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

Jones, Anamaria; Silva, P.G.; Silva, A.C.; Colucci, Marcelo; Tuffanin, A.; Jardim, José Roberto; Natour, Jamil

doi:10.1016/j.gaitpost.2011.11.003

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…Although healthy subjects were tested in both studies, the agreement in kinematic data between these studies supports the validity and relevance of the data. In patients with knee osteoarthritis, cane use causes an immediate increase in energy expenditure and decrease in pain during gait [2]. Hence, an optimal crutch-gait pattern in patients will be presumably defined primarily by pain in their index joint or limb and by their energy expenditure and only to a lesser extent by the pressure loads between the crutch cuff and forearm.…”

Section: Discussionmentioning

confidence: 99%

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Forearm pressure distribution during ambulation with elbow crutches: a cross-sectional study

Fischer

Nüesch

Göpfert

et al. 2014

J NeuroEngineering Rehabil

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BackgroundIncreasing numbers of patients require permanent walking aids to maintain mobility. Current elbow crutches are not designed for long-term use, and overuse is often associated with hematoma formation and pain along the forearm. We therefore hypothesized that the highest pressures between the forearm and crutch cuff during walking and stance are located in the ulnar region and that the level of weight-bearing, forearm circumference and kinematic parameters influence peak pressure values and pressure distribution.MethodsTen healthy adults participated in a cross-sectional study. A pressure sensor array was attached to the forearm of each participant separating the forearm into four quadrants (lateral, ulnar, intermediate and medial). Measurements were taken during crutch gait and during partial and full weight-bearing stance. A three-dimensional motion analysis system with reflective markers attached to the subject’s body and to the crutches was used to obtain kinematic data.ResultsThe mean pressure on the forearm during crutch gait was 37.5 kPa (SD 8.8 kPa). Highest mean pressure values were measured in the ulnar (41.0 kPa, SD 9.6 kPa) and intermediate (38.0 kPa, SD 9.0 kPa) quadrants. The center of pressure was mainly located in an oblique lamellar area in these two quadrants. With increasing weight-bearing on the crutches during stance, we observed a shift of the peak pressures towards the ulnar quadrant. The circumference of the forearm correlated with the peak pressure in the medial and intermediate quadrants during crutch gait (P < 0.05). Peak pressures on the forearm showed a trend towards correlation with crutch abduction, but no association with other kinematic parameters was detected.ConclusionThe pressure load on the forearm during crutch-assisted gait is located predominantly over the ulna and may be linked to a range of secondary conditions caused by crutch use including hematoma formation and pain.

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Section: Discussionmentioning

confidence: 99%

“…This development is reflected by an increase in patients requiring and benefitting from permanent walking aids in form of crutches or walkers for maintaining mobility. For instance, the use of walking aids significantly improves the quality of life in patients with knee OA [2]. …”

Section: Introductionmentioning

confidence: 99%

Forearm pressure distribution during ambulation with elbow crutches: a cross-sectional study

Fischer

Nüesch

Göpfert

et al. 2014

J NeuroEngineering Rehabil

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“…It is unknown whether similar increases would be seen, as factors such as knee pain, not present in healthy individuals, may impact the metabolic cost of walking in individuals with knee OA 18 . The effect of other gait modifications have been assessed in people with knee OA, with Jones et al 19 reporting a 50% increase in energy expenditure during cane walking in 64 people with knee OA. Other studies have found increases in energy expenditure in people without knee OA when performing other gait modifications such as stiffknee gait, with energy expenditure increasing by 37% in a sample of 20 healthy individuals 20 .…”

Section: Introductionmentioning

confidence: 99%

Lateral trunk lean gait modification increases the energy cost of treadmill walking in those with knee osteoarthritis

Takacs

Kirkham

Perry

et al. 2014

Osteoarthritis and Cartilage

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Increased lateral trunk lean walking on a treadmill resulted in significantly higher levels of steady-state energy expenditure, HR, and perceived exertion, but no difference in knee pain. While increased lateral trunk lean has been shown to reduce biomechanical measures of joint loading relevant to OA progression, it should be prescribed with caution given the potential increase in energy expenditure experienced when it is employed.

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“…177 Moreover, patients should be encouraged to achieve earlier peak bodyweight support through the cane during the load-acceptance phase of gait, which coincides with the largest peak in KAM. The prescription of cane use for novice users should take into account the substantial increase in energy expenditure at the onset of cane use, 102 which decreases over time through an ongoing process of adaptation to using an assistive device. 103 Clinicians should also be reminded that, although cane use appears to be an effective offloading strategy, lack of patient compliance is a significant clinical obstacle, due to a common patient perception that canes are for frail, elderly people and imply aging.…”

Section: Contralateral Cane Usementioning

confidence: 99%

A Biomechanical Perspective on Physical Therapy Management of Knee Osteoarthritis

Farrokhi¹,

Voycheck²,

Tashman³

et al. 2013

J Orthop Sports Phys Ther

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

Cited by 13 publications

References 30 publications

Forearm pressure distribution during ambulation with elbow crutches: a cross-sectional study

Forearm pressure distribution during ambulation with elbow crutches: a cross-sectional study

Lateral trunk lean gait modification increases the energy cost of treadmill walking in those with knee osteoarthritis

A Biomechanical Perspective on Physical Therapy Management of Knee Osteoarthritis

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