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James KA, Neogi T, Felson DT, Corrigan P, Lewis CL, Davis IS, Bacon KL, Torner JC, Lewis CE, Nevitt MC, Stefanik JJ. Association of walking cadence to changes in knee pain and physical function: The multicenter osteoarthritis study. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100575. [PMID: 39995587 PMCID: PMC11849617 DOI: 10.1016/j.ocarto.2025.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2025] [Accepted: 01/23/2025] [Indexed: 02/26/2025] Open
Abstract
Objective Determine the association of walking cadence to incident and worsening knee pain and physical function over 2 years in adults with or at risk for knee OA. Design Participants from the Multicenter Osteoarthritis study were included.Cadence was measured using a GAITRite walkway. Incident and worsening knee symptoms, pain with walking, and functional limitations were assessed at baseline and 2 years later. The association of cadence to each outcome was analyzed using log binomial regression. Cadence was assessed continuously as a 10-unit change and categorically using quartiles. Analyses were adjusted for age, sex, race, BMI, presence of tibiofemoral OA, depression, and history of knee injury. Sensitivity analyses were conducted for all outcomes adjusted for gait speed and stratified by sex. Results Among 1600 participants (60.3 % female, age 67.1 ± 7.7 years), lower cadence was not significantly associated with incident or worsening knee symptoms, pain with walking, or functional limitations. For every 10-step/min decrease in cadence, the risk of incident knee symptoms increased by 10 % (RR = 1.10, 95%CI [0.97, 1.25]), though this was not statistically significant and was attenuated after adjusting for gait speed (RR = 0.95, 95%CI [0.80, 1.12]). No significant associations were observed for incident or worsening pain with walking or functional limitations. Sex-stratified analyses revealed inconsistent findings, including an increased risk for incident functional limitations in females (RR = 1.45, 95%CI [1.02, 2.08]), which was attenuated after adjusting for gait speed. Conclusion Lower cadence was not significantly associated with pain and function, suggesting that the interplay between cadence, gait speed, and clinical outcomes warrants further investigation.
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Affiliation(s)
- Khara A. James
- Northeastern University, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Tuhina Neogi
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
| | - David T. Felson
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
| | | | - Cara L. Lewis
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
- Sargent College of Health & Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Irene S. Davis
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Kathryn L. Bacon
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
| | | | - Cora E. Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Joshua J. Stefanik
- Northeastern University, Boston, MA, USA
- Boston University Chobanian & Avedisian School of Medicine, Section of Rheumatology, Boston, MA, USA
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Négyesi J, Kovács B, Petró B, Salman DN, Khandoker A, Katona P, Moussa MM, Hortobágyi T, Rácz K, Pálya Z, Grand L, Kiss RM, Nagatomi R. Side dominance and eye patches obscuring half of the visual field do not affect walking kinematics. Sci Rep 2025; 15:6189. [PMID: 39979477 PMCID: PMC11842710 DOI: 10.1038/s41598-025-90936-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Accepted: 02/17/2025] [Indexed: 02/22/2025] Open
Abstract
Vision plays a fundamental role in the control of human locomotion, including walking gait. Given that side-dominance is associated with differences in motor control, the present study aimed to determine if patches obscuring half of the visual field affect left- and right-side dominant individuals' gait kinematics and accompanying leg muscle activation differently. Healthy right- (n = 15, age = 28.2 ± 5.5 years) and left-side (n = 9, age = 27.9 ± 5.8 years) dominant participants performed 10 min of walking trials on a treadmill at a self-selected speed with 5 min of rest between three randomized trials, i.e., wearing clear glasses or glasses with left-or right half-field eye patching. In addition to a set of spatiotemporal and kinematic gait parameters, the average activity during the separated gait cycle phases, and the start and end of muscle activation in % of the gait cycle were calculated from five muscles in three muscle groups. Our results indicate that gait kinematics of left- and right-side dominant participants were similar both in their dominant and non-dominant legs, regardless of half-field eye patching condition. On the other hand, inter-group differences were found in selected kinematic variables. For instance, in addition to larger but less variable step width, our results suggest larger ankle and knee ROM in right- vs. left-sided participants. Furthermore, medial gastrocnemius and biceps femoris muscle activation showed selected differences at certain phases of the gait cycle between participants' dominant and non-dominant legs. However, it was also unaffected by the half-field eye patching condition. Moreover, the endpoint of medial gastrocnemius activation was affected by side-dominance, i.e., its activation ended earlier in the non-dominant leg of right- as compared to left-side dominant participants. Our results suggest no major differences in walking gait kinematics and accompanying muscle activation between half-field eye patching conditions in healthy adults; nevertheless, side-dominance may affect biomechanical and neuromuscular control strategies during walking gait.
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Affiliation(s)
- János Négyesi
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary.
- Neurocognitive Research Center, Nyírő Gyula National Institute of Psychiatry, and Addictology, Budapest, Hungary.
- CRU Hungary Kft, Budapest, Hungary.
| | - Bálint Kovács
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
- Faculty of Sport Science, Ningbo University, Ningbo, China
| | - Bálint Petró
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | | | - Ahsan Khandoker
- Biomedical Engineering Department, Khalifa University, Abu Dhabi, UAE
| | - Péter Katona
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
| | | | - Tibor Hortobágyi
- Department of Kinesiology, Hungarian University of Sports Science, Budapest, Hungary
- Department of Neurology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, 7400, Hungary
- Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Pécs, Hungary
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kristóf Rácz
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Zsófia Pálya
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - László Grand
- Faculty of Information Technology, Pázmány Péter Catholic University, Budapest, Hungary
| | - Rita Mária Kiss
- Faculty of Mechanical Engineering, Department of Mechatronics, Optics and Mechanical Engineering Informatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ryoichi Nagatomi
- Designing Future Health Initiative (DFHI), Promotion Office of Strategic Innovation, Tohoku University, Sendai, Japan
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3
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King MG, Ackland DC, Hart HF, Schache AG, Sritharan P, Pandy MG, Crossley KM. Walking biomechanics in women with patellofemoral osteoarthritis differ compared to men with and women without patellofemoral osteoarthritis. Braz J Phys Ther 2024; 28:101132. [PMID: 39476510 PMCID: PMC11564953 DOI: 10.1016/j.bjpt.2024.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/05/2024] [Accepted: 10/16/2024] [Indexed: 11/18/2024] Open
Abstract
BACKGROUND Differences in walking biomechanics between women and men with patellofemoral joint (PF) osteoarthritis (OA) may contribute to the development or progression of persistent symptoms in people with PF OA. OBJECTIVE Evaluate how walking biomechanics of women with PF OA differ from: (i) men with PFJ OA; and (ii) women without PF OA. Second, explore the relationship between knee-related symptoms/function and walking biomechanics in individuals with PF OA, and whether these are modified by sex. METHODS Sixty-seven individuals with PF OA (43 women) and 14 women without PF OA were included. Biomechanics data were recorded during walking. Patient-reported symptoms and function were obtained using the Knee injury and Osteoarthritis Outcome Score. Differences in continuous biomechanical data were assessed using statistical parametric mapping, with discrete data and relationships evaluated using linear models. RESULTS Women with PF OA walked with a greater hip adduction angle throughout stance (t > 2.757) and lower impulses for the hip flexion, knee flexion, and ankle dorsiflexion moments (adjusted mean differences [95% CI]:3.3 × 10-2 [-4.9 × 10-2, -1.6 × 10-2], -2.9 × 10-2 [-5.3 × 10-2, -0.4 × 10-2], -5.1 × 10-2 [-8.2 × 10-2, -2.0 × 10-2] Nms/kg, respectively) compared to men with PF OA. Compared to their asymptomatic peers, women with PF OA displayed a 5° offset towards greater hip flexion. Higher knee adduction moment impulse correlated with worse KOOS-ADL scores in men, not women. CONCLUSION Observed biomechanical differences were small in nature with moderate to weak relationship observed with the KOOS. Findings were not limited to the knee, indicating that women with PF OA display unique biomechanical features across the kinetic-chain.
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Affiliation(s)
- Matthew G King
- Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Victoria, Australia
| | - Harvi F Hart
- Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia; School of Physical Therapy, Faculty of Health Sciences, Western University, Ontario, Canada
| | - Anthony G Schache
- Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Prasanna Sritharan
- Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Kay M Crossley
- Australian IOC Research Centre, La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia.
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Takiyama K, Kubota K, Yokoyama H, Kanemura N. Speed-dependent modulations of muscle modules in the gait of people with radiographical and asymptomatic knee osteoarthritis and elderly controls: Case-control pilot study. J Biomech 2024; 171:112194. [PMID: 38901294 DOI: 10.1016/j.jbiomech.2024.112194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024]
Abstract
This study investigates the muscle modules involved in the increase of walking speed in radiographical and asymptomatic knee osteoarthritis (KOA) patients using tensor decomposition. The human body possesses redundancy, which is the property to achieve desired movements with more degrees of freedom than necessary. The muscle module hypothesis is a proposed solution to this redundancy. While previous studies have examined the pathological muscle activity modulations in musculoskeletal diseases such as KOA, they have focused on single muscles rather than muscle modules. Moreover, most studies have only examined the gait of KOA patients at a single speed, leaving the way in which gait speed affects gait parameters in KOA patients unclear. Assessing this influence is crucial for determining appropriate gait speed and understanding why preferred gait speed decreases in KOA patients. In this study, we apply tensor decomposition to muscle activity data to extract muscle modules in KOA patients and elderly controls during walking at different speeds. We found a muscle module comprising hip adductors and back muscles that activate bimodally in a gait cycle, specific to KOA patients when they increase their walking speed. These findings may provide valuable insights for rehabilitation for KOA patients.
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Affiliation(s)
- Ken Takiyama
- Tokyo University of Agriculture and Technology, Department of Electrical Engineering and Computer Science, Nakacho, Koganei, Tokyo, Japan.
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Hikaru Yokoyama
- Tokyo University of Agriculture and Technology, Division of Advanced Health Science, Nakacho, Koganei, Tokyo, Japan
| | - Naohiko Kanemura
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama, Japan
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Dami A, Chicoine D, Payen E, Bouchard M, Belzile EL, Corbeil P, Moisan G. Lower limbs biomechanical deficits associated with stage 1 and 2 posterior tibialis tendon dysfunction during walking. Gait Posture 2024; 110:10-16. [PMID: 38460464 DOI: 10.1016/j.gaitpost.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Posterior tibialis tendon dysfunction (PTTD) is a chronic degenerative musculoskeletal disorder causing a progressive ankle complex and arch collapse altering lower limb biomechanics. However, biomechanical changes associated with stage 1 and 2 PTTD need to be better characterized during walking to guide clinical recommendations and improve non-operative treatments. RESEARCH QUESTION What are the lower limb kinematic and kinetic differences between individuals with stage 1 (PTTD1), individuals with stage 2 PTTD (PTTD2) and healthy counterparts during gait? METHODS Sixteen PTTD1, 11 PTTD2 and 20 healthy controls were included in this multicentric case-control study to compare their lower limb gait biomechanics. Kinematic and kinetic data were recorded using a three-dimensional motion capture system and a force plate. One-dimensional statistical parametric mapping was used to compare lower limb joint motion and moments between groups during the stance phase. RESULTS PTTD1 had minimal biomechanical differences compared with the control group. In contrast, PTTD2 presented significant differences compared with controls and PTTD1. At the ankle, PTTD2 exhibited greater plantarflexion and eversion angles and midfoot dorsiflexion and inversion angles throughout stance compared with controls and PTTD1. PTTD2 presented lower midfoot abduction moments compared with controls. These changes led PTTD2 to exhibit knee and hip adaptative biomechanical mechanisms in the frontal and transverse planes in late stance. PTTD2 had greater knee internal rotation angles and smaller knee external rotation moments compared to controls. PTTD2 had smaller hip internal rotation angles compared with PTTD1 and smaller hip adduction moments compared with controls. SIGNIFICANCE PTTD1 showed minimal biomechanical differences compared to controls and important differences compared to PTTD2. The lower limb biomechanical deficits accentuate as the pathology advances from stage 1 to stage 2. PTTD is a progressive condition needing early clinical management at stage 1 to avoid successive biomechanical changes associated with stage 2.
