCLUSIONS: Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained.

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Using auditory feedback from pressure insoles to lower medial knee compartment loads.

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Journal Osteoarthritis Cartilage
Year 2015

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Real-time visual feedback for gait retraining: toward application in knee osteoarthritis.

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Journal Medical & biological engineering & computing
Year 2015
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Real-time visual feedback might be effective for gait retraining in patients with knee osteoarthritis, to potentially relieve symptoms and postpone knee replacement. In this study, we investigated the effect of various types of real-time visual feedback on a kinetic and a kinematic gait parameter and the different kinematic strategies adopted to reduce knee load. Seventeen healthy subjects walked on an instrumented treadmill while receiving real-time visual kinetic feedback aimed at minimizing the external knee adduction moment (KAdM, reflecting the knee load) or kinematic feedback on the hip internal rotation angle (HIR, a gait modification to reduce the KAdM). Four types of visual feedback (bar, polar plot, color change, graph) were provided. The KAdM decreased by 50 % with kinetic feedback, while kinematic feedback resulted in an HIR increase of 8° but no decrease in KAdM. The degree of change was not influenced by the type of visual feedback. The kinematic changes that reduced KAdM were increased toe-in, increased step width, and decreased hip adduction. Real-time visual feedback can effectively modify gait parameters. Feedback of the KAdM may be more effective in reducing the KAdM than controlling a kinematic parameter that is assumed to unload the knee.

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Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results.

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Journal The Knee
Year 2014
Links Pubmed DOI

This article is included in 6 Systematic reviews Systematic reviews (6 references)

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BACKGROUND: Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. METHODS: Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. RESULTS: VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. CONCLUSION: This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). LEVEL OF EVIDENCE: level IV.

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Superiority of laterally elevated wedged insoles to neutrally wedged insoles in medial knee osteoarthritis symptom relief.

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Journal International journal of rheumatic diseases
Year 2014
Links Pubmed DOI

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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AIM: Knee osteoarthritis (OA), is the most common degenerative joint disease. Several non-pharmacological interventions have been used for this purpose such as insoles. There are contradictory data about the superiority and effectiveness of laterally wedged compared with neutrally wedged insoles. This study was designed to compare the effectiveness of laterally and neutrally wedged insoles in management of knee OA. METHODS: In this double-blind, parallel treatment trial, 118 patients with knee OA according to American College of Rheumatology (ACR) criteria were enrolled and were followed for 2 months. Patients were randomly divided into two groups. Fifty-seven of them were treated with 5° laterally elevated wedged insoles (group A) and 61 patients were treated with neutrally wedged insoles (group B). Edinburg Knee Functional Scale (EKFS) was used to evaluate knee function before and after interventions. At the end of 2 months, severity of knee pain during the previous 2 days, numbers of non-steroid anti inflammatory drugs (NSAIDs) used for pain relief within the last 2 weeks and EKFS were assessed. RESULTS: Severity of knee pain decreased in both groups after intervention. The mean difference in groups A (laterally wedged insole) and B (neutrally wedged insole) were 29.3 (95% confidence interval [95% CI]: 25.12, 33.55) and 6.25 (95% CI: 3.09, 9.4), respectively (P < 0.001 for both). In addition, at the end of the study, EKFS improved significantly in group A (mean: 7.54, 95% CI: 6.3, 8.8; P < 0.001), while in group B we could not find significant improvement (mean: 0.54, 95% CI: -0.41, 1.5; P = 0.166). Numbers of NSAIDs used during the two final weeks of the study significantly decreased compared with baseline in group A (P = 0.001; mean: 2.6, 95% CI: 1.3, 3.9); while in group B this was not shown (P = 0.9; mean: 0.05, 95% CI:-0.87, 0.97). CONCLUSION: This study suggests that laterally elevated wedged insoles are more effective than neutrally wedged insoles, in pain relief of knee OA.

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Comparison of mirror, raw video, and real-time visual biofeedback for training toe-out gait in individuals with knee osteoarthritis.

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Journal Archives of physical medicine and rehabilitation
Year 2014
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To compare performance error and perceived difficulty during toe-out gait modification in people with knee osteoarthritis (OA) across 3 different types of visual feedback: mirror, raw video, and real-time biofeedback of toe-out angle. DESIGN: Repeated-measures, within-subject trial. SETTING: University motion analysis laboratory. PARTICIPANTS: Individuals with knee OA (N=20; 11 women; mean age, 65.4±9.8y) participated in this study. Seven participants had mild knee OA, 9 had moderate knee OA, and 4 had severe knee OA. INTERVENTIONS: Participants were trained to walk on a treadmill while matching a target indicating a 10° increase in stance phase toe-out compared with toe-out angle measured during self-selected walking. The target was provided visually via the 3 types of feedback listed above and were presented in a random order. MAIN OUTCOME MEASURES: Kinematic data were collected and used to calculate the difference between the target angle and the actual performed angle for each condition (toe-out performance error). Difficulty was assessed using a numerical rating scale (0-10) provided verbally by participants. RESULTS: Toe-out performance error was significantly less when using the real-time biofeedback method than when using the other 2 methods (P=.025; mean difference vs mirror=2.05°; mean difference vs raw video=1.51°). Perceived difficulty was not statistically different between the groups (P=.51). CONCLUSIONS: Although statistically significant, the 2° difference in toe-out gait performance error may not necessitate the large economic and personnel costs of real-time biofeedback as a means to modify movement in clinical or research settings.

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Effects of a 10-week toe-out gait modification intervention in people with medial knee osteoarthritis: a pilot, feasibility study.

