The Effect of Real-Time Tibial Acceleration Feedback on Running Biomechanics During Gait Retraining: A Systematic Review and Meta-Analysis

Abstract

Objectives: To explore the immediate and retention effect of real-time tibial acceleration feedback on running biomechanics during gait retraining. Methods: Five electronic databases were searched to identify relevant studies published before May 2022. The included studies were evaluated for methodological quality and bias risk, and data were extracted. A meta-analysis was conducted on the primary outcomes, including peak tibial acceleration (PTA) and vertical ground reaction force. Subgroup analysis was performed by gender, feedback criterion, mode, dosage, fading, retention period, and running environment to evaluate the source of heterogeneity. Qualitative analysis was performed to describe other variables. Results: Fourteen studies (174 participants) were eligible. Meta-analysis showed that real-time tibial acceleration feedback reduced PTA (P < .01, P < .01), vertical impact peak (P = .004, P < .01), vertical average loading rate (P < .01, P < .01), and vertical instantaneous loading rate (P < .01, P < .01) after feedback and during retention period (5 min–12 mo). Subgroup analysis showed that the immediate effect of vertical impact peak was more noticeable with mixed gender (P = .005) and fading feedback (P = .005) conditions, and the retention effect of PTA was more noticeable with high feedback dosage (P < .01) and fading feedback (P < .01) conditions. Conclusions: Real-time tibial acceleration feedback can reduce PTA and vertical ground reaction force during gait retraining, and for periods of 5 minutes to 12 months when the feedback is removed.

Developing gait modification strategies to improve knee joint loading and clinical outcomes in adults with knee osteoarthritis

“…In contrast, similarly designed gait retraining interventions in runners have demonstrated that real-time biofeedback to reduce PTA by >50% can result in immediate and long-term reductions in impact loading with moderate to large effect sizes. 82 Motor learning principles suggest that skill transfer is one indicator that a motor skill was learned. 150 Skill transfer tests are often thought of in terms of generalizability, such that a learned skill can be performed in a novel but similar context.…”

“…81 These findings subsequently motivated the development of several gait retraining interventions demonstrating that PTA is a modifiable gait parameter that can be used to reduce vertical impact force metrics by 18-34% with real-time biofeedback. 82 The role of PTA in knee OA is unknown, but warrants investigation given that gait modifications that reduce the vertical GRF is one way in which KAM and KFM can be reduced.…”

“…A recent meta-analysis of 14 studies showed immediate and long-term reductions in vertical ground reaction force (GRF) peaks and loading rates following gait retraining to reduce PTA in runners. 82 This gait retraining strategy may be promising for knee OA, given that high rates of loading is associated with disease progression. 25,136 In addition, since PTA can quickly and easily be measured with commercially available wearable devices, clinical implementation may be simpler compared to the previous strategies that target KAM.…”