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Affiliation(s)
- Ahmed Dami
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada.
| | - Dominic Chicoine
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Eléna Payen
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada
| | - Marc Bouchard
- CHU de Québec-Université Laval, 11, côte du Palais, Québec, QC G1R 2J6, Canada
| | - Etienne L Belzile
- CHU de Québec-Université Laval, 11, côte du Palais, Québec, QC G1R 2J6, Canada
| | - Phillipe Corbeil
- Department of Kinesiology, University Laval, 2325, rue de l'Université, Québec, QC G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, Boul. Wilfrid-Hamel, Québec, QC G1M 2S8, Canada
| | - Gabriel Moisan
- Department of Human Kinetics, University du Québec à Trois-Rivières, 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Groupe de Recherche sur les Affections Neuromusculosquelettiques (GRAN), 3351, Boul. des Forges, Trois-Rivières, QC G8Z 4M3, Canada; Department of Kinesiology, University Laval, 2325, rue de l'Université, Québec, QC G1V 0A6, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525, Boul. Wilfrid-Hamel, Québec, QC G1M 2S8, Canada
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Doslikova K, Reeves ND, Maganaris CN, Baltzopoulos V, Verschueren SMP, Luyten FP, Jones RK, Felson DT, Callaghan MJ. The effects of a sleeve knee brace during stair negotiation in patients with symptomatic patellofemoral osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 111:106137. [PMID: 37988779 DOI: 10.1016/j.clinbiomech.2023.106137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The patellofemoral joint is an important source of pain in knee osteoarthritis. Most biomechanical research in knee osteoarthritis has focused on the tibiofemoral joint during level walking. It is unknown what happens during stair negotiation in patients with patellofemoral joint osteoarthritis, a task commonly increasing pain. Conservative therapy for patellofemoral joint osteoarthritis includes the use of a sleeve knee brace. We aimed to examine the effect of a sleeve knee brace on knee biomechanics during stair negotiation in patellofemoral joint osteoarthritis patients. METHODS 30 patellofemoral joint osteoarthritis patients (40-70 years) ascended and descended an instrumented staircase with force plates under two conditions - wearing a Lycra flexible knee support (Bioskin Patellar Tracking Q Brace) and no brace (control condition). Knee joint kinematics (VICON) and kinetics were recorded. FINDINGS During stair ascent, at the knee, the brace significantly reduced the maximal flexion angle (2.70, P = 0.002), maximal adduction angle (2.00, P = 0.044), total sagittal range of motion (2.00, P = 0.008), total frontal range of motion (1.70, P = 0.023) and sagittal peak extension moment (0.05 Nm/kg, P = 0.043) compared to control. During stair descent, at the knee, the brace significantly reduced the maximal flexion angle (1.80, P = 0.039) and total sagittal range of motion (1.50, P = 0.045) compared to control. INTERPRETATION The small changes in knee joint biomechanics during stair negotiation observed in our study need to be investigated further to help explain mechanisms behind the potential benefits of a sleeve knee brace for painful patellofemoral joint osteoarthritis.
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Affiliation(s)
- K Doslikova
- Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK.
| | - N D Reeves
- Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - C N Maganaris
- Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK; School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - V Baltzopoulos
- Department of Life Sciences, Faculty of Science & Engineering, Manchester Metropolitan University, Manchester, UK; School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - S M P Verschueren
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - F P Luyten
- Skeletal Biology & Engineering Research Center, Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - R K Jones
- School of Health Sciences, University of Salford, Salford, UK
| | - D T Felson
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; School of Medicine, Boston University, Boston, MA, USA
| | - M J Callaghan
- Institute of Sport, Manchester Metropolitan University, Manchester, UK; Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; Department of Health Professions, Manchester Metropolitan University, Manchester, UK; Manchester University Foundation NHS Trust, Manchester, UK
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Aydemir B, Huang CH, Foucher KC. Gait speed and kinesiophobia explain physical activity level in adults with osteoarthritis: A cross-sectional study. J Orthop Res 2023; 41:2629-2637. [PMID: 37254645 PMCID: PMC10926713 DOI: 10.1002/jor.25624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 06/01/2023]
Abstract
Identifying potential contributing factors for physical inactivity in people with knee osteoarthritis is vital for designing practical activity promoting interventions. Walking is a common activity, but it is unknown how gait characteristics may influence physical activity and if psychological factors, specifically fear of movement (kinesiophobia), contribute to this relationship. The aim of our study was to investigate the contributions of select gait parameters and kinesiophobia to activity levels. Cross-sectional data from 40 participants (F 24|M 16; age 57.6 ± 8.9 years; BMI 34.7 ± 7.0 kg/m2 ) with uni- or bilateral knee osteoarthritis were included. Physical activity and kinesiophobia were assessed by self-report using the University of California, Los Angeles activity rating scale, and Tampa scale for kinesiophobia, respectively. Gait parameters were collected with three-dimensional gait analysis while participants walked on an instrumented split-belt treadmill at a self-selected speed. Higher peak sagittal plane joint moments at the ankle (ρ = 0.418, p = 0.007), and hip (ρ = 0.348, p = 0.028), faster self-selected gait speed (ρ = 0.553, p < 0.001), and less kinesiophobia or fear of movement (ρ = -0.695, p < 0.001) were independently related to higher physical activity level in adults with knee osteoarthritis. In hierarchical regression models, after accounting for covariates, only self-selected gait speed, and kinesiophobia significantly contributed to explaining the variation in physical activity level. Statement of clinical significance: Interventions aimed at improving physical activity participation in those with lower limb osteoarthritis should consider assessing the contribution of pain-related fear of movement.
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Affiliation(s)
- Burcu Aydemir
- Division of Rheumatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chun-Hao Huang
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Kharma C. Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Langley B, Greig M. The gait abnormality index: A summary metric for three-dimensional gait analysis. Gait Posture 2023; 105:87-91. [PMID: 37499421 DOI: 10.1016/j.gaitpost.2023.07.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND This paper proposes an easy to calculate and adaptable summary gait metric, the Gait Abnormality Index (GAI), which is capable of simultaneously including kinematic and kinetic data, overcoming a key limitation of existing metrics. RESEARCH QUESTION To determine the validity, reliability and sensitivity of the GAI. METHODS The GAI is calculated by averaging Gait Abnormality Scores, which are normalised distance metrics used to describe the deviation of pathological gait data from that of healthy controls. Validity was assessed using Pearson's correlation analysis to explore relationships between the GAI and the Gait Profile Score. Test-retest reliability of the GAI was assessed using intra-class correlation coefficients (ICC) and standard error of the measurement (SEM), and data from total hip arthroplasty patients. An independent samples t-test was used to compare GAI scores between knee osteoarthritis and total hip arthroplasty patients to explore the metrics sensitivity. RESULTS A strong positive correlation (r ≥ 0.896; p < 001) was reported between the GAI and the Gait Profile Score. Good test-retest reliability (ICC =0.830) was reported for the GAI. Knee osteoarthritis patients displayed significantly (p = .017; Hedge's g effect size = 0.98) greater GAI scores compared to total hip arthroplasty patients, with the mean difference (0.34 a.u) above the SEM (0.15 a.u). SIGNIFICANCE The GAI offers an easy to calculate summary metric for three-dimensional gait analysis, which displays good validity and reliability, and is sensitive to different pathological conditions.
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Affiliation(s)
- Ben Langley
- Sport and Physical Activity, Edge Hill University, Lancashire, UK.
| | - Matt Greig
- Sport and Physical Activity, Edge Hill University, Lancashire, UK
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Wang J, Hu Q, Wu C, Li S, Deng Q, Tang R, Li K, Nie Y, Shen B. Gait Asymmetry Variation in Kinematics, Kinetics, and Muscle Force along with the Severity Levels of Knee Osteoarthritis. Orthop Surg 2023; 15:1384-1391. [PMID: 37057620 PMCID: PMC10157696 DOI: 10.1111/os.13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVE Knee osteoarthritis (OA) patients exhibit greater gait asymmetry than healthy controls. However, gait asymmetry in kinematics, kinetics and muscle forces across patients with different severity levels of knee OA is still unknown. The study aimed to investigate the changes of gait asymmetry in lower limb kinematics, kinetics, and muscle force across patients with different severity levels of knee OA. METHODS This is a cross-sectional study. From January 2020 to January 2021, 118 patients with symptomatic and radiographic medial knee OA were categorized into three groups using the Kellgren and Lawrence scale (mild: grade 1 and 2, n = 37; moderate: grade 3, n = 31; severe: grade 4, n = 50). During self-paced walking, marker trajectories and ground reaction forces data were recorded. Musculoskeletal simulations were used to determine gait kinematics, kinetics, and muscle force. One-way analysis of variance with Tukey's post-hoc test was used to evaluate group difference. Paired-sample t-test was used to compared the between-limb difference. RESULTS In the Severe group, significantly greater asymmetry index in knee flexion/extension range of motion (45%) was observed with a greater value on the contralateral side (p < 0.01), compared to the Mild (15%) and Moderate (15%) groups. Significantly higher peak hip contact force (JCF) on the contralateral side was found in the Mild (more affected side: 3.80 ± 0.67 BW, contralateral side: 4.01 ± 0.58 BW), Moderate (more affected side: 3.67 ± 0.56 BW, contralateral side: 4.07 ± 0.81 BW), and Severe groups (more affected side: 3.66 ± 0.79 BW, contralateral side: 3.94 ± 0.64 BW) (p < 0.05). Significantly greater gluteus medius muscle force on the contralateral side was found in Mild (more affected side: 0.48 ± 0.09 BW, contralateral side: 0.52 ± 0.12 BW), Moderate (more affected side: 0.45 ± 0.10 BW, contralateral side: 0.51 ± 0.15 BW), and Severe groups (more affected side: 0.42 ± 0.15 BW, contralateral side: 0.47 ± 0.12 BW) (p < 0.05). The contralateral side showing significantly higher peak knee adduction moment and medial knee JCF was only observed in the Mild group (p < 0.05). CONCLUSIONS Gait asymmetry in kinematics and muscle forces increased from mild to severe knee OA. Asymmetrical gait pattern tends to transfer loads from the more affected side to the contralateral side. Peak hip JCF and gluteus medius muscle force can be used to detect this asymmetrical gait pattern in patients with knee OA, regardless of severity levels.
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Affiliation(s)
- Junqing Wang
- West China Biomedical Big Data CenterSichuan University West China HospitalChengduChina
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical SchoolSichuan UniversityChengduChina
- Med‐X Center for InformaticsSichuan UniversityChengduChina
| | - Qinsheng Hu
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical SchoolSichuan UniversityChengduChina
| | - Chenyu Wu
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical SchoolSichuan UniversityChengduChina
| | - Shiqi Li
- College of Electrical EngineeringSichuan UniversityChengduChina
| | - Qian Deng
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical SchoolSichuan UniversityChengduChina
| | - Ruoliang Tang
- Sichuan University‐Pittsburgh Institute (SCUPI)Sichuan UniversityChengduChina
| | - Kang Li
- West China Biomedical Big Data CenterSichuan University West China HospitalChengduChina
| | - Yong Nie
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical SchoolSichuan UniversityChengduChina
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute and National Clinical Research Center for Geriatrics, West China Hospital, West China Medical SchoolSichuan UniversityChengduChina
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10
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Ghaffari A, Rasmussen J, Kold S, Lauritsen REK, Kappel A, Rahbek O. Accelerations Recorded by Simple Inertial Measurement Units with Low Sampling Frequency Can Differentiate between Individuals with and without Knee Osteoarthritis: Implications for Remote Health Care. SENSORS (BASEL, SWITZERLAND) 2023; 23:2734. [PMID: 36904954 PMCID: PMC10006888 DOI: 10.3390/s23052734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Determining the presence and severity of knee osteoarthritis (OA) is a valuable application of inertial measurement units (IMUs) in the remote monitoring of patients. This study aimed to employ the Fourier representation of IMU signals to differentiate between individuals with and without knee OA. We included 27 patients with unilateral knee osteoarthritis (15 females) and 18 healthy controls (11 females). Gait acceleration signals were recorded during overground walking. We obtained the frequency features of the signals using the Fourier transform. The logistic LASSO regression was employed on the frequency domain features as well as the participant's age, sex, and BMI to distinguish between the acceleration data from individuals with and without knee OA. The model's accuracy was estimated by 10-fold cross-validation. The frequency contents of the signals were different between the two groups. The average accuracy of the classification model using the frequency features was 0.91 ± 0.01. The distribution of the selected features in the final model differed between patients with different severity of knee OA. In this study, we demonstrated that using logistic LASSO regression on the Fourier representation of acceleration signals can accurately determine the presence of knee OA.
