Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis

Neil A Segal, Natalie A Glass, Patricia Teran-Yengle, Bhupinder Singh, Robert B Wallace, H John Yack, Neil A Segal, Natalie A Glass, Patricia Teran-Yengle, Bhupinder Singh, Robert B Wallace, H John Yack

Abstract

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.

Figures

Figure 1
Figure 1
Participant-specific biofeedback during instrumented treadmill gait training. Example of real-time biofeedback provided during gait training for correction of kinematic patterns. Visual 3D was used to provide feedback to participants either as a (A) skeleton model which introduced gross concepts of body movements or (B) target area which was used for more specific feedback.
Figure 2
Figure 2
Participant Inclusion Diagram *1 missed visit due to minor surgery

References

    1. Nevitt MC, Lane N. Body weight and osteoarthritis. Am J Med. 1999;107(6):632–3.
    1. March LM, Bachmeier CJ. Economics of osteoarthritis: a global perspective. Baillieres Clin Rheumatol. 1997;11(4):817–34.
    1. Davis MA. Epidemiology of osteoarthritis. Clin Geriatr Med. 1988;4(2):241–55.
    1. Guccione AA. Arthritis and the process of disablement. Phys Ther. 1994;74(5):408–14.
    1. Kramer JS, Yelin EH, Epstein WV. Social and economic impacts of four musculoskeletal conditions. A study using national community-based data. Arthritis Rheum. 1983;26(7):901–7.
    1. Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, et al. Lifetime Risk and Age at Diagnosis of Symptomatic Knee Osteoarthritis in the US. Arthritis Care Res (Hoboken) 2013;65(5):703–11.
    1. Murphy L, Schwartz TA, Helmick CG, Renner JB, Tudor G, Koch G, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthritis Rheum. 2008;59(9):1207–13.
    1. Hootman JM, Helmick CG. Projections of US prevalence of arthritis and associated activity limitations. Arthritis Rheum. 2006;54(1):226–9.
    1. Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint power with functional limitations in older adults with symptomatic knee osteoarthritis. Arch Phys Med Rehabil. 2009;90(11):1821–8.
    1. McGibbon CA, Puniello MS, Krebs DE. Mechanical energy transfer during gait in relation to strength impairment and pathology in elderly women. Clin Biomech (Bristol, Avon) 2001;16(4):324–33.
    1. Pai YC, Chang HJ, Chang RW, Sinacore JM, Lewis JL. Alteration in multijoint dynamics in patients with bilateral knee osteoarthritis. Arthritis Rheum. 1994;37(9):1297–304.
    1. Ettinger WH, Jr., Afable RF. Physical disability from knee osteoarthritis: the role of exercise as an intervention. Med Sci Sports Exerc. 1994;26(12):1435–40.
    1. Hirvensalo M, Rantanen T, Heikkinen E. Mobility difficulties and physical activity as predictors of mortality and loss of independence in the community-living older population. J Am Geriatr Soc. 2000;48(5):493–8.
    1. McGibbon CA, Krebs DE, Scarborough DM. Rehabilitation effects on compensatory gait mechanics in people with arthritis and strength impairment. Arthritis Rheum. 2003;49(2):248–54.
    1. Segal NA, Torner JC, Felson DT, Niu J, Sharma L, Lewis CE, et al. Knee extensor strength does not protect against incident knee symptoms at 30 months in the multicenter knee osteoarthritis (MOST) cohort. PM R. 2009;1(5):459–65.
    1. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16(4):494–502.
    1. Segal NA, Nevitt MC, Gross KD, Hietpas J, Glass NA, Lewis CE, et al. The Multicenter Osteoarthritis Study: opportunities for rehabilitation research. PM R. 2013;5(8):647–54.
    1. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–31.
    1. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006;33(11):2271–9.
    1. United Nations. Department of Economic and Social Affairs . Population Division. World population ageing, 1950-2050. United Nations; New York: 2002.
    1. Ferrucci L, Guralnik JM, Studenski S, Fried LP, Cutler GB, Jr., Walston JD. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: a consensus report. J Am Geriatr Soc. 2004;52(4):625–34.
    1. Bean JF, Leveille SG, Kiely DK, Bandinelli S, Guralnik JM, Ferrucci L. A comparison of leg power and leg strength within the InCHIANTI study: which influences mobility more? J Gerontol A Biol Sci Med Sci. 2003;58(8):728–33.
    1. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.
    1. Haley SM, Jette AM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, et al. Late Life Function and Disability Instrument: II. Development and evaluation of the function component. J Gerontol A Biol Sci Med Sci. 2002;57(4):M217–22.
