Challenges in dealing with walking speed in knee osteoarthritis gait analyses

Wilson, Janie L. Astephen

doi:10.1016/j.clinbiomech.2011.09.009

Cited by 85 publications

(44 citation statements)

References 16 publications

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“…However, reduced velocity appears inherently linked to disease progression, and can as such be regarded to be an intrinsic key feature of hip OA gait. Thus, it is not straightforward to consider velocity solely as a “disturbing” variable, that should be controlled for in a regular analysis of variance, leaving the unadjusted analyses out [26]. From a clinical perspective, controlling for velocity can give diminutive meaning; as it is inapplicable to just tell the patients to walk faster in order to reduce their joint moments.…”

Section: Discussionmentioning

confidence: 99%

“…Including seven articles; a total of 46 different biomechanical variables were reported. This illustrates the lack of a clear consensus on which specific gait parameters should be regarded as being of most relevance for patients with hip OA [19,25,26]. Consequently, the role of gait biomechanics in hip OA initiation and progression is not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study

Eitzen

Fernandes

Nordsletten

et al. 2012

BMC Musculoskelet Disord

102

123

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BackgroundExistent biomechanical studies on hip osteoarthritic gait have primarily focused on the end stage of disease. Consequently, there is no clear consensus on which specific gait parameters are of most relevance for hip osteoarthritis patients with mild to moderate symptoms. The purpose of this study was to explore sagittal plane gait characteristics during the stance phase of gait in hip osteoarthritis patients not eligible for hip replacement surgery. First, compared to healthy controls, and second, when categorized into two subgroups of radiographic severity defined from a minimal joint space of ≤/>2 mm.MethodsSagittal plane kinematics and kinetics of the hip, knee and ankle joint were calculated for total joint excursion throughout the stance phase, as well as from the specific events initial contact, midstance, peak hip extension and toe-off following 3D gait analysis. In addition, the Western Ontario and McMaster Universities Osteoarthritis Index, passive hip range of motion, and isokinetic muscle strength of hip and knee flexion and extension were included as secondary outcomes. Data were checked for normality and differences evaluated with the independent Student’s t-test, Welch’s t-test and the independent Mann–Whitney U-test. A binary logistic regression model was used in order to control for velocity in key variables.ResultsFourty-eight hip osteoarthritis patients and 22 controls were included in the final material. The patients walked significantly slower than the controls (p=0.002), revealed significantly reduced joint excursions of the hip (p<0.001) and knee (p=0.011), and a reduced hip flexion moment at midstance and peak hip extension (p<0.001). Differences were primarily manifested during the latter 50% of stance, and were persistent when controlling for velocity. Subgroup analyses of patients with minimal joint space ≤/>2 mm suggested that the observed deviations were more pronounced in patients with greater radiographic severity. The biomechanical differences were, however, not reflected in self-reported symptoms or function.ConclusionsReduced gait velocity, reduced sagittal plane joint excursion, and a reduced hip flexion moment in the late stance phase of gait were found to be evident already in hip osteoarthritis patients with mild to moderate symptoms, not eligible for total hip replacement. Consequently, these variables should be considered as key features in studies regarding hip osteoarthritic gait at all stages of disease. Subgroup analyses of patients with different levels of radiographic OA further generated the hypothesis that the observed characteristics were more pronounced in patients with a minimal joint space ≤2 mm.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study

Eitzen

Fernandes

Nordsletten

et al. 2012

BMC Musculoskelet Disord

102

123

View full text Add to dashboard Cite

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“…We discovered a significantly greater ratio of men to women in our symptomatic group compared to asymptomatic, and proceeded to use sex‐adjusted analysis of variance to compare biomechanical and muscle activation variables between groups differences because we have previously reported biomechanical differences during gait between men and women . The walking velocity difference between groups was approximately 5%, and although we are aware that walking velocity and joint level mechanics can be related (e.g., Landry et al [2007]), reduced walking speed is an integrated effect of OA symptoms and controlling walking speed using an ANCOVA model would not be appropriate as this effect is not simply an erroneous sampling issue such as the difference in sex distribution between the groups …”

Section: Discussionmentioning

confidence: 93%

Asymptomatic and symptomatic individuals with the same radiographic evidence of knee osteoarthritis walk with different knee moments and muscle activity

2016

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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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“…Thus we used speed as a covariate to ensure that differences we observed in the walking variables were due to differences in the subjects rather than differences in walking speed. None-the-less, using speed as a covariate may have removed portions of the main effect or group from the analysis (Wilson, 2012). Finally, when examining movement compensation strategies it is important to examine all the joints involved, such as the ankle, knee and hip during walking.…”

Section: Discussionmentioning

confidence: 99%

Quadriceps rate of force development affects gait and function in people with knee osteoarthritis

Winters

Rudolph

2013

Eur J Appl Physiol

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Objective Quadriceps weakness exists in people with knee osteoarthritis (OA) but other muscle factors like rate of force development (RFD) may also be affected by knee OA. The purpose of this study was to determine if people with knee OA have deficits in quadriceps RFD, determine if quadriceps RFD would improve predicting knee joint power absorption and generation during free and fast walking, and determine if RFD would improve predicting functional outcomes. Methods 26 subjects with knee OA and 23 healthy control subjects performed maximal voluntary isometric strength (MVIC) and RFD measures of the quadriceps. Subjects also underwent a 3-D motion analysis of both self-selected free and self-selected fast walking speeds. Joint kinetics were calculated from inverse dynamics. Results RFD was not different by group (p=0.763), however the OA subjects generated the highest peak RFD at a lower %MVIC (p=0.008). Controls walked significantly faster at both free and fast walking speeds (p=0.001, p=0.029). Knee angles at heel strike and peak knee extension were lower (p=0.004, p=0.027) in the OA group. During fast walking knee power generation was higher in Controls (p=0.028). MVIC and force of highest peak RFD predicted KOOS ADL score in the OA subjects, but only MVIC predicted stair climbing time. Conclusions The submaximal force at which peak RFD occurs plays a significant role in knee joint power as well as functional measures in the OA subjects, providing further evidence that factors other than maximal strength are also important in people with knee OA.

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Challenges in dealing with walking speed in knee osteoarthritis gait analyses

Cited by 85 publications

References 16 publications

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study

Sagittal plane gait characteristics in hip osteoarthritis patients with mild to moderate symptoms compared to healthy controls: a cross-sectional study

Asymptomatic and symptomatic individuals with the same radiographic evidence of knee osteoarthritis walk with different knee moments and muscle activity

Quadriceps rate of force development affects gait and function in people with knee osteoarthritis

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