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Affiliation(s)
- Arash Ghaffari
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, 9220 Aalborg East, Denmark
| | - Søren Kold
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Andreas Kappel
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Aalborg University Hospital, 9000 Aalborg, Denmark
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11
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Sorby-Adams AJ, Marian OC, Bilecki IM, Elms LE, Camargo J, Hall K, Crowther RG, Leonard AV, Wadsworth GI, Spear JH, Turner RJ, Jones CF. Neurological scoring and gait kinematics to assess functional outcome in an ovine model of ischaemic stroke. Front Neurol 2023; 14:1071794. [PMID: 36891474 PMCID: PMC9986303 DOI: 10.3389/fneur.2023.1071794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023] Open
Abstract
Background Assessment of functional impairment following ischaemic stroke is essential to determine outcome and efficacy of intervention in both clinical patients and pre-clinical models. Although paradigms are well described for rodents, comparable methods for large animals, such as sheep, remain limited. This study aimed to develop methods to assess function in an ovine model of ischaemic stroke using composite neurological scoring and gait kinematics from motion capture. Methods Merino sheep (n = 26) were anaesthetised and subjected to 2 hours middle cerebral artery occlusion. Animals underwent functional assessment at baseline (8-, 5-, and 1-day pre-stroke), and 3 days post-stroke. Neurological scoring was carried out to determine changes in neurological status. Ten infrared cameras measured the trajectories of 42 retro-reflective markers for calculation of gait kinematics. Magnetic resonance imaging (MRI) was performed at 3 days post-stroke to determine infarct volume. Intraclass Correlation Coefficients (ICC's) were used to assess the repeatability of neurological scoring and gait kinematics across baseline trials. The average of all baselines was used to compare changes in neurological scoring and kinematics at 3 days post-stroke. A principal component analysis (PCA) was performed to determine the relationship between neurological score, gait kinematics, and infarct volume post-stroke. Results Neurological scoring was moderately repeatable across baseline trials (ICC > 0.50) and detected marked impairment post-stroke (p < 0.05). Baseline gait measures showed moderate to good repeatability for the majority of assessed variables (ICC > 0.50). Following stroke, kinematic measures indicative of stroke deficit were detected including an increase in stance and stride duration (p < 0.05). MRI demonstrated infarction involving the cortex and/or thalamus (median 2.7 cm3, IQR 1.4 to 11.9). PCA produced two components, although association between variables was inconclusive. Conclusion This study developed repeatable methods to assess function in sheep using composite scoring and gait kinematics, allowing for the evaluation of deficit 3 days post-stroke. Despite utility of each method independently, there was poor association observed between gait kinematics, composite scoring, and infarct volume on PCA. This suggests that each of these measures has discreet utility for the assessment of stroke deficit, and that multimodal approaches are necessary to comprehensively characterise functional impairment.
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Affiliation(s)
- Annabel J Sorby-Adams
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Oana C Marian
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Isabella M Bilecki
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Levi E Elms
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jonathan Camargo
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Kelly Hall
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Robert G Crowther
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Anna V Leonard
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - George I Wadsworth
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Joshua H Spear
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Renée J Turner
- School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Claire F Jones
- School of Mechanical Engineering, Faculty of Sciences, Engineering and Technology, The University of Adelaide, Adelaide, SA, Australia.,Adelaide Spinal Research Group, Centre for Orthopaedics and Trauma Research, The University of Adelaide, North Terrace, SA, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
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12
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Munsch AE, Pietrosimone B, Franz JR. Walking speed does not affect net vastus lateralis fascicle length change on average during weight acceptance. J Biomech 2022; 144:111300. [DOI: 10.1016/j.jbiomech.2022.111300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
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13
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Pamukoff DN, Holmes SC, Garcia SA, Vakula MN, Shumski EJ, Moffit TJ. Influence of body mass index and anterior cruciate ligament reconstruction on gait biomechanics. J Orthop Res 2022; 41:994-1003. [PMID: 36205181 DOI: 10.1002/jor.25451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/06/2022] [Accepted: 10/01/2022] [Indexed: 02/04/2023]
Abstract
Body mass index (BMI) and history of anterior cruciate ligament reconstruction (ACLR) independently influence gait biomechanics and knee osteoarthritis risk, but the interaction between these factors is unclear. The purpose of this study was to compare gait biomechanics between individuals with and without ACLR, and with and without overweight/obesity. We examined 104 individuals divided into four groups: with and without ACLR, and with low or high BMI (n = 26 per group). Three-dimensional gait biomechanics were evaluated at preferred speed. The peak vertical ground reaction force, knee flexion angle and excursion, external knee flexion moment, and external knee adduction moment were extracted for analysis. Gait features were compared between groups using 2 (with and without overweight/obesity) × 2 (with and without ACLR) analysis of variance. Primary findings indicated that those with ACLR and high BMI had a larger external knee adduction moment compared with those with low BMI and with (p = 0.004) and without ACLR (p = 0.005), and compared with those without ACLR and high BMI (p = 0.001). The main effects of ACLR and BMI group were found for the knee flexion moment, and those with ACLR and with high BMI had lower knee flexion moments compared with those without ACLR (p = 0.031) and with low BMI (p = 0.021), respectively. Data suggest that individuals with ACLR and high BMI may benefit from additional intervention targeting the knee adduction moment. Moreover, lower external knee flexion moments in those with high BMI and ACLR were consistent, but high BMI did not exacerbate deficits in the knee flexion moment in those with ACLR. [Correction added on 9 November 2022, after first online publication: In the preceding sentence, for clarity, the words "reductions in the lower" was removed from the initial sentence to read "Moreover, lower external knee flexion moments".].
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Affiliation(s)
- Derek N Pamukoff
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts, USA
| | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael N Vakula
- Department of Kinesiology & Health Science, Utah State University, Logan, Utah, USA
| | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Tyler J Moffit
- Department of Kinesiology, California State University, Bakersfield, California, USA
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14
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Boekesteijn RJ, van Gerven J, Geurts ACH, Smulders K. Objective gait assessment in individuals with knee osteoarthritis using inertial sensors: A systematic review and meta-analysis. Gait Posture 2022; 98:109-120. [PMID: 36099732 DOI: 10.1016/j.gaitpost.2022.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/16/2022] [Accepted: 09/01/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Objective assessment of gait using inertial sensors has shown promising results for functional evaluations in individuals with knee osteoarthritis (OA). However, the large number of possible outcome measures calls for a systematic evaluation of most relevant parameters to be used for scientific and clinical purposes. AIM This systematic review and meta-analysis aimed to identify gait parameters derived from inertial sensors that reflect gait deviations in individuals with knee OA compared to healthy control subjects (HC). METHODS A systematic search was conducted in five electronic databases (Medline, Embase, Web of Science, CINAHL, IEEE) to identify eligible articles. Risk of bias was assessed using a modified version of the Downs and Black scale. Data regarding study population, experimental procedures, and biomechanical outcomes were extracted. When a gait parameter was reported by a sufficient number of studies, a random-effects meta-analysis was conducted using the inverse variance method. RESULTS Twenty-three articles comparing gait between 411 individuals with knee OA and 507 HC were included. Individuals with knee OA had a lower gait speed than HC (standardized mean difference = -1.65), driven by smaller strides with a longer duration. Stride time variability was slightly higher in individuals with knee OA than in HC. Individuals with knee OA walked with a lower range of motion of the knee during the swing phase, less lumbar motion in the coronal plane, and a lower foot strike and toe-off angle compared to HC. SIGNIFICANCE This review shows that inertial sensors can detect gait impairments in individuals with knee OA. Large standardized mean differences found on spatiotemporal parameters support their applicability as sensitive endpoints for mobility in individuals with knee OA. More advanced measures, including kinematics of knee and trunk, may reveal gait adaptations that are more specific to knee OA, but compelling evidence was lacking.
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Affiliation(s)
- R J Boekesteijn
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - J van Gerven
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, the Netherlands.
| | - A C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - K Smulders
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands.
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15
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Lalumiere M, Bourbonnais D, Goyette M, Perrino S, Desmeules F, Gagnon DH. Unilateral symptomatic Achilles tendinopathy has limited effects on bilateral lower limb ground reaction force asymmetries and muscular synergy attributes when walking at natural and fast speeds. J Foot Ankle Res 2022; 15:66. [PMID: 36071465 PMCID: PMC9450385 DOI: 10.1186/s13047-022-00570-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) may affect ground reaction force (GRF) and muscle synergy (MS) during walking due to pain, biological integrity changes in the tendon and neuroplastic adaptations. The objective of this study was to compare GRF asymmetries and MS attributes between symptomatic and asymptomatic lower limbs (LL) during walking at natural and fast speeds in adults with unilateral AT. METHODS A convenience sample consisting of twenty-eight participants walked on an instrumented treadmill at natural (1.3 m/s) and fast (1.6 m/s) speeds. Peak GRF were measured in mediolateral, anteroposterior and vertical directions. Individualized electromyography (EMG) activation profiles were time- and amplitude-normalized for three consecutive gait cycles and MS were extracted using non-negative matrix factorization algorithms. MS were characterized by the number, composition (i.e., weighting of each muscle) and temporal profiles (i.e., duration and amplitude) of the MS extracted during walking. Paired Student's t-tests assessed peak GRF and MS muscle weighting differences between sides whereas Pearson correlation coefficients characterized the similarities of the individualized EMG and MS activation temporal profiles within sides. RESULTS AT had limited effects on peak GRF asymmetries and the number, composition and temporal profiles of MS between symptomatic and asymptomatic LL while walking on a level treadmill at natural and fast speeds. In most participants, four MS with a specific set of predominantly activated muscles were extracted across natural (71 and 61%) and fast (54 and 50%) walking speeds for the symptomatic and asymptomatic side respectively. Individualized EMG activation profiles were relatively similar between sides (r = 0.970 to 0.999). As for MS attributes, relatively similar temporal activation profiles (r = 0.988 to 0.998) and muscle weightings (p < 0.05) were found between sides for all four MS and the most solicited muscles. Although the faster walking speed increased the number of merged MS for both sides, it did not significantly alter MS symmetry. CONCLUSION Faster walking speed increased peak GRF values but had limited effects on GRF symmetries and MS attribute differences between the LL. Corticospinal neuroplastic adaptations associated with chronic unilateral AT may explain the preserved quasi-symmetric LL motor control strategy observed during natural and fast walking among adults with chronic unilateral AT.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Daniel Bourbonnais
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Michel Goyette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - François Desmeules
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H Gagnon
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.
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16
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Lisee CM, Bjornsen E, Horton WZ, Davis-Wilson H, Blackburn JT, Fisher MB, Pietrosimone B. Differences in Gait Biomechanics Between Adolescents and Young Adults With Anterior Cruciate Ligament Reconstruction. J Athl Train 2022; 57:921-928. [PMID: 36638344 PMCID: PMC9842117 DOI: 10.4085/1062-6050-0052.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Adolescents and adults are treated similarly in rehabilitation and research despite differences in clinical recovery after anterior cruciate ligament reconstruction (ACLR). Aberrant gait is a clinical outcome associated with poor long-term health post-ACLR but has not been compared between adolescents and adults. OBJECTIVE To compare gait biomechanical waveforms throughout stance between adolescents (<18 years old) and young adults (≥18 years old) post-ACLR. DESIGN Case-control study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Adolescents (n = 13, girls = 77%, age = 16.7 ± 0.6 years, height = 1.7 ± 0.1 m, weight = 22.2 ± 3.7 kg/m2) were identified from a cross-sectional cohort assessing clinical outcomes 6 to 12 months post-ACLR. Young adults (n = 13, women = 77%, age = 22.3 ± 4.0 years, height = 1.7 ± 0.1 m, weight = 22.9 ± 3.3 kg/m2) were matched based on sex, time since surgery (±2 months), and body mass index (±3 kg/m2). INTERVENTION(S) Participants performed 5 gait trials at their habitual speed. MAIN OUTCOME MEASURE(S) Three-dimensional gait biomechanics and forces were collected. Vertical ground reaction force normalized to body weight (xBW), knee-flexion angle (°), knee-abduction moment (xBW × height), and knee-extension moment (BW × height) waveforms were calculated during the stance phase of gait (0%-100%). Habitual walking speed was compared using independent t tests. We used functional waveforms to compare gait biomechanics throughout stance with and without controlling for habitual walking speed by calculating mean differences between groups with 95% CIs. RESULTS Adolescents walked with slower habitual speeds compared with adults (adolescents = 1.1 ± 0.1 m/s, adults = 1.3 ± 0.1 m/s, P < .001). When gait speed was not controlled, adolescents walked with less vertical ground reaction force (9%-15% of stance) and knee-abduction moment (12%-25% of stance) during early stance and less knee-extension moment during late stance (80%-99% of stance). Regardless of their habitual walking speed, adolescents walked with greater knee-flexion angle throughout most stances (0%-21% and 29%-100% of stance). CONCLUSIONS Adolescents and adults demonstrated different gait patterns post-ACLR, suggesting that age may play a role in altered gait biomechanics.
