No effects of functional exercise therapy on walking biomechanics in patients with knee osteoarthritis: exploratory outcome analyses from a randomised trial

Abstract

AimTo assess the effects of a functional and individualised exercise programme on gait biomechanics during walking in people with knee OA.MethodsSixty participants were randomised to 12 weeks of facility-based functional and individualised neuromuscular exercise therapy (ET), 3 sessions per week supervised by trained physical therapists, or a no attention control group (CG). Three-dimensional gait analyses were used, from which a comprehensive list of conventional gait variables were extracted (totally 52 kinematic, kinetic and spatiotemporal variables). According to the protocol, the analyses were based on the ‘Per-Protocol’ population (defined as participants following the protocol with complete and valid gait analyses). Analysis of covariance adjusting for the level at baseline was used to determine differences between groups (95% CIs) in the changes from baseline at follow-up.ResultsThe per-protocol population included 46 participants (24 ET/22 CG). There were no group differences in the analysed gait variables, except for a significant group difference in the second peak knee flexor moment and second peak vertical ground reaction force.ConclusionWhile plausible we have limited confidence in the findings due to multiple statistical tests and lack of biomechanical logics. Therefore we conclude that a 12-week supervised individualised neuromuscular exercise programme has no effects on gait biomechanics. Future studies should focus on exercise programmes specifically designed to alter gait patterns, or include other measures of mobility, such as walking on stairs or inclined surfaces.Trial registration numberClinicalTrials.gov: NCT01545258.

Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis

“…For all the included RCT studies 14 – 17 , 25 , the total scores of the PEDro scale were higher than 5 points, thus defined as high quality. Based on the NIH scale, the overall quality rating of the included non-RCT studies 18 , 26 , 27 was "Good" (Table 2 ).…”

“…Several studies have pointed out that resistance training may be able to improve the gait velocity of knee OA patients by increasing the strength of the quadriceps 14 – 16 . On the contrary, a few others showed that resistance training failed to improve the gait velocity of knee OA patients 17 , 18 . The difference in outcomes could be possibly due to the small sample size or different interventions in the studies 17 , 18 .…”

“…On the contrary, a few others showed that resistance training failed to improve the gait velocity of knee OA patients 17 , 18 . The difference in outcomes could be possibly due to the small sample size or different interventions in the studies 17 , 18 . Therefore, to date, the overall effect of resistance training on gait velocity is still unclear.…”

Wearable Sensor Data to Track Subject-Specific Movement Patterns Related to Clinical Outcomes Using a Machine Learning Approach

“…While exercise interventions have consistently demonstrated improvements in the pain and function of knee OA patients, identifying concomitant changes in gait patterns has been rarely reported using conventional group-based methods [ 39 , 40 , 41 , 42 ]. Given that much of this research has examined single, discrete variables (e.g., knee adduction moment), the sensitivity of this type of univariate statistical approaches is questionable [ 17 ].…”

“…Nevertheless, these multivariate changes often remain limited when assessed in conventional group-based analyses [ 44 ]. This further suggests that exercise interventions may not elicit any consistent change in gait patterns, univariate or multivariate, across heterogeneous diseases such as knee OA [ 39 , 40 , 41 , 42 ]. Therefore, a significant strength of the current study is the introduction of an alternative, single-subject model to track multivariate, multi-segment changes in gait biomechanics.…”