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Authors Hunt MA , Takacs J
Journal Osteoarthritis and cartilage
Year 2014
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To examine the feasibility of a 10-week gait modification program in people with medial tibiofemoral knee osteoarthritis (OA), and to assess changes in clinical and biomechanical outcomes. DESIGN: Fifteen people with medial knee OA completed 10 weeks of gait modification focusing on increasing toe-out angle during stance 10° compared to their self-selected angle measured at baseline. In addition to adherence and performance difficulty outcomes, knee joint symptoms (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and total score, numerical rating scale (NRS) of pain), and knee joint loading during gait (late stance peak knee adduction moment (KAM)) were assessed. RESULTS: Participants were able to perform the toe-out gait modification program with minimal to moderate difficulty, and exhibited significant increases in self-selected toe-out angle during walking (P < 0.001). Joint discomfort was reported by five participants (33%) in the hip or knee joints, though none lasted longer than 2 weeks. Participants reported statistically significant reductions in WOMAC pain (P = 0.02), NRS pain (P < 0.001), WOMAC total score (P = 0.02), and late stance KAM (P = 0.04). CONCLUSIONS: These preliminary findings suggest that toe-out gait modification is feasible in people with medial compartment knee OA. Preliminary changes in clinical and biomechanical outcomes provide the impetus for conducting larger scale studies of gait modification in people with knee OA to confirm these findings.

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A preliminary assessment of a novel pneumatic unloading knee brace on the gait mechanics of patients with knee osteoarthritis.

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Journal PM & R : the journal of injury, function, and rehabilitation
Year 2013
Links Pubmed DOI

This article is included in 5 Systematic reviews Systematic reviews (5 references)

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OBJECTIVES: To determine whether a knee brace incorporating inflatable air bladders can alter the net peak external knee adduction moment in persons with medial compartment knee osteoarthritis. DESIGN: Prospective cohort study. SETTING: Motion analysis laboratory. PARTICIPANTS: Subjects (n = 18) diagnosed with knee osteoarthritis as defined by the Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. METHODS: Instrumented gait analysis was performed while subjects walked with and without the knee brace. When subjects wore the knee brace, the air bladders were either uninflated or inflated to 7 psi. The net external knee adduction moment was obtained by subtracting the abduction moment produced by the knee brace (estimated using a finite element analysis model) from the external knee adduction moment (estimated using a camera-based motion analysis system). MAIN OUTCOME MEASUREMENTS: The net external knee adduction moment was compared across all testing conditions. RESULTS: A 7.6% decrease in net peak external knee adduction moment was observed when subjects wore the knee brace uninflated compared with when they did not wear the brace. Inflation of the bladders to 7 psi led to a 26.0% decrease in net peak external knee adduction moment. CONCLUSIONS: The results of the study suggest that the effects of an unloading knee brace may be enhanced by incorporating inflatable air bladders into the design of the brace, thus leading to an improved correction of the excessive peak external knee adduction moment observed in patients with medial compartment knee osteoarthritis.

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Frontal plane corrective ability of a new unloader orthosis for medial compartment of the knee.

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Journal Prosthetics and orthotics international
Year 2013
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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BACKGROUND: Patients with medial compartment osteoarthritis of the knee suffer from pain and stiffness. However, current unloader braces are not being used for extended periods by knee osteoarthritis patients due to interface problems, so compliance is an issue. The aim of this study was to design a new bespoke orthosis that could be comfortable to wear while also providing the required correction to reduce medial compartment loading. CASE DESCRIPTION AND METHODS: A new knee orthosis design was initially tested for its frontal plane correction of knee varus using a surrogate knee model. It was then assessed by a volunteer subject with grade 2 medial compartment knee osteoarthritis using a static standing radiograph. FINDINGS AND OUTCOMES: When fitted to the surrogate knee model, the brace corrected the knee from 10° of varus to neutral alignment in the frontal plane. When worn in situ during static stance on the affected leg of the volunteer patient, it corrected the knee by 6° to a less varus position. CONCLUSION: The orthosis provided frontal plane correction of the knee during static standing. It could therefore prove to be suitable for use by knee osteoarthritis patients.

Primary study

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Performance of subjects with knee osteoarthritis during walking: differential parameters.

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Journal Rheumatology international
Year 2013
Links Pubmed DOI

This article is included in 1 Systematic review Systematic reviews (1 reference)

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The effect of knee OA on kinetic and kinematic parameters during walking and standing is still controversial. Stability and energy consumption have not been well investigated in patients with OA. This research investigated the parameters distinguishing between the healthy subjects and patients with OA performance. It also examined the differences in stability and energy consumption between patients with OA and healthy subjects. Fifteen patients with OA and fifteen healthy subjects were recruited into this study. Kinematic and kinetic assessments were performed using Qualysis motion analysis and a force plate Kistler, respectively. Stability of the subjects during walking was determined using COP. Energy consumption was calculated using the Physiological Index. Independent t test was used to determine the differences between gait, stability, and energy consumption healthy participants and patients with knee OA. The excursion of the knee, hip and pelvis in sagittal plane, excursion of the knee joint in the mediolateral plane were significantly higher (all p < 0.05) in patients with OA of the knee compared with their healthy counterparts. In addition, energy consumption was significantly higher in patients with OA (p = 0.009) than in healthy participants. However, margin of stability was significantly lower (p = 0.05) in patients with OA of the knee than in healthy subjects. These findings suggest that gait parameters and energy consumption assessments may be important in patients with OA of the knee. Therefore, clinicians are to be aware of these findings by developing appropriate gait rehabilitation for patients with OA of the knee.