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Affiliation(s)
| | - Elizabeth Bjornsen
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | | | - Hope Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - J. Troy Blackburn
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, and North Carolina State University, Raleigh
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill
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17
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Pamukoff DN, Holmes SC, Garcia SA, Shumski EJ, Rubin DA. Lower extremity coordination and joint kinetic distribution during gait in adults with and without Prader-Willi Syndrome. J Biomech 2022; 141:111213. [DOI: 10.1016/j.jbiomech.2022.111213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022]
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Steingrebe H, Stetter BJ, Sell S, Stein T. Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis. Front Bioeng Biotechnol 2022; 10:888775. [PMID: 35898647 PMCID: PMC9309805 DOI: 10.3389/fbioe.2022.888775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Hip Osteoarthritis (HOA) is a common joint disease with serious impact on the quality of life of the affected persons. Additionally, persons with HOA often show alterations in gait biomechanics. Developing effective conservative treatment strategies is of paramount importance, as joint replacement is only indicated for end-stage HOA. In contrast to knee osteoarthritis, little is known about the effectiveness of hip bracing for the management of HOA. Studies analysing mechanically unloading hip braces partly showed beneficial results. However, methodological limitations of these studies, such as small sample sizes or lack of control groups, limit the applicability of the results. Additionally, mechanically unloading braces might impose restrictions on motion and comfort and thus, might not be suitable for people with only mild or moderate symptoms. The aim of this study was to comprehensively quantify the effects of unilateral HOA as well as functional hip bracing on gait biomechanics, pain, proprioception and functional capacity in people with mild to moderate HOA. Hip and pelvis biomechanics during walking were analysed in 21 subjects with mild to moderate HOA under three bracing conditions: unbraced, immediately after brace application and after 1 week of brace usage. Additionally, pain, hip proprioception and functional capacity were assessed. A matched group of 21 healthy subjects was included as reference. Kinematic and kinetic data were collected using a 16-camera infrared motion capturing system and two force plates. Visual analogue scales, an angle reproduction test and a 6-min walking test were applied to measure pain, hip proprioception and functional capacity, respectively. Subjects with HOA walked slower, with reduced step length, sagittal hip range of motion and peak extension angle and had a reduced functional capacity. After 1 week of brace application step length, walking speed and functional capacity were significantly increased. Additionally, pain perception was significantly lower in the intervention period. These results encourage the application of functional hip braces in the management of mild to moderate HOA. However, as key parameters of HOA gait such as a reduced peak extension angle remained unchanged, the underlying mechanisms remain partly unclear and have to be considered in the future.
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Affiliation(s)
- Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Bernd J. Stetter
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Joint Center Black Forest, Hospital Neuenbürg, Neuenbürg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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19
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Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ, Blyth MJG. Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial. Bone Joint J 2022; 104-B:433-443. [PMID: 35360949 DOI: 10.1302/0301-620x.104b4.bjj-2021-0837.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. METHODS A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model. RESULTS Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R2 = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R2 = 0.352; p = 0.029), and TKA femoral sagittal alignment (R2 = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception. CONCLUSION Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433-443.
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Affiliation(s)
- Matthew S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Mark J G Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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20
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Hart HF, Patterson BE, Crossley KM, Culvenor AG, Khan MCM, King MG, Sritharan P. May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions-a systematic review and meta-analysis. Br J Sports Med 2022; 56:521-530. [PMID: 35115309 DOI: 10.1136/bjsports-2021-104686] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To systematically review and synthesise patellofemoral joint reaction force (PFJRF) in healthy individuals and those with patellofemoral pain and osteoarthritis (OA), during everyday activities, therapeutic exercises and with physical interventions (eg, foot orthotics, footwear, taping, bracing). DESIGN A systematic review with meta-analysis. DATA SOURCES Medline, Embase, Scopus, CINAHL, SportDiscus and Cochrane Library databases were searched. ELIGIBILITY CRITERIA Observational and interventional studies reporting PFJRF during everyday activities, therapeutic exercises, and physical interventions. RESULTS In healthy individuals, the weighted average of mean (±SD) peak PFJRF for everyday activities were: walking 0.9±0.4 body weight (BW), stair ascent 3.2±0.7 BW, stair descent 2.8±0.5 BW and running 5.2±1.2 BW. In those with patellofemoral pain, peak PFJRF were: walking 0.8±0.2 BW, stair ascent 2.5±0.5 BW, stair descent 2.6±0.5 BW, running 4.1±0.9 BW. Only single studies reported peak PFJRF during everyday activities in individuals with patellofemoral OA/articular cartilage defects (walking 1.3±0.5 BW, stair ascent 1.6±0.4 BW, stair descent 1.0±0.5 BW). The PFJRF was reported for many different exercises and physical interventions; however, considerable variability precluded any pooled estimates. SUMMARY Everyday activities and exercises involving larger knee flexion (eg, squatting) expose the patellofemoral joint to higher PFJRF than those involving smaller knee flexion (eg, walking). There were no discernable differences in peak PFJRF during everyday activities between healthy individuals and those with patellofemoral pain/OA. The information on PFJRF may be used to select appropriate variations of exercises and physical interventions.
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Affiliation(s)
- Harvi F Hart
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia .,Department of Physical Therapy, Western University, London, Ontario, Canada
| | - Brooke E Patterson
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Michaela C M Khan
- Motion Analysis and Biofeedback Laboratory, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
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21
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Jayaram P, Kang GE, Heldt BL, Sokunbi O, Song B, Yeh PC, Epstein M, Shybut TB, Lee BH, Najafi B. Novel assessment of leukocyte-rich platelet-rich plasma on functional and patient-reported outcomes in knee osteoarthritis: a pilot study. Regen Med 2021; 16:823-832. [PMID: 34424054 DOI: 10.2217/rme-2021-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Leukocyte-rich platelet-rich plasma (LR-PRP) has demonstrated to be beneficial for patients with knee osteoarthritis (KOA); however, reliable objective end points to accurately assess its therapeutic effects is lacking. Aim: To investigate the efficacy of LR-PRP as assessed by functional and patient-reported outcomes at early time points (6 weeks). Materials & methods: We conducted a prospective cohort study in 12 patients with diagnosed KOA (Kellgren Lawrence score of II-III), who underwent a single ultrasound-guided LR-PRP injection. Results: There was significant improvement in timed up and go, pain and quality of life scales and balance parameters. There were nonsignificant improvements in range of motion and gait parameters. Conclusion: LR-PRP demonstrates efficacy in meaningful end points for functional and patient-reported outcomes at early time points in patients with KOA.
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Affiliation(s)
- Prathap Jayaram
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA.,Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Gu Eon Kang
- Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, TX 77030, USA
| | - Brett L Heldt
- School of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Olumide Sokunbi
- School of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bo Song
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter C Yeh
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Max Epstein
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Theodore B Shybut
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA
| | - Brendan H Lee
- Department of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bijan Najafi
- Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Baylor College of Medicine, Houston, TX 77030, USA
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22
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Costello KE, Felson DT, Neogi T, Segal NA, Lewis CE, Gross KD, Nevitt MC, Lewis CL, Kumar D. Ground reaction force patterns in knees with and without radiographic osteoarthritis and pain: descriptive analyses of a large cohort (the Multicenter Osteoarthritis Study). Osteoarthritis Cartilage 2021; 29:1138-1146. [PMID: 33757856 PMCID: PMC8319033 DOI: 10.1016/j.joca.2021.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare ground reaction force patterns (GRF) during walking among legs defined by presence or absence of knee pain and/or radiographic knee osteoarthritis (ROA). METHOD Principal component analysis extracted major modes of variation (PCs) in GRF data from the Multicenter Osteoarthritis Study during self-paced walking. Legs were categorized as pain + ROA (n = 168), ROA only (n = 303), pain only (n = 476), or control (n = 1877). Relationships between group and GRF PCs were examined using Generalized Estimating Equations, adjusted for age, sex, body mass index, race, and clinic site with and without additional adjustment for gait speed. RESULTS With or without speed adjustment, pain + ROA had flatter vertical GRF waveforms than control (speed adjusted PC2 difference [95%CI]: -66 [-113,-20]), pain + ROA and ROA only had higher lateral GRF at impact and greater mid-stance medial GRF than control (speed adjusted PC3 difference: 9 [3,16] and 6 [2,10], respectively), and ROA only had higher early vs late medial GRF than control (speed adjusted PC2 difference: 7 [2,13]). Pain only had flatter vertical GRF waveforms and a smaller difference between anterior and posterior GRF than control only without speed adjustment. CONCLUSION In this large sample, sustained mid-stance loading and higher impact loads were identified in legs with ROA or ROA and pain, even when adjusting for differences in gait speed and other confounders. While it remains to be seen whether these features precede or result from ROA and pain, the presence of these patterns in the speed-adjusted models could have implications on gait interventions aimed to change joint loading.
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Affiliation(s)
- K E Costello
- Boston University, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| | - D T Felson
- Boston University School of Medicine, Boston, MA, USA
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA
| | - N A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA
| | - C E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - K D Gross
- MGH Institute of Health Professions, Boston, MA, USA
| | - M C Nevitt
- University of California at San Francisco, San Francisco, CA, USA
| | - C L Lewis
- Boston University, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - D Kumar
- Boston University, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
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23
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Ismailidis P, Kaufmann M, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Mündermann A, Nüesch C. Kinematic changes in severe hip osteoarthritis measured at matched gait speeds. J Orthop Res 2021; 39:1253-1261. [PMID: 32930435 DOI: 10.1002/jor.24858] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
Kinematic differences between patients with osteoarthritis (OA) and control participants have been reported to be influenced by gait speed. The purpose of this study was to experimentally detect the effect of walking speed on differences in spatiotemporal parameters and kinematic trajectories between patients with hip OA and age-matched asymptomatic participants using wearable sensors and statistical parametric mapping (SPM). Twenty-four patients with severe unilateral hip OA and 48 control participants were included in this study. Patients walked at a self-selected normal speed and control participants at self-selected normal and slow speeds. Spatiotemporal parameters and kinematic trajectories were measured with the inertial sensor system Rehagait®. Gait parameters were compared between patients with hip OA and control participants for normal and matched speed using SPM with independent sample t-tests. At self-selected normal speed, the patient group walked slower (-0.20 m/s, p < .001) and at lower cadence (-5.0 steps/minute, p < .001) as well as with smaller hip flexion (-7.4°, p < .001) and extension (-4.1°, p = .001), higher knee flexion during terminal stance (+8.0°, p < .001) and higher ankle dorsiflexion and plantarflexion (+7.1°, p < .001). While differences in spatiotemporal parameters and the ankle trajectory disappeared at matched speed, some clinically relevant and statistically significant differences in hip and knee trajectories remained. Most differences in sagittal plane gait kinematics between patients with hip OA and control participants were present for matched speed, and therefore appear to be associated with a disease rather than gait speed. Nevertheless, studies investigating hip kinematics in patients with hip OA should involve trials at matched speeds.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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24
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Boekesteijn RJ, Smolders JMH, Busch VJJF, Geurts ACH, Smulders K. Independent and sensitive gait parameters for objective evaluation in knee and hip osteoarthritis using wearable sensors. BMC Musculoskelet Disord 2021; 22:242. [PMID: 33658006 PMCID: PMC7931541 DOI: 10.1186/s12891-021-04074-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
Background Although it is well-established that osteoarthritis (OA) impairs daily-life gait, objective gait assessments are not part of routine clinical evaluation. Wearable inertial sensors provide an easily accessible and fast way to routinely evaluate gait quality in clinical settings. However, during these assessments, more complex and meaningful aspects of daily-life gait, including turning, dual-task performance, and upper body motion, are often overlooked. The aim of this study was therefore to investigate turning, dual-task performance, and upper body motion in individuals with knee or hip OA in addition to more commonly assessed spatiotemporal gait parameters using wearable sensors. Methods Gait was compared between individuals with unilateral knee (n = 25) or hip OA (n = 26) scheduled for joint replacement, and healthy controls (n = 27). For 2 min, participants walked back and forth along a 6-m trajectory making 180° turns, with and without a secondary cognitive task. Gait parameters were collected using 4 inertial measurement units on the feet and trunk. To test if dual-task gait, turning, and upper body motion had added value above spatiotemporal parameters, a factor analysis was conducted. Effect sizes were computed as standardized mean difference between OA groups and healthy controls to identify parameters from these gait domains that were sensitive to knee or hip OA. Results Four independent domains of gait were obtained: speed-spatial, speed-temporal, dual-task cost, and upper body motion. Turning parameters constituted a gait domain together with cadence. From the domains that were obtained, stride length (speed-spatial) and cadence (speed-temporal) had the strongest effect sizes for both knee and hip OA. Upper body motion (lumbar sagittal range of motion), showed a strong effect size when comparing hip OA with healthy controls. Parameters reflecting dual-task cost were not sensitive to knee or hip OA. Conclusions Besides more commonly reported spatiotemporal parameters, only upper body motion provided non-redundant and sensitive parameters representing gait adaptations in individuals with hip OA. Turning parameters were sensitive to knee and hip OA, but were not independent from speed-related gait parameters. Dual-task parameters had limited additional value for evaluating gait in knee and hip OA, although dual-task cost constituted a separate gait domain. Future steps should include testing responsiveness of these gait domains to interventions aiming to improve mobility. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04074-2.
