No effects of a 12-week supervised exercise therapy program on gait in patients with mild to moderate osteoarthritis: a secondary analysis of a randomized trial

Abstract

BackgroundIt is unknown whether gait biomechanics in hip osteoarthritis patients with mild to moderate symptoms change following exercise therapy interventions. The aim of the present study was to compare stance phase gait characteristics in hip osteoarthritis patients with mild to moderate symptoms participating in a randomized trial with two different interventions; patient education only or patient education followed by a 12-week supervised exercise therapy program.ResultsThe study was conducted as a secondary analysis of a single-blinded randomized controlled trial. Patients aged 40 to 80 years, with hip osteoarthritis verified from self-reported pain and radiographic changes, were included. The final material comprised 23 patients (10 males/13 females, mean (SD) age 58.2 (10.02) years) in the patient education only group, and 22 patients (9 males/13 females, mean (SD) age 60.2 (9.49) years) in the patient education + exercise therapy group. Three-dimensional gait analysis was conducted at baseline and at four month follow-up. Sagittal and frontal plane joint angle displacement and external joint moments of the hip, knee and ankle were compared from a one-way analysis of covariance between the groups at follow-up, with baseline values as covariates (p < 0.05). No group differences were observed at the four-month follow-up in gait velocity, joint angle displacement, or moments. As the compliance in the exercise therapy group was inadequate, we calculated possible associations between the number of completed exercise sessions and change in each of the kinematic or kinetic variables. Associations were weak to neglible. Thus, the negative findings in this study cannot be explained from inadequate compliance alone, but most likely also suggest the exercise therapy program itself to be insufficient to engender gait alterations.ConclusionsAdding a 12-week supervised exercise therapy program to patient education did not induce changes in our selected biomechanical variables during the stance phase of gait, even when adjusting for poor compliance. Thus, we did not find evidence to support our exercise therapy program to be an efficacious intervention to induce gait alterations in this population of hip osteoarthritis patients.Trial registrationNCT00319423 at ClinicalTrials.gov (registration date 2006-04-26).

Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review

“…Group-based interventions may improve outcomes by increasing compliance compared to individual-based interventions [ 33 ]. Eitzen et al found no effect of a 12-week supervised education and exercise therapy program on gait in patients with osteoarthritis, but the exercise component was delivered individually and resulted in low compliance while the education component was group-based and showed 100% compliance [ 34 ]. Even over the course of a year, a community-based water exercise program achieved 70% compliance for the twice-a-week group sessions [ 35 ].…”

Unilateral hip osteoarthritis: The effect of compensation strategies and anatomic measurements on frontal plane joint loading

“…Although numerous studies have shown that HOAP adopt characteristic compensation strategies, their relation to load alterations in the knee and hip joint have not been satisfactorily established. Clarification of the latter would seem beneficial, as physical exercise and gait retraining programs often fail . Because HOAP retain their pre‐operative gait patterns for several years after hip joint replacement, these patients may be disproportionally at higher risk for abnormal joint loading and thus for the development of OA in other joints of the lower extremities .…”

“…Conservative management of HOAP, like physical exercise programs and gait retraining, is complex . To do so, it is beneficial to gather detailed information about factors that impact asymmetrical knee and hip joint loading.…”

Gait mechanics and tibiofemoral loading in men of the ACL‐SPORTS randomized control trial

“…The failure of the ACL‐SPORTS training program to restore symmetry in every knee gait biomechanical variable assessed following training, at only 7 months after primary ACLR, may be unremarkable in light of the findings from Kaur et al Other post‐operative rehabilitation interventions also have been unsuccessful at improving gait biomechanics in various populations. For example, Eitzen et al found a 12‐week supervised exercises therapy program did not change frontal or sagittal plane hip, knee, or ankle kinematics or kinetics in patients with hip osteoarthritis. Previous studies investigating strength and perturbation training on gait mechanics in ACL‐deficient participants have found a greater response in women compared to men, who walked with similar patterns before and after training .…”