Project: Gait modification by real-time visual feedback in patients with knee osteoarthritis
Osteoarthritis of the knee (KOA) is one of the most common disabilities in older adults in the developed world. With an ageing population the prevalence of OA is rising. Non-surgical interventions to reduce the symptoms of OA include weight management, exercise, including walking and resistance exercises, strength training and water-based exercises. People with KOA generally have higher knee adduction moment (KAM) than healthy subjects. KAM is considered to be a good surrogate measure for the knee joint loading. Higher KAM is linked to increase in pain and loss of function. Real-time visual feedback has been shown to be effective in reducing the knee adduction moment. The objective of this project is to evaluate the use of real-time visual and audio feedback on the knee adduction moment and on kinematic patterns during gait to decrease the biomechanical load on the knee.
In the first part of the study, the gait pattern of 41 patients will be measured during walking on a treadmill with different types of feedback on a screen in front of them. Feedback will be personalized to the individual based on their baseline data. Data collected in this part of the study will be used to establish what features of the program work well and what patients respond best to; both important considerations for the second stage of the project.
In the second part of the study treatment using bio-feedback will be carried out over 6 weeks to assess the use of real-time feedback to alter the gait pattern. Patients will attend for biofeedback training sessions once a week for six weeks. Follow-up measurements will be carried out at 3 and 6 months. Modification of knee load and gait characteristics will be assessed by 3D motion analysis on the GRAIL (instrumented treadmill with a motion capture system and a semi cylindrical screen with virtual reality environment).
Impact and Dissemination
At the end of this project, it is expected that the features of biofeedback that are important for a gait retraining program will be better understood. After this, the potential impact of such an intervention in clinical practice, as an alternative to more conventional therapy, can better be realised. The study is expected to result in several publications in peer reviewed journals. Results will also be disseminated at relevant conferences and to patients and the public via websites and in print (e.g. the Reumafonds magazine).