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Affiliation(s)
- Ramon J Boekesteijn
- Department of Research, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen, Nijmegen, The Netherlands. .,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - José M H Smolders
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Vincent J J F Busch
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katrijn Smulders
- Department of Research, Sint Maartenskliniek, Hengstdal 3, 6574 NA Ubbergen, Nijmegen, The Netherlands
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25
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Moudy SC, Tillin NA, Sibley AR, Strike S. Lead limb loading during a single-step descent in persons with and without a transtibial amputation in the trailing limb. Clin Biomech (Bristol, Avon) 2021; 82:105279. [PMID: 33550002 DOI: 10.1016/j.clinbiomech.2021.105279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Decreased mechanical work done by the trailing limb when descending a single-step could affect load development and increase injury risk on the leading limb. This study assessed the effect of trailing limb mechanics on the development of lead limb load during a step descent by examining individuals with unilateral transtibial amputations who are known to exhibit reduced work in the prosthetic limb. METHODS Eight amputees and 10 able-bodied controls walked 5 m along the length of a raised platform, descended a single-step of 14 cm height, and continued walking. The intact limb of amputees led during descent. Kinematic and kinetic data were recorded using integrated motion capture and force platform system. Lead limb loading was assessed through vertical ground reaction force, and knee moments and joint reaction forces. Sagittal-plane joint work was calculated for the ankle, knee, and hip in both limbs. FINDINGS No differences were found in lead limb loading despite differences in trail limb mechanics evidenced by amputees performing 58% less total work by the trailing (prosthetic) limb to lower the centre of mass (P = 0.004) and 111% less for propulsion (P < 0.001). Amputees descended the step significantly slower (P = 0.003) and performed significantly greater lead limb ankle work (P = 0.017). After accounting for speed differences, initial loading at the knee was significantly higher in the lead limb of amputees versus controls. INTERPRETATION Increasing lead limb work and reducing forward velocity may be effective compensatory strategies to limit lead limb loading during a step descent, in response to reduced trailing limb work.
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Affiliation(s)
- Sarah C Moudy
- Department of Life Sciences, University of Roehampton, London, UK.
| | - Neale A Tillin
- Department of Life Sciences, University of Roehampton, London, UK
| | - Amy R Sibley
- Department of Life Sciences, University of Roehampton, London, UK
| | - Siobhán Strike
- Department of Life Sciences, University of Roehampton, London, UK
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26
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Legrand T, Younesian H, Gélinas-Trudel C, Barthod CV, Campeau-Lecours A, Turcot K. Influence of the overground walking speed control modality: Modification to the walk ratio and spatio-temporal parameters of gait. Gait Posture 2021; 83:256-261. [PMID: 33197862 DOI: 10.1016/j.gaitpost.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
Affiliation(s)
- T Legrand
- Department of Kinesiology, Medicine Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada.
| | - H Younesian
- Department of Kinesiology, Medicine Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - C Gélinas-Trudel
- Department of Mechanical Engineering, Science and Engineering Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - C V Barthod
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - A Campeau-Lecours
- Department of Mechanical Engineering, Science and Engineering Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
| | - K Turcot
- Department of Kinesiology, Medicine Faculty, Université Laval, Québec City, QC, Canada; Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
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27
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Garcia SA, Vakula MN, Holmes SC, Pamukoff DN. The influence of body mass index and sex on frontal and sagittal plane knee mechanics during walking in young adults. Gait Posture 2021; 83:217-222. [PMID: 33171375 DOI: 10.1016/j.gaitpost.2020.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/11/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Obesity and female sex are independent risk factors for knee osteoarthritis and also influence gait mechanics. However, the interaction between obesity and sex on gait mechanics is unclear, which may have implications for tailored gait modification strategies. RESEARCH QUESTION The purpose of this study was to examine the influence of obesity and sex on sagittal and frontal plane knee mechanics during gait in young adults. METHODS Forty-eight individuals with (BMI = 33.03 ± 0.59; sex:50 % female; age:21.9 ± 2.6 years) and 48 without obesity (BMI:21.59 ± 0.25; sex:50 % female; age:22.9 ± 3.57 years) matched on age and sex completed over-ground gait assessments at a self-selected speed. Two (BMI) by two (sex) analysis of variance was used to compare knee biomechanics during the first half of stance in the sagittal (knee flexion moment [KFM] and excursion [KFE]) and frontal plane (first peak knee adduction moment [KAM], knee varus velocity [KVV]). RESULTS We observed a BMI by sex interaction for normalized KFM (P = 0.03). Females had smaller normalized KFM compared to males (P = 0.03), but only in individuals without obesity. Males without obesity had larger normalized KFM compared to males with obesity (P = 0.01), while females did not differ between BMI groups. We observed main effects of sex and BMI group, where females exhibited greater normalized KAM (P < 0.01) and KVV (P < 0.01) compared to males, and individuals with obesity walked with greater KVV compared to those without obesity (P < 0.01). All absolute joint moments were greater in individuals with obesity (all P<0.01) and males had greater absolute KFM compared to females (P < 0.01). SIGNIFICANCE We observed sex differences in gait mechanics, however, KFM differences between males and females were only evident in individuals without obesity. Further, females and individuals with obesity had a larger KAM and KVV, which may contribute to larger medial compartment joint loading.
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Affiliation(s)
- Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, MI, United States
| | - Michael N Vakula
- Department of Kinesiology, Utah State University, Logan, UT, United States
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts, Amherst, Amherst, MA, United States
| | - Derek N Pamukoff
- Department of Kinesiology, California State University, Fullerton, 800 N State College Blvd Fullerton, CA, United States.
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28
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Pamukoff DN, Vakula MN, Holmes SC, Shumski EJ, Garcia SA. Body mass index moderates the association between gait kinetics, body composition, and femoral knee cartilage characteristics. J Orthop Res 2020; 38:2685-2695. [PMID: 32162713 DOI: 10.1002/jor.24655] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
This study compared femoral cartilage characteristics between age- and sex-matched individuals with (n = 48, age = 22.8 ± 3.5 years; body mass index [BMI] = 33.1 ± 4.1 kg/m2 ) and without obesity (n = 48 age = 22.0 ± 2.6 years; BMI = 21.7 ± 1.7 kg/m2 ) and evaluated the associations between body composition, quadriceps function, and gait kinetics with femoral cartilage characteristics. Medial and lateral femoral cartilage thickness, medial:lateral thickness ratio and medial and lateral cartilage echo intensity were measured using ultrasound imaging. Body composition was assessed using air displacement plethysmography. Quadriceps function was assessed via maximal isometric knee extension. Three-dimensional gait biomechanics were recorded to extract peak external knee flexion and adduction moments, and peak loading rate of the vertical ground reaction force. Cartilage outcomes were compared between groups using one-way multivariate analysis of variance. Stepwise moderated regression evaluated the association between body composition, quadriceps function, and gait kinetics with femoral cartilage outcomes in individuals with and without obesity. Medial (75.24 vs 65.84; P < .001, d = 1.02) and lateral (58.81 vs 52.22; P < .001, d = 0.78) femoral cartilage echo intensity were higher in individuals with compared with those without obesity. A higher body fat percentage was associated with higher medial and lateral cartilage echo intensity (ΔR2 = 0.09-0.12) in individuals with obesity. A higher knee adduction moment was associated with a larger medial:lateral thickness ratio (ΔR2 = 0.09) in individuals without obesity. No associations were found between quadriceps function and cartilage outcomes. These findings suggest that high body fat in adults with obesity is associated with cartilage echo intensity. The obese body mass index was also associated with a lack of a positive relationship between cartilage thickness and joint loading during walking.
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Affiliation(s)
- Derek N Pamukoff
- Department of Kinesiology, California State University, Fullerton, California
| | - Michael N Vakula
- Department of Kinesiology & Health Science, Utah State University, Logan, Utah
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts
| | - Eric J Shumski
- Department of Kinesiology, California State University, Fullerton, California
| | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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29
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Effects of age and speed on the ankle-foot system's power during walking. Sci Rep 2020; 10:14903. [PMID: 32913325 PMCID: PMC7484792 DOI: 10.1038/s41598-020-71763-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/31/2020] [Indexed: 11/08/2022] Open
Abstract
Structural and functional changes in the foot have been associated with age-related changes in gait mechanics, but walking speed may be a confounding factor in this relationship. The aim of this study was to investigate the effect of aging and speed on the ankle-foot power output during level walking. The effects of speed and aging on features of the mechanical power and work of the ankle and foot were quantified with a gait analysis of 24 young and 16 older individuals walking at different speeds. We observed gait speed having a significant effect on all the investigated features: peak power and positive and negative work of the ankle, foot, and sum of the ankle and foot (average effect size: 0.64 ± 0.22, from 0.26 to 0.87). We observed age having no effect on these same features (average effect size: 0.23 ± 0.12, from 0.03 to 0.39), with the exception of age's effect when combined with speed on the negative work of the foot. We performed additional analysis to illustrate how the speed can become a confounding factor to the understanding of the age effect on the gait biomechanics. Based on the influence of gait speed on the mechanical power of the ankle-foot system, it is essential that studies control for the effect of gait speed if there is interest in understanding age-related effects, particularly when studying frail older individuals.
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30
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Kinematic changes in patients with severe knee osteoarthritis are a result of reduced walking speed rather than disease severity. Gait Posture 2020; 79:256-261. [PMID: 32460135 DOI: 10.1016/j.gaitpost.2020.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic changes in patients with knee osteoarthritis (OA) have been extensively studied. Concerns have been raised whether the measured spatiotemporal and kinematic alterations are associated with disease progression or merely a result of reduced walking speed. RESEARCH QUESTION The purpose of this study was to investigate the effect of walking speed on kinematic parameters in patients with knee OA using statistical parametric mapping (SPM). METHODS Twenty-three patients with unilateral knee OA scheduled for a total knee replacement and 28 age matched control subjects were included in this study. Spatiotemporal parameters and sagittal plane kinematics were measured in the hip, knee, and ankle using the inertial sensors system RehaGait® while walking at a self-selected normal (patients and controls) and slow walking speed (controls) for a distance of 20 m. Gait parameters were compared between groups for self-selected walking speed and for matched walking speed using SPM with independent sample t tests. RESULTS At self-selected walking speed, patients had significantly lower knee flexion during stance (maximum difference, -6.8°) and during swing (-11.0°), as well as higher ankle dorsiflexion during stance phase (+12.5°) and lower peak hip extension at the end of stance compared to controls (+4.2°). At matched speed, there were no significant differences in joint kinematics between groups. SIGNIFICANCE Differences in sagittal plane gait kinematics between patients with knee OA and asymptomatic controls appear to be mainly a result of reduced walking speed. These results emphasize the importance of considering walking speed in research on gait kinematics in patients with knee OA and in clinical trials using gait parameters as outcome measures.
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Capin JJ, Williams JR, Neal K, Khandha A, Durkee L, Ito N, Stefanik JJ, Snyder-Mackler L, Buchanan TS. Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction. J Orthop Res 2020; 38:645-652. [PMID: 31710115 PMCID: PMC7028512 DOI: 10.1002/jor.24503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/14/2019] [Indexed: 02/04/2023]
Abstract
Post-traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T2 relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T2 relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T2 relaxation times 6 months after ACLR. Twenty-six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T2 relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T2 relaxation times in the involved limb (Pearson's r: -0.583, p = 0.002) and greater interlimb differences in trochlear T2 relaxation times (Pearson's r: -0.349, p = 0.080). Walking mechanics were weakly related to trochlear T2 relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645-652, 2020.
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Affiliation(s)
- Jacob J. Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO,Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO
| | - Jack R. Williams
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Kelsey Neal
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA
| | - Ashutosh Khandha
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA
| | - Laura Durkee
- Athletic Training Education Program, University of Delaware, Newark, DE, USA
| | - Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA
| | - Joshua J. Stefanik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Lynn Snyder-Mackler
- Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA,Physical Therapy Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
| | - Thomas S. Buchanan
- Mechanical Engineering Department, University of Delaware, Newark, DE, USA,Biomedical Engineering Department, University of Delaware, Newark, DE, USA,Delaware Rehabilitation Institute, University of Delaware, Newark, DE, USA
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Robert-Lachaine X, Parent G, Fuentes A, Hagemeister N, Aissaoui R. Inertial motion capture validation of 3D knee kinematics at various gait speed on the treadmill with a double-pose calibration. Gait Posture 2020; 77:132-137. [PMID: 32035296 DOI: 10.1016/j.gaitpost.2020.01.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/23/2019] [Accepted: 01/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inertial motion capture (IMC) is rapidly gaining in popularity to evaluate gait in clinical settings. Previous examinations of IMC knee kinematics were often limited to the sagittal plane and IMC calibration has not been thoroughly investigated. RESEARCH QUESTION The objective was to validate IMC 3D knee kinematics calibrated with a double-pose during gait with reference to optical motion capture (OMC). The hypotheses are that IMC can estimate adequately knee kinematics and that both systems will detect similarly the changes with gait speed. METHODS Twenty-four healthy participants walked on the treadmill at gait speed of 0.6, 0.8, 1.0 and 1.2 m/s. Knee kinematics were obtained simultaneously with two magnetic and inertial measurement units and passive markers fixed on the KneeKG system. OMC was calibrated with a functional anatomical approach and the IMC with a double-pose. RESULTS Root mean square differences of the two systems yielded 3-6° for knee flexion, adduction and external rotation. Knee kinematics were more similar during the stance phase than the swing phase. Gait speed showed a significant progressive effect on the three knee angles that was similarly detected by the two systems. SIGNIFICANCE IMC 3D knee kinematics can be obtained independently with a simple calibration and only two magnetic and inertial measurement units at an acceptable level of error especially during stance.
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Affiliation(s)
- Xavier Robert-Lachaine
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, QC, H2X 0A9, Canada; École de Technologie Supérieure, Département du génie de la Production Automatisée, 1100 rue Notre-Dame Ouest, Montréal, QC, H2L 2W5, Canada.
| | - Gerald Parent
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, QC, H2X 0A9, Canada; École de Technologie Supérieure, Département du génie de la Production Automatisée, 1100 rue Notre-Dame Ouest, Montréal, QC, H2L 2W5, Canada
| | - Alexandre Fuentes
- Centre du Genou EMOVI, 3095 Laval Autoroute West, Laval, QC, H7P 4W5, Canada
| | - Nicola Hagemeister
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, QC, H2X 0A9, Canada; École de Technologie Supérieure, Département du génie de la Production Automatisée, 1100 rue Notre-Dame Ouest, Montréal, QC, H2L 2W5, Canada
| | - Rachid Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 St-Denis, Montréal, QC, H2X 0A9, Canada; École de Technologie Supérieure, Département du génie de la Production Automatisée, 1100 rue Notre-Dame Ouest, Montréal, QC, H2L 2W5, Canada
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Hall M, Chabra S, Shakoor N, Leurgans SE, Demirtas H, Foucher KC. Hip joint moments in symptomatic vs. asymptomatic people with mild radiographic hip osteoarthritis. J Biomech 2019; 96:109347. [DOI: 10.1016/j.jbiomech.2019.109347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/13/2019] [Accepted: 09/14/2019] [Indexed: 01/18/2023]
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Wei RH, Zhao C, Rao JS, Zhao W, Wei YQ, Zhou X, Tian PY, Liu RX, Yang ZY, Li XG. Neuromuscular control pattern in rhesus monkeys during bipedal walking. Exp Anim 2019; 68:341-349. [PMID: 30930341 PMCID: PMC6699981 DOI: 10.1538/expanim.18-0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Walking is characterized by repetitive limb movements associated with highly structured patterns of muscle activity. The causal relationships between the muscle activities and hindlimb segments of walking are difficult to decipher. This study investigated these particular relationships and clarified whether they are correlated with speed to further understand the neuromuscular control pattern. Four adult female rhesus monkeys (Macaca mulatta) were selected to record gait parameters while walking on a bipedal treadmill at speeds of 0.2, 0.8, 1.4, and 2.0 km/h. We recorded 3 ipsilateral hindlimb muscles by surface recording. In this study, we calculated the correlations between electromyography (EMG) and kinematic parameters (24 EMG*17 kinematic parameters). Of the 408 calculated coefficients, 71.6% showed significant linear correlations. Significant linear correlations were found between muscle activity, such as burst amplitudes and the integral of muscle activity, and the corresponding kinematic parameters of each joint. Most of these relationships were speed independent (91.7% of all variables). Through correlation analysis, this study demonstrated a causal association between kinematic and EMG patterns of rhesus monkey locomotion. Individuals have particular musculoskeletal control patterns, and most of the relationships between hindlimb segments and muscles are speed independent. The current findings may enhance our understanding of neuromusculoskeletal control strategies.
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Affiliation(s)
- Rui-Han Wei
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Can Zhao
- Beijing International Cooperation Bases for Science and Technology on Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China.,School of Instrumentation and Optoelectronic Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Jia-Sheng Rao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China.,Beijing International Cooperation Bases for Science and Technology on Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Wen Zhao
- Department of Neurobiology, Capital Medical University, No. 10 Xitoutiao Road, Youanmenwai, Xicheng District, Beijing 100069, P.R. China
| | - Yan-Qin Wei
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Xia Zhou
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Peng-Yu Tian
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Ruo-Xi Liu
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China
| | - Zhao-Yang Yang
- Beijing International Cooperation Bases for Science and Technology on Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China.,Department of Neurobiology, Capital Medical University, No. 10 Xitoutiao Road, Youanmenwai, Xicheng District, Beijing 100069, P.R. China
| | - Xiao-Guang Li
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China.,Beijing International Cooperation Bases for Science and Technology on Biomaterials and Neural Regeneration, Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing 100083, P.R. China.,Department of Neurobiology, Capital Medical University, No. 10 Xitoutiao Road, Youanmenwai, Xicheng District, Beijing 100069, P.R. China
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Kobsar D, Charlton JM, Hunt MA. Individuals with knee osteoarthritis present increased gait pattern deviations as measured by a knee-specific gait deviation index. Gait Posture 2019; 72:82-88. [PMID: 31173950 DOI: 10.1016/j.gaitpost.2019.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/10/2019] [Accepted: 05/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A biomechanical analysis can provide valuable information on osteoarthritis (OA) gait, but important multidimensional interactions are often ignored. The Gait Deviation Index (GDI) was designed to address the issue of data complexity in gait analyses by providing a single, encompassing, value for one's deviation from a normative reference group. RESEARCH QUESTION The primary aim of this study was to examine differences in a knee-specific GDI among young adults, and older individuals with and without knee OA. Secondarily, we aimed to examine these differences while controlling for gait speed. METHOD Sagittal and frontal plane knee joint angles and moments were used in the computation of a GDI among young adults, and older individuals with and without knee OA. The GDI was calculated such that scores ≥100% were considered typical young-healthy gait and a 10% decrease below 100 equated to 1 standard deviation from typical gait. Scores were first examined using a one-way analysis of variance, and examined again after correcting for gait speed. RESULTS The GDI was calculated for three groups: young-healthy adults (n = 52), older individuals without knee OA (n = 56), and individuals with knee OA (n = 191). Those with knee osteoarthritis exhibited a mean GDI of 87.2 (11.1), which was significantly lower than young adults (99.6 (10.6); p < 0.001) and older individuals without knee OA (94.3 (11.0); p < 0.001). Differences in GDI remained consistent after controlling for gait speed. Knee OA gait waveforms displayed significant variability across similar GDIs, specifically in frontal plane patterns. CONCLUSION Those with knee osteoarthritis exhibited lower (worse) GDIs compared to those without knee osteoarthritis and young, healthy individuals. After correcting for gait speed, these findings did not change. The GDI highlighted the significant variability in gait waveforms within individuals with knee OA, but the clinical utility of the GDI score itself remains limited.
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Affiliation(s)
- Dylan Kobsar
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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Holsgaard-Larsen A, Thorlund JB, Blackmore T, Creaby MW. Changes in total lower limb support moment in middle-aged patients undergoing arthroscopic partial meniscectomy - A longitudinal observational cohort study. Knee 2019; 26:595-602. [PMID: 31031126 DOI: 10.1016/j.knee.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/27/2019] [Accepted: 04/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with a meniscal tear are frequently treated with arthroscopic partial meniscectomy (APM) which may alter the net extension moment across the entire lower limb - known as the total support moment (TSM). PURPOSE To investigate changes in TSM during walking in patients undergoing APM. METHODS Three-dimensional motion analysis of walking was performed in individuals with meniscal tear prior to APM and 12 months after. Peak TSM, positive ankle (ASM), knee (KSM), and hip (HSM) moments at the time of peak TSM were calculated together with corresponding angular impulses. RESULTS Patients (n = 20) were middle aged (45.9 ± 6.3 years) and the majority male (70%). At baseline a lower KSM (mean [95%CI]; 0.59 Nm/BM · HT% [-1.93; 3.11], P = 0.048) and a trend towards lower peak TSM (0.46 Nm/BM · HT% [-1.82; 2.78], P = 0.099) were observed for the APM leg compared with the contralateral. Pre- versus post-APM change scores indicated a relative decrease in loading of the contralateral leg for peak TSM (-0.49 Nm/BM · HT% [-0.96; -0.01], P = 0.047) and a trend towards a relative increase in loading of the APM leg for peak KSM (-0.41 Nm/BM · HT% [-0.92; 0.09], P = 0.105). No differences were observed in angular impulse variables. CONCLUSIONS Prior to APM a strategy to unload the injured knee was manifested by reduced KSM and a tendency to a reduced peak TSM. A more equal distribution of joint moments between injured and contralateral legs was observed 12 months following APM.
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Affiliation(s)
- Anders Holsgaard-Larsen
- Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Tim Blackmore
- Department of Sport and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom; School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
| | - Mark W Creaby
- School of Exercise Science, Australian Catholic University, Brisbane, Queensland, Australia
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Biggs PR, Whatling GM, Wilson C, Metcalfe AJ, Holt CA. Which osteoarthritic gait features recover following total knee replacement surgery? PLoS One 2019; 14:e0203417. [PMID: 30682010 PMCID: PMC6347391 DOI: 10.1371/journal.pone.0203417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Background Gait analysis can be used to measure variations in joint function in patients with knee osteoarthritis (OA), and is useful when observing longitudinal biomechanical changes following Total Knee Replacement (TKR) surgery. The Cardiff Classifier is an objective classification tool applied previously to examine the extent of biomechanical recovery following TKR. In this study, it is further developed to reveal the salient features that contribute to recovery towards healthy function. Methods Gait analysis was performed on 30 patients before and after TKR surgery, and 30 healthy controls. Median TKR follow-up time was 13 months. The combined application of principal component analysis (PCA) and the Cardiff Classifier defined 18 biomechanical features that discriminated OA from healthy gait. Statistical analysis tested whether these features were affected by TKR surgery and, if so, whether they recovered to values found for the controls. Results The Cardiff Classifier successfully discriminated between OA and healthy gait in all 60 cases. Of the 18 discriminatory features, only six (33%) were significantly affected by surgery, including features in all three planes of the ground reaction force (p<0.001), ankle dorsiflexion moment (p<0.001), hip adduction moment (p = 0.003), and transverse hip angle (p = 0.007). All but two (89%) of these features remained significantly different to those of the control group after surgery. Conclusions This approach was able to discriminate gait biomechanics associated with knee OA. The ground reaction force provided the strongest discriminatory features. Despite increased gait velocity and improvements in self-reported pain and function, which would normally be clinical indicators of recovery, the majority of features were not affected by TKR surgery. This TKR cohort retained pre-operative gait patterns; reduced sagittal hip and knee moments, decreased knee flexion, increased hip flexion, and reduced hip adduction. The changes that were associated with surgery were predominantly found at the ankle and hip, rather than at the knee.