    1. Newman AB, Simonsick EM, Naydeck BL, Boudreau RM, Kritchevsky SB, Nevitt MC, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. Jama. 2006;295(17):2018–26.
    1. Reuben DB, Seeman TE, Keeler E, Hayes RP, Bowman L, Sewall A, et al. Refining the categorization of physical functional status: the added value of combining self-reported and performance-based measures. J Gerontol A Biol Sci Med Sci. 2004;59(10):1056–61.
    1. Segal NA, Boyer ER, Wallace R, Torner JC, Yack HJ. Association between chair stand strategy and mobility limitations in older adults with symptomatic knee osteoarthritis. Arch Phys Med Rehabil. 2013;94(2):375–83.
    1. Cuoco A, Callahan DM, Sayers S, Frontera WR, Bean J, Fielding RA. Impact of muscle power and force on gait speed in disabled older men and women. J Gerontol A Biol Sci Med Sci. 2004;59(11):1200–6.
    1. Roos EM, Toksvig-Larsen S. Knee injury and Osteoarthritis Outcome Score (KOOS) - validation and comparison to the WOMAC in total knee replacement. Health Qual Life Outcomes. 2003;1(1):17.
    1. Washburn RA, McAuley E, Katula J, Mihalko SL, Boileau RA. The physical activity scale for the elderly (PASE): evidence for validity. J Clin Epidemiol. 1999;52(7):643–51.
    1. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.
    1. Winter DA. Biomechanics and motor control of human movement. 3rd ed. Wiley; Hoboken, N.J.: 2005.
    1. Taaffe DR. Sarcopenia--exercise as a treatment strategy. Australian family physician. 2006;35(3):130–4.
    1. Fregly BJ, Reinbolt JA, Rooney KL, Mitchell KH, Chmielewski TL. Design of patient539 specific gait modifications for knee osteoarthritis rehabilitation. IEEE Trans Biomed Eng. 2007;54(9):1687–95.
    1. Hunt MA, Bennell KL. Predicting dynamic knee joint load with clinical measures in people with medial knee osteoarthritis. Knee. 2011;18(4):231–4.
    1. Huang SC, Wei IP, Chien HL, Wang TM, Liu YH, Chen HL, et al. Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis. Med Eng Phys. 2008;30(8):997–1003.
    1. Jackson BD, Wluka AE, Teichtahl AJ, Morris ME, Cicuttini FM. Reviewing knee osteoarthritis--a biomechanical perspective. Journal of Science & Medicine in Sport. 2004;7(3):347–57.
    1. Fisher NM, White SC, Yack HJ, Smolinski RJ. Pendergast DR: Muscle function and gait in patients with knee osteoarthritis before and after muscle rehabilitation. Disabil Rehabil. 1997;19(2):47–55.
    1. Hunt MA, Wrigley TV, Hinman RS, Bennell KL. Individuals with severe knee osteoarthritis (OA) exhibit altered proximal walking mechanics compared with individuals with less severe OA and those without knee pain. Arthritis Care & Research. 2010;62(10):1426–32.
    1. Wang TJ, Chern HL, Chiou YE. A theoretical model for preventing osteoarthritis-related disability. Rehabil Nurs. 2005;30(2):62–7.
    1. Wang SY, Olson-Kellogg B, Shamliyan TA, Choi JY, Ramakrishnan R, Kane RL. Physical therapy interventions for knee pain secondary to osteoarthritis: a systematic review. Ann Intern Med. 2012;157(9):632–44.
    1. Tanaka R, Ozawa J, Kito N, Moriyama H. Efficacy of strengthening or aerobic exercise on pain relief in people with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation. 2013;27(12):1059–71.
    1. Fransen M, McConnell S. Exercise for osteoarthritis of the knee. The Cochrane database of systematic reviews. 2008;(4):CD004376.
    1. de Vreede PL, Samson MM, van Meeteren NL, van der Bom JG, Duursma SA, Verhaar HJ. Functional tasks exercise versus resistance exercise to improve daily function in older women: A feasibility study. Arch Phys Med Rehabil. 2004;85(12):1952–61.
    1. Rogind H, Bibow-Nielsen B, Jensen B, Moller HC, Frimodt-Moller H, Bliddal H. The effects of a physical training program on patients with osteoarthritis of the knees. Arch Phys Med Rehabil. 1998;79(11):1421–7.
    1. Teixeira PE, Piva SR, Fitzgerald GK. Effects of impairment-based exercise on performance of specific self-reported functional tasks in individuals with knee osteoarthritis. Phys Ther. 2011;91(12):1752–65.
    1. Talbot LA, Gaines JM, Huynh TN, Metter EJ. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. J Am Geriatr Soc. 2003;51(3):387–92.
    1. Shull PB, Silder A, Shultz R, Dragoo JL, Besier TF, Delp SL, et al. Six-week gait retraining program reduces knee adduction moment, reduces pain, and improves function for individuals with medial compartment knee osteoarthritis. Journal of orthopaedic research : official publication of the Orthopaedic Research Society. 2013;31(7):1020–5.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi