Energy Expenditure During Cane-Assisted Gait in Patients with Knee Osteoarthritis

Abstract

Jones A, Alves ACM, de Oliveira LM, Saad M, Natour J. Energy expenditure during cane-assisted gait in patients with knee osteoarthritis. Clinics. 2008;63:197-200. OBJECTIVE:To compare the energy expenditure in patients with unilateral knee osteoarthritis while walking with canes of different lengths. METHODS: A quasi-experimental study (single-group) was carried out on thirty patients with unilateral knee osteoarthritis. An adjustable aluminum cane was used, and three different cane lengths were determined for each subject: C1 -length from the floor to the greater trochanter; C2 -length from the floor to the distal wrist crease; and C3 -length obtained by the formula: height x 0.45 + 0.87 m. Resting and walking heart rates were measured with a Polar hear rate meter. Walking speed was calculated by the time required for the patient to walk 10 m. Gait energy cost was estimated using the physiological cost index, and results were compared. RESULTS: The sample consisted of 25 women and five men (average age of 68 years). Statistically significant differences in physiological cost index measurements were observed between unassisted walking and assisted walking with a cane of any length (p<0.001), as well as between walking with a C2-length cane and unassisted walking, and walking with a C1-length cane and walking with a C3-length cane (p=0.001; p = 0.037; p=0.001; respectively). CONCLUSION: These data demonstrate that small alterations in the length of canes used for weight-bearing ambulation in patients with unilateral knee osteoarthritis increase the energy expenditure measured by the physiological cost index during walking. Further studies are needed for a more precise quantification of the increase in energy expenditure during cane-assisted gait and an assessment of the effectiveness of cane use in relieving pain and improving function in patients with knee osteoarthritis.

Evaluation of immediate impact of cane use on energy expenditure during gait in patients with knee osteoarthritis

“…Cane length may affect energy expenditure. A previous study involving patients with knee OA demonstrated that small changes in cane length led to greater or lesser energy expenditure, as assessed by heart rate [14]. The findings of this study contrast those from a study carried out to assess energy expenditure during gait with crutches in healthy young individuals, which found that, within certain limits, the length of the crutches exerted no influence over energy expenditure or gait speed [32].…”

“…This find is very similar to the findings of a previous study by the same group, in which energy expenditure was estimated by monitoring heart rate [14]. Another important parameter is the O 2 cost of walking that was approximately 80% increased in the cane-assisted gait, it is a considerable increase taking into account that our sample is made of aged people.…”

“…Cane-assisted gait was shown to require greater energy expenditure than normal gait and a cane reaching the distal fold of the wrist was the length that caused the least impact on energy expenditure. However, the study used heart rate to estimate energy expenditure [14]. No studies were found assessing energy expenditure during cane-assisted gait in individuals with knee OA through an analysis of oxygen expenditure (VO 2 ).…”

Effects of Walking with Aids on Walking Speed and Selected Cardiovascular Parameters in Apparently Healthy Elderly Individuals

“…Similar to the findings of Foley et al (16), the results of this study showed that there was no significant difference in heart rate when walking with a walking cane was compared with walking unaided. This is contrary to the findings of Jones et al (19) where the comparison was made between cane-assisted gait and unassisted walking in patients with knee osteoarthritis, where it was found that heart rate was higher when walking with a walking cane was compared with walking unaided.…”

Características da marcha de um paciente com osteoartrose de quadril com e sem auxílio de bengala

“…No entanto, essa maior velocidade difere dos resultados encontrados por Jones et al 22 6 . Para Sapiña 6 , tais mudanças ocorrem para melhorar a segurança durante o deslocamento, surgindo diminuição do comprimento do passo, da velocidade e da cadência, bem como incremento na largura do passo, aumentando assim o equilíbrio durante a marcha.…”