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Affiliation(s)
- Paul Robert Biggs
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- * E-mail:
| | - Gemma Marie Whatling
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
| | - Chris Wilson
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- University Hospital of Wales, Cardiff, United Kingdom
| | - Andrew John Metcalfe
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Cathy Avril Holt
- Cardiff School of Engineering, College of Physical Sciences, Cardiff University, Cardiff, United Kingdom
- Arthritis Research UK Biomechanics and Bioengineering Centre, Cardiff University, Cardiff, United Kingdom
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Smith AJJ, Lemaire ED, Nantel J. Lower limb sagittal kinematic and kinetic modeling of very slow walking for gait trajectory scaling. PLoS One 2018; 13:e0203934. [PMID: 30222772 PMCID: PMC6141077 DOI: 10.1371/journal.pone.0203934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 08/30/2018] [Indexed: 11/19/2022] Open
Abstract
Lower extremity powered exoskeletons (LEPE) are an emerging technology that assists people with lower-limb paralysis. LEPE for people with complete spinal cord injury walk at very slow speeds, below 0.5m/s. For the able-bodied population, very slow walking uses different neuromuscular, locomotor, postural, and dynamic balance control. Speed dependent kinetic and kinematic regression equations in the literature could be used for very slow walking LEPE trajectory scaling; however, kinematic and kinetic information at walking speeds below 0.5 m/s is lacking. Scaling LEPE trajectories using current reference equations may be inaccurate because these equations were produced from faster than real-world LEPE walking speeds. An improved understanding of how able-bodied people biomechanically adapt to very slow walking will provide LEPE developers with more accurate models to predict and scale LEPE gait trajectories. Full body motion capture data were collected from 30 healthy adults while walking on an instrumented self-paced treadmill, within a CAREN-Extended virtual reality environment. Kinematic and kinetic data were collected for 0.2 m/s-0.8 m/s, and self-selected walking speed. Thirty-three common sagittal kinematic and kinetic gait parameters were identified from motion capture data and inverse dynamics. Gait parameter relationships to walking speed, cadence, and stride length were determined with linear and quadratic (second and third order) regression. For parameters with a non-linear relationship with speed, cadence, or stride-length, linear regressions were used to determine if a consistent inflection occurred for faster and slower walking speeds. Group mean equations were applied to each participant's data to determine the best performing equations for calculating important peak sagittal kinematic and kinetic gait parameters. Quadratic models based on walking speed had the strongest correlations with sagittal kinematic and kinetic gait parameters, with kinetic parameters having the better results. The lack of a consistent inflection point indicated that the kinematic and kinetic gait strategies did not change at very slow gait speeds. This research showed stronger associations with speed and gait parameters then previous studies, and provided more accurate regression equations for gait parameters at very slow walking speeds that can be used for LEPE joint trajectory development.
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Affiliation(s)
- Andrew J. J. Smith
- Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa, Department of Human Kinetics, University of Ottawa, Ottawa, Canada
- * E-mail:
| | - Edward D. Lemaire
- Ottawa Hospital Research Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Julie Nantel
- University of Ottawa, Department of Human Kinetics, University of Ottawa, Ottawa, Canada
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Gait Mechanics Differences Between Healthy Controls and Patients With Peripheral Artery Disease After Adjusting for Gait Velocity Stride Length and Step Width. J Appl Biomech 2018; 35:19–24. [PMID: 29989479 PMCID: PMC6328338 DOI: 10.1123/jab.2017-0257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Patients with peripheral artery disease (PAD) experience significant leg dysfunction. The effects of PAD on gait include shortened steps, slower walking velocity, and altered gait kinematics and kinetics, which may confound joint torques and power measurements. Spatiotemporal parameters, joint torques and powers were calculated and compared between 20 patients with PAD and 20 healthy controls using independent t-tests. Separate ANCOVA models were used to evaluate group differences after independently adjusting for gait velocity, stride length and step width. Compared to healthy controls, patients with PAD exhibited reduced peak extensor and flexor torques at the knee, and hip. After adjusting for all covariates combined, differences between groups remained for ankle power generation in late stance, and knee flexor torque. Reduced walking velocity observed in subjects affected by PAD was closely connected with reductions in joint torques and powers during gait. Gait differences remained, at the knee and ankle, after adjusting for the combined effect of spatiotemporal parameters. Improving muscle function through exercise or with the use of assistive devices needs to be a key tool in the development of interventions that aim to enhance the ability of PAD patients to restore spatiotemporal gait parameters.
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Roscoe D, Roberts AJ, Hulse D, Shaheen A, Hughes MP, Bennett A. Barefoot plantar pressure measurement in Chronic Exertional Compartment Syndrome. Gait Posture 2018; 63:10-16. [PMID: 29702369 DOI: 10.1016/j.gaitpost.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/18/2017] [Accepted: 04/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with Chronic Exertional Compartment Syndrome (CECS) have exercise-limiting pain that subsides at rest. Diagnosis is confirmed by intramuscular compartment pressure (IMCP) measurement. Accompanying CECS, subjective changes to gait (foot slap) are frequently reported by patients. This has not previously been investigated. The aim of this study was to investigate differences in barefoot plantar pressure (BFPP) between CECS cases and asymptomatic controls prior to the onset of painful symptoms. METHODS 40 male military volunteers, 20 with symptoms of CECS and 20 asymptomatic controls were studied. Alternative diagnoses were excluded with rigorous inclusion criteria, magnetic resonance imaging and dynamic IMCP measurement. BFPP was measured during walking and marching. Data were analysed for: Stance Time (ST); foot progression angle (FPA); centre of force; plantarflexion rate after heel strike (IFFC-time); the distribution of pressure under the heel; and, the ratio between inner and outer metatarsal loading. Correlation coefficients of each variable with speed and leg length were calculated followed by ANCOVA or t-test. Receiver operating characteristic (ROC) curves were constructed for IFFC-time. RESULTS Caseshad shorter ST and IFFC-times than controls. FPA was inversely related to walking speed (WS) in controls only. The area under the ROC curve for IFFC-time ranged from 0.746 (95%CI: 0.636-0.87) to 0.773 (95%CI: 0.671-0.875) representing 'fair predictive validity'. CONCLUSION Patients with CECS have an increased speed of ankle plantarflexion after heel strike that precedes the onset of painful symptoms likely resulting from a mechanical disadvantage of Tibialis Anterior. These findings provide further insight into the pathophysiology of CECS and support further investigation of this non-invasive diagnostic. The predictive value of IFFC-time in the diagnosis of CECS is comparable to post-exercise IMCP but falls short of dynamic IMCP measured during painful symptoms.
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Affiliation(s)
- D Roscoe
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom; Department of Biomedical Engineering, University of Surrey Postgraduate Medical School, Duke of Kent Building, University of Surrey, Guildford, Surrey, GU2 7TE, United Kingdom.
| | - A J Roberts
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom; Department of Sport and Health Sciences, University of Exeter, College of Life and Environmental Sciences, St. Luke's Campus, Exeter, EX1 2LU, United Kingdom
| | - D Hulse
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom
| | - A Shaheen
- Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, United Kingdom
| | - M P Hughes
- Department of Biomedical Engineering, University of Surrey Postgraduate Medical School, Duke of Kent Building, University of Surrey, Guildford, Surrey, GU2 7TE, United Kingdom
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom; Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
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Hendershot BD, Shojaei I, Acasio JC, Dearth CL, Bazrgari B. Walking speed differentially alters spinal loads in persons with traumatic lower limb amputation. J Biomech 2018; 70:249-254. [PMID: 29217090 DOI: 10.1016/j.jbiomech.2017.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
Persons with lower limb amputation (LLA) perceive altered motions of the trunk/pelvis during activities of daily living as contributing factors for low back pain. When walking (at a singular speed), larger trunk motions among persons with vs. without LLA are associated with larger spinal loads; however, modulating walking speed is necessary in daily life and thus understanding the influences of walking speed on spinal loads in persons with LLA is of particular interest here. Three-dimensional trunk-pelvic kinematics, collected during level-ground walking at self-selected (SSW) and two controlled speeds (∼1.0 and ∼1.4 m/s), were obtained for seventy-eight participants: 26 with transfemoral and 26 with transtibial amputation, and 26 uninjured controls (CTR). Using a kinematics-driven, non-linear finite element model of the lower back, the resultant compressive and mediolateral/anteroposterior shear loads at the L5/S1 spinal level were estimated. Peak values were extracted and compiled. Despite walking slower at SSW speeds (∼0.21 m/s), spinal loads were 8-14% larger among persons with transfemoral amputation vs. CTR. Across all participants, peak compressive, mediolateral, and anteroposterior shear loads increased with increasing walking speed. At the fastest (vs. slowest) controlled speed, these increases were respectively 24-84% and 29-77% larger among persons with LLA relative to CTR. Over time, repeated exposures to these increased spinal loads, particularly at faster walking speeds, may contribute to the elevated risk for low back pain among persons with LLA. Future work should more completely characterize relative risk in daily life between persons with vs. without LLA by analyzing additional activities and tissue-level responses.
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Affiliation(s)
- Brad D Hendershot
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Iman Shojaei
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
| | - Julian C Acasio
- Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Christopher L Dearth
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD, USA; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Babak Bazrgari
- F. Joseph Halcomb III, M.D. Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Influences of knee osteoarthritis and walking difficulty on knee kinematics and kinetics. Gait Posture 2018; 61:439-444. [PMID: 29477961 PMCID: PMC6311109 DOI: 10.1016/j.gaitpost.2018.01.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 12/15/2017] [Accepted: 01/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Self-reported walking difficulty is a problem among patients with knee osteoarthritis (OA), however, these patients have never been studied as a subgroup population. OBJECTIVE The purpose of this study is to examine known knee OA gait mechanics among those with knee OA, with (Diff) and without (NoDiff) self-reported walking difficulty, as compared to age- and sex-matched controls without knee OA. METHODS A total of 39 subjects in three groups of 13 individuals walked at a controlled gait speed during instrumented gait analysis. Gait mechanics were compared between a priori determined groups using the independent t-test. RESULTS The results of the study found that among those with knee OA, knee excursion angles were not significantly different between the Diff and NoDiff groups. Whereas, external knee moments were significantly different between the Diff and NoDiff groups but not between the NoDiff and the control groups. The lack of difference between the NoDiff and control groups were especially interesting because of the moderate to severe OA in the NoDiff group. Therefore, the findings of this study suggest the importance of considering self-reported walking difficulty among those with knee OA. Perhaps patients with knee OA-related walking difficulties use alternative gait parameters that may need to be clinically addressed. Strengths of the study included a matched design and controlled walking speed, whereas limitations were the small sample size and cross-sectional design. CONCLUSIONS Given the relationships found among self-reported walking difficulty, OA presence, and gait parameters, addressing gait parameters specifically related to walking difficulty may be indicated in this sub-group knee OA population.
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Brisson NM, Stratford PW, Maly MR. Relative and absolute test-retest reliabilities of biomechanical risk factors for knee osteoarthritis progression: benchmarks for meaningful change. Osteoarthritis Cartilage 2018; 26:220-226. [PMID: 29128508 DOI: 10.1016/j.joca.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/24/2017] [Accepted: 11/03/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Biomechanical factors are important treatment targets in knee osteoarthritis. The knee adduction (KAM) and flexion (KFM) moments, quadriceps strength and power, load frequency, and body mass index (BMI) all have the potential to affect knee articular cartilage integrity by modulating forces across the joint. To identify clinically meaningful change, however, these measurements must be reliable and sensitive to change. This study estimated relative and absolute test-retest reliabilities over long periods of biomechanical risk factors for knee osteoarthritis progression. METHOD Data from a longitudinal, observational study were analyzed for knee osteoarthritis patients with data at baseline, 6-month and 24-month follow-ups. Gait kinematics and kinetics, quadriceps strength and power, daily load frequency and BMI were collected. Relative and absolute test-retest reliabilities of these measures were estimated using intraclass correlation coefficients (ICCs) and standard errors of measurement (SEMs), respectively. Minimal detectable change at the 95% confidence level (MDC95) was also calculated. RESULTS Data from 46 participants [36 women; age 61.0 (6.6) years] were included. Good-to-excellent relative reliabilities (ICC ≥ 0.80) indicated that KAM peak and impulse, quadriceps strength and power, and BMI had a strong ability to discriminate amongst participants. Absolute reliabilities were high for quadriceps strength and BMI, which demonstrated reasonable within-participant variability (SEMs ≤ 11% of the mean). The MDC95 values supported use of clinical interventions effective in reducing BMI and KAM, and increasing quadriceps strength. CONCLUSION These data are useful in interpreting findings from interventional or longitudinal investigations by determining whether observed changes are beyond measurement error and interpretable as true change.
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Affiliation(s)
- N M Brisson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - P W Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - M R Maly
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
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Hip movement pathomechanics of patients with hip osteoarthritis aim at reducing hip joint loading on the osteoarthritic side. Gait Posture 2018; 59:11-17. [PMID: 28968547 DOI: 10.1016/j.gaitpost.2017.09.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/11/2017] [Accepted: 09/19/2017] [Indexed: 02/02/2023]
Abstract
This study aims at defining gait pathomechanics in patients with hip osteoarthritis (OA) and their effect on hip joint loading by combining analyses of hip kinematics, kinetics and contact forces during gait. Twenty patients with hip OA and 17 healthy volunteers matched for age and BMI performed three-dimensional gait analysis. Hip OA level was evaluated based on plane radiographs using the Tönnis classification. Hip joint kinematics, kinetics as well as hip contact forces were calculated. Waveforms were time normalized and compared between groups using statistical parametric mapping analysis. Patients walked with reduced hip adduction angle and reduced hip abduction and external rotation moments. The work generated by the hip abductors during the stance phase of gait was largely decreased. These changes resulted in a decrease and a more vertical and anterior orientation of the hip contact forces compared to healthy controls. This study documents alterations in hip kinematics and kinetics resulting in decreased hip loading in patients with hip OA. The results suggested that patients altered their gait to increase medio-lateral stability, thereby decreasing demand on the hip abductors. These findings support discharge of abductor muscles that may bear clinical relevance of tailored rehabilitation targeting hip abductor muscles strengthening and gait retraining.
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Solomonow-Avnon D, Herman A, Levin D, Rozen N, Peled E, Wolf A. Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study. J Orthop Res 2017; 35:2222-2232. [PMID: 28052440 DOI: 10.1002/jor.23511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/20/2016] [Indexed: 02/04/2023]
Abstract
UNLABELLED Footwear-generated biomechanical manipulation of lower-limb joints was shown to beneficially impact gait and quality of life in knee osteoarthritis patients, but has not been tested in hip osteoarthritis patients. We examined a customized gait treatment program using a biomechanical device shown in previous investigations to be capable of manipulating hip biomechanics via foot center of pressure (COP) modulation. The objective of this study was to assess the treatment program for hip osteoarthritis patients, enrolled in a 1-year prospective investigation, by means of objective gait and spatiotemporal parameters, and subjective quality of life measures. Gait analysis and completion of questionnaires were performed at the start of the treatment (baseline), and after 3, 6, and 12 months. Outcome parameters were evaluated over time using linear mixed effects models, and association between improvement in quality of life measures and change in objective outcomes was tested using mixed effect linear regression models. Quality of life measures improved compared to baseline, accompanied by increased gait speed and cadence. Sagittal-plane hip joint kinetics, kinematics, and spatiotemporal parameters changed throughout the study compared to baseline, in a manner suggesting improvement of gait. The most substantial improvement occurred within 3 months after treatment initiation, after which improvement approximately plateaued, but was sustained at 12 months. Speed and cadence, as well as several sagittal-plane gait parameters, were significant predictors of improvement in quality of life. CLINICAL SIGNIFICANCE Evidence suggests that a biomechanical gait therapy program improves subjective and objective outcomes measures and is a valid treatment option for hip osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2222-2232, 2017.
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Affiliation(s)
- Deborah Solomonow-Avnon
- Faculty of Mechanical Engineering, Biorobotics and Biomechanics Lab (BRML), Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Amir Herman
- Department of Orthopedic Surgery A, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Daniel Levin
- Department of Orthopedics B, Rambam Medical Center, Haifa, Israel
| | - Nimrod Rozen
- Department of Orthopedic Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Eli Peled
- Department of Orthopedics B, Rambam Medical Center, Haifa, Israel
| | - Alon Wolf
- Faculty of Mechanical Engineering, Biorobotics and Biomechanics Lab (BRML), Technion-Israel Institute of Technology, Haifa 32000, Israel
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46
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Astephen Wilson JL, Stanish WD, Hubley-Kozey CL. Asymptomatic and symptomatic individuals with the same radiographic evidence of knee osteoarthritis walk with different knee moments and muscle activity. J Orthop Res 2017; 35:1661-1670. [PMID: 27775183 DOI: 10.1002/jor.23465] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 10/14/2016] [Indexed: 02/04/2023]
Abstract
There is an established discordance between the structural joint damage and clinical symptoms of knee osteoarthritis; however, there has been little investigation into the differences in joint level biomechanics and muscle activation patterns during gait between symptomatic and asymptomatic individuals with the same radiographic evidence of osteoarthritis. The objective of this study was to examine three-dimensional knee joint biomechanics and muscle activation differences during gait between asymptomatic and symptomatic individuals with radiographic knee osteoarthritis. A total of 54 asymptomatic and 59 symptomatic individuals with a Kellgren-Lawrence osteoarthritis radiographic grade of 2 underwent a comprehensive gait analysis to examine differences in the magnitude and patterns of the knee flexion angle, three-dimensional net resultant moments, and electromyography of the quadriceps, hamstrings, and gastrocnemii during over ground walking between the two groups. The symptomatic group walked with significantly higher overall magnitudes and less mid-stance unloading of the net resultant knee adduction moment, lower peak flexion moments, and higher lateral hamstrings and quadriceps activity during stance than the Asymptomatic group (p < 0.05, sex-adjusted analysis), with a trend (p = 0.07) toward greater transverse plane range of moment over stance. The differences found suggest a "stiffer" frontal and sagittal plane pattern with symptomatic individuals, but with more muscle activity and a trend toward more torsional loading in the transverse plane, which may have implications for shear loading of the joint. This is the first evidence of differences in three-dimensional knee joint biomechanics and muscle activation between asymptomatic and symptomatic individuals with the same radiographic grade. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1661-1670, 2017.
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Affiliation(s)
- Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue 15000, Halifax B3H 4R2, Nova Scotia, Canada
| | - William D Stanish
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue 15000, Halifax B3H 4R2, Nova Scotia, Canada.,Division of Orthopaedics, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, 5981 University Avenue 15000, Halifax B3H 4R2, Nova Scotia, Canada.,School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
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47
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Thoma LM, McNally MP, Chaudhari AM, Best TM, Flanigan DC, Siston RA, Schmitt LC. Differential knee joint loading patterns during gait for individuals with tibiofemoral and patellofemoral articular cartilage defects in the knee. Osteoarthritis Cartilage 2017; 25:1046-1054. [PMID: 28232097 DOI: 10.1016/j.joca.2017.02.794] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/31/2017] [Accepted: 02/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine compartment-specific loading patterns during gait, quantified as joint reaction forces (JRF), of individuals with knee articular cartilage defects (ACD) compared to healthy controls (HC). METHODS Individuals with ACDs and HC participated. Individuals with ACDs were divided into groups according to ACD location: PF (only a patellofemoral ACD), TF (only a tibiofemoral ACD), and MIX (both PF and TF ACDs). Participants underwent three-dimensional gait analysis at self-selected speed. TF joint reaction force (TF-JRF) was calculated using inverse dynamics. PF joint reaction force (PF-JRF) was derived from estimated quadriceps force (FQUAD) and knee flexion angle. Primary variables of interest were the PF- and TF-JRF peaks (body weight [×BW]). Related secondary variables (gait speed, quadriceps strength, knee function, activity level) were evaluated as covariates. RESULTS First peak PF-JRF and TF-JRF were similar in the TF and MIX groups (0.75-1.0 ×BW, P = 0.6-0.9). Both peaks were also similar in the PF and HC groups (1.1-1.3 ×BW, P = 0.7-0.8), and higher than the TF and MIX groups (P = 0.004-0.02). For the second peak PF-JRF, only the HC group was higher than the TF group (P = 0.02). The PF group walked at a similar speed as the HC group; both groups walked faster than the TF and MIX groups (P < 0.001). With gait speed and quadriceps strength as covariates, no differences were observed in JRF peaks. CONCLUSIONS The results suggest the presence of a TF ACD (TF and MIX groups), but not a PF ACD (PF group), may affect joint loading patterns during walking. Walking slower may be a protective gait modification to reduce load.
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Affiliation(s)
- L M Thoma
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - M P McNally
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - A M Chaudhari
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Orthopedics, The Ohio State University, Columbus, OH, USA; Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
| | - T M Best
- Departments of Orthopedics, Family Medicine, Biomedical Engineering, University of Miami, Miami, FL, USA; UHealth Sports Medicine Institute, Miami, FL, USA
| | - D C Flanigan
- OSU Sports Medicine, Columbus, OH, USA; Department of Orthopedics, The Ohio State University, Columbus, OH, USA
| | - R A Siston
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Department of Orthopedics, The Ohio State University, Columbus, OH, USA; Department of Mechanical and Aerospace Engineering, College of Engineering, The Ohio State University, Columbus, OH, USA
| | - L C Schmitt
- School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA; Division of Physical Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Broom L, Ellison BA, Worley A, Wagenaar L, Sörberg E, Ashton C, Bennett DA, Buchman AS, Saper CB, Shih LC, Hausdorff JM, VanderHorst VG. A translational approach to capture gait signatures of neurological disorders in mice and humans. Sci Rep 2017; 7:3225. [PMID: 28607434 PMCID: PMC5468293 DOI: 10.1038/s41598-017-03336-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/26/2017] [Indexed: 01/08/2023] Open
Abstract
A method for capturing gait signatures in neurological conditions that allows comparison of human gait with animal models would be of great value in translational research. However, the velocity dependence of gait parameters and differences between quadruped and biped gait have made this comparison challenging. Here we present an approach that accounts for changes in velocity during walking and allows for translation across species. In mice, we represented spatial and temporal gait parameters as a function of velocity and established regression models that reproducibly capture the signatures of these relationships during walking. In experimental parkinsonism models, regression curves representing these relationships shifted from baseline, implicating changes in gait signatures, but with marked differences between models. Gait parameters in healthy human subjects followed similar strict velocity dependent relationships which were altered in Parkinson’s patients in ways that resemble some but not all mouse models. This novel approach is suitable to quantify qualitative walking abnormalities related to CNS circuit dysfunction across species, identify appropriate animal models, and it provides important translational opportunities.
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Affiliation(s)
- Lauren Broom
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Brian A Ellison
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Audrey Worley
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Lara Wagenaar
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Elina Sörberg
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Christine Ashton
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Il 60612, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Il 60612, USA
| | - Clifford B Saper
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Ludy C Shih
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Tel-Aviv Sourasky Medical Center, Tel Aviv, 64239, Israel.,Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Veronique G VanderHorst
- Department of Neurology, Division of Movement Disorders, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
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49
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Chehab E, Andriacchi T, Favre J. Speed, age, sex, and body mass index provide a rigorous basis for comparing the kinematic and kinetic profiles of the lower extremity during walking. J Biomech 2017; 58:11-20. [DOI: 10.1016/j.jbiomech.2017.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/31/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
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50
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Wiik AV, Aqil A, Brevadt M, Jones G, Cobb J. Abnormal ground reaction forces lead to a general decline in gait speed in knee osteoarthritis patients. World J Orthop 2017; 8:322-328. [PMID: 28473960 PMCID: PMC5396017 DOI: 10.5312/wjo.v8.i4.322] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/01/2017] [Accepted: 01/16/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To analyse ground reaction forces at higher speeds using another method to be more sensitive in assessing significant gait abnormalities. METHODS A total of 44 subjects, consisting of 24 knee osteoarthritis (OA) patients and 20 healthy controls were analysed. The knee OA patients were recruited from an orthopaedic clinic that were awaiting knee replacement. All subjects had their gait patterns during stance phase at top walking speed assessed on a validated treadmill instrumented with tandem force plates. Temporal measurements and ground reaction forces (GRFs) along with a novel impulse technique were collected for both limbs and a symmetry ratio was applied to all variables to assess inter-limb asymmetry. All continuous variables for each group were compared using a student t-test and χ2 analysis for categorical variables with significance set at α = 0.05. Receiver operator characteristics curves were utilised to determine best discriminating ability. RESULTS The knee OA patients were older (66 ± 7 years vs 53 ± 9 years, P = 0.01) and heavier (body mass index: 31 ± 6 vs 23 ± 7, P < 0.001) but had a similar gender ratio when compared to the control group. Knee OA patients were predictably slower at top walking speed (1.37 ± 0.23 m/s vs 2.00 ± 0.20 m/s, P < 0.0001) with shorter mean step length (79 ± 12 cm vs 99 ± 8 cm, P < 0.0001) and broader gait width (14 ± 5 cm vs 11 ± 3 cm, P = 0.015) than controls without any known lower-limb joint disease. At a matched mean speed (1.37 ± 0.23 vs 1.34 ± 0.07), ground reaction results revealed that push-off forces and impulse were significantly (P < 0.0001) worse (18% and 12% respectively) for the knee OA patients when compared to the controls. Receiver operating characteristic curves analysis demonstrated total impulse to be the best discriminator of asymmetry, with an area under the curve of 0.902, with a cut-off of -3% and a specificity of 95% and sensitivity of 88%. CONCLUSION Abnormal GRFs in knee osteoarthritis are clearly evident at higher speeds. Analysing GRFs with another method may explain the general decline in knee OA patient's gait.
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