C. Morisset

Gait analysis as a quantifiable outcome measure in hip or knee osteoarthritis: a systematic review.

OBJECTIVESnKinematic gait analysis consisting of measuring gait parameters (stride length, gait speed, dynamic joint angles) is a potential outcome measure in osteoarthritis (OA). The aim of this study was to evaluate its psychometric properties.nnnMETHODSnA systematic literature search was performed in PUBMED and the Cochrane database until January 2008 by selecting manuscripts assessing any psychometric property of gait analysis in knee or hip OA. Were assessed feasibility (cost, time and access); reliability; discriminant capacity by differences between OA and non-OA patients; construct validity by correlation between gait analysis and OA symptoms: pain or functional disability (Lequesne/WOMAC); and responsiveness by improvement of gait analysis after treatment of OA using effect size.nnnRESULTSnAmong the 252 articles identified, the final analysis included 30 reports (i.e., 781 knee OA patients and 343 hip OA patients). Gait analysis presents various feasibility issues and there was limited evidence regarding reliability (three studies, 67 patients). Discriminant capacity showed significant reduction of gait speed, stride length and knee flexion in OA patients compared to healthy subjects. Few data were available concerning construct validity (three studies, 79 patients). Responsiveness of gait speed was moderate to large with effect size ranging respectively from 0.33 to 0.89 for total knee replacement, and from 0.50 to 1.41 for total hip replacement.nnnCONCLUSIONnAvailable data concerning validity and reliability of kinematic gait analysis are insufficient to date to consider kinematic parameters as valuable outcome measures in OA. Further studies evaluating a large number of patients are needed.

Test–retest reliability of 3D kinematic gait variables in hip osteoarthritis patients

OBJECTIVESn(1) to investigate the test-retest reliability of 3D gait analysis (3DGA) in hip Osteoarthritis (OA) patients; (2) to find the minimum number of gait trials needed to overcome intrinsic variability; (3) to check the accuracy of angles measured by the 3D system.nnnDESIGNn23 Patients suffering from hip OA with no other major disease were recruited. We evaluated the reliability of spatio-temporal variables and body angles (lower-limb joints, trunk and pelvis angles) during two sessions of 3DGA using intra-class correlation coefficients (ICC). The minimum number of trials needed to overcome intrinsic variability was evaluated using an exponential fit model and the Bland and Altman coefficient of repeatability (CoR). The accuracy of measurement was evaluated using a manual goniometer and the recording of 18 different angles.nnnRESULTSnSpatio-temporal variables and most of the kinematic joint and trunk angles calculated demonstrated good to excellent reliability (ICC from 0.77 to 0.97). This was not the case for pelvic angles. The fitting model combined with the CoR showed that 5-10 trials are sufficient to obtain good reliability [ICC>0.7; CoR<2 standard deviation (SD)] for most of the spatio-temporal variables. All body angles showed good reliability (ICC>0.7) and low CoR (<2 SD) after five trials except for the pelvic angles. The reliability of marker positioning was found to be good (ICC>0.7) to excellent (ICC>0.9). Differences between angles measured using 3DGA and angles measured with a manual goniometer were found to be less than one percent.nnnCONCLUSIONnThe present study shows that most of variables obtained using 3DGA in hip OA patients are reliable. Moreover, for most variables, 5-10 trials are needed to obtain good reliability and to overcome intrinsic variability, rather than 30 or more, thus improving the feasibility of measurement.

Three-dimensional kinematics of the lower limbs in hip osteoarthritis during walking

OBJECTIVEnTo describe the kinematic adaptations of all lower limb joints in hip osteoarthritis patients during walking.nnnMETHODSnPatients with unilateral primary hip OA, without associated joint disorders were included. Normal subjects were included as controls. Gait analysis, using a 3-dimensional computerised gait analysis system was used to evaluate the usual spatiotemporal parameters, the peak motion of the hips, knees, and ankles during walking, and the intersegmental coordination of the lower limbs.nnnRESULTSnEleven patients, mean age =60.5 ± 7 years and nine controls, mean age=60.3 ± 7 years, were included. The gait of hip OA patients was characterised as follows: a reduced stride length, a reduced maximal flexion and extension in the OA hip, a reduced maximal contralateral hip range of motion, an increased ipsi- and contralateral ankle dorsal flexion, a decreased ipsilateral relative temporal phase between the thighs and shanks segments and an increased ipsilateral relative phase between the shanks and foot segments.nnnCONCLUSIONnThe present results suggest that hip OA patients use shorter stride length, less contra lateral and especially ipsilateral hip motion, modify ankles motion, and have a different intra-limb coordination pattern compared to control subjects.

Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: Preliminary results

BACKGROUNDnNon-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients.nnnMETHODSnTwenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session.nnnRESULTSnVAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5.nnnCONCLUSIONnThis new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months).nnnLEVEL OF EVIDENCEnlevel IV.

Eccentric training in chronic heart failure: feasibility and functional effects. Results of a comparative study.

OBJECTIVESnTo evaluate, in chronic heart failure (CHF) patients, feasibility, safety, compliance and functional improvements of an eccentric (ECC) cycle training protocol personalized by the rate of perceived exertion (RPE; 9-11 Borg Scale), compared to concentric (CON) training at workload corresponding to the first ventilatory threshold.nnnMETHODSnThirty patients were randomly allocated to ECC or CON training (20 sessions). Compliance was evaluated with RPE, visual analog scale for muscle soreness and monitoring of heart rate (HR). Functional parameters were measured by the distance walked and the VO(2) uptake during the 6-minute walk test (6MWT) before and after training.nnnRESULTSnTwo patients were excluded due to adverse effects in each group. RPE was 9-11 in ECC training while it reached 12-14 in CON training. HR remained stable in ECC group during exercise whereas it increased during CON exercise. 6MWT distance improved in both group (ECC: +53 m; CON: +33 m). 6MWT VO(2) uptake remained stable in ECC group whereas it increased in CON group.nnnCONCLUSIONnECC training tailored by RPE appears to be an efficient and safe alternative for CHF patients. Indeed, it induces functional improvement similar to conventional CON training with lower demand on the cardiovascular system during exercise.

Cross-talk correction method for knee kinematics in gait analysis using principal component analysis (PCA): a new proposal.

Background In 3D gait analysis, the knee joint is usually described by the Eulerian way. It consists in breaking down the motion between the articulating bones of the knee into three rotations around three axes: flexion/extension, abduction/adduction and internal/external rotation. However, the definition of these axes is prone to error, such as the “cross-talk” effect, due to difficult positioning of anatomical landmarks. This paper proposes a correction method, principal component analysis (PCA), based on an objective kinematic criterion for standardization, in order to improve knee joint kinematic analysis. Methods The method was applied to the 3D gait data of two different groups (twenty healthy subjects and four with knee osteoarthritis). Then, this method was evaluated with respect to three main criteria: (1) the deletion of knee joint angle cross-talk (2) the reduction of variance in the varus/valgus kinematic profile (3) the posture trial varus/valgus deformation matching the X-ray value for patients with knee osteoarthritis. The effect of the correction method was tested statistically on variabilities and cross-talk during gait. Results Cross-talk was lower (p<0.05) after correction (the correlation between the flexion-extension and varus-valgus kinematic profiles being annihilated). Additionally, the variance in the kinematic profile for knee varus/valgus and knee flexion/extension was found to be lower and higher (p<0.05), respectively, after correction for both the left and right side. Moreover, after correction, the posture trial varus/valgus angles were much closer to x-ray grading. Conclusion The results show that the PCA correction applied to the knee joint eliminates the cross-talk effect, and does not alter the radiological varus/valgus deformation for patients with knee osteoarthritis. These findings suggest that the proposed correction method produces new rotational axes that better fit true knee motion.

Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis

OBJECTIVEnEvaluation of the clinical effectiveness and safety of a new custom-made valgus knee brace (OdrA) in medial knee osteoarthritis (OA) in terms of pain and secondary symptoms.nnnMETHODSnOpen-label prospective study of patients with symptomatic medial knee OA with clinical evaluation at 6 and 52 weeks (W6, W52). We systematically assessed pain on a visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), spatio-temporal gait variables, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic-sparing effects of the brace and tolerance. Mean scores were compared at baseline, W6 and W52 and the effect size (ES) and 95% confidence intervals (95% CIs) were calculated.nnnRESULTSnWe included 20 patients with knee OA (mean age 64.2±10.2 years, mean body mass index 27.2±5.4 kg/m2). VAS pain and KOOS were improved at W6 and W52: pain (ES=0.9 at 1 year), amelioration of other symptoms (ES=0.4), and function in activities of daily living (ES=1.1), sports and leisure (ES=1.5), quality of life (ES=0.9) and gait speed (ES=0.41). In total, 76% of patients showed clinical improvement at 1 year. Analgesic and NSAIDs consumption was significantly decreased at W6 and W52. One serious adverse effect noted was lower-limb varices, and observance was deemed satisfactory at 1 year.nnnCONCLUSIONnThis new unloader brace appeared to have good effect on medial knee OA, with an acceptable safety profile and good patient compliance.

Is It Possible to Individualize Intensity of Eccentric Cycling Exercise From Perceived Exertion on Concentric Test

OBJECTIVEnTo assess the safety and acute effects of a procedure using perceived exertion during a prior submaximal concentric (CON) test to individualize eccentric (ECC) cycling exercise intensity.nnnDESIGNnProspective, monocentric open study.nnnSETTINGnTechnological investigation platform at a physical medicine and rehabilitation department in a university hospital.nnnPARTICIPANTSnHealthy subjects (N=18; 15 men, 3 women) aged between 22 and 37 years.nnnINTERVENTIONSnThe subjects performed 3 cycling exercises: (1) incremental CON test to determine the comfortable pedaling power (CPP) corresponding to a Borg scale rating of 12 (rate of perceived exertion); (2) steady-state CON exercise at the CPP workload to determine the corresponding plantar pressure; and (3) steady-state ECC exercise with an imposed resistance corresponding to the CPP plantar pressure.nnnMAIN OUTCOME MEASURESnRate of perceived exertion on Borg scale, oxygen uptake (V˙o2), heart rate, cardiac output, and stroke volume using inert gas rebreathing techniques were measured during steady-state CON and ECC exercises. Muscle soreness was rated on a visual analog scale immediately, 24, and 48 hours after the tests.nnnRESULTSnNo adverse effects were reported. V˙o2 was about 5 times the resting value during CON exercise, while it was twice that during ECC exercise. Cardiac output was lower during ECC exercise (P<.05). This moderate increase of cardiac output was exclusively linked to a greater increase in stroke volume during ECC exercise than during CON exercise (P<.05).nnnCONCLUSIONSnModerate-intensity ECC cycling exercise tailored according to perceived exertion during a prior CON test is well tolerated. It corresponds to a limited muscular use of oxygen and to an isolated increase in stroke volume. It appears to be a feasible procedure for preconditioning before ECC training.

Psychometric properties of shoulder-pelvis coordination in hip osteoarthritis patients

Introduction Coordination between shoulder and pelvis girdles during walking is pivotal to optimise a stable forward displacement (Lamoth and van Heuvelen, 2012). Hip osteoarthritis (HOA) increases the stiffness of the pelvis and the low back and should impair this coordination. To our knowledge, no study evaluates this outcome for HOA. The aim was to evaluate the psychometric properties of the pelvis-shoulder coordination in healthy (HEA) and non-severe unilateral HOA subjects. Material and methods HEA and HOA subjects were enrolled. Each participant performed a 3D gait analysis along a 6-metre walkway using an optoelectronic system with 8 cameras (100xa0Hz). HOA performed a second session to evaluate measurements reliability (test-retest). Pelvis and shoulder yaws (transverse plane) and rolls (frontal plane) were calculated using markers positioned on the acromial process and the anterior-superior iliac spines. The phase-lag between angle waveforms expressed as a gait cycles percentage was computed using continuous estimate of relative phase (CRP; Russell Esposito and Wilken, 2014). Intraclass correlation (ICC), one-way Anova and Pearson correlation coefficient were used to evaluate respectively, reliability, responsiveness and validity (against HOOS scores; Ornetti et al., 2009). Results Seventy-eight HEA (58.4xa0±xa015.4 years) and 103 HOA (61.0xa0±xa08.1 years) subjects were included. ICC were excellent for roll-lag (0.918) and yaw-lag (0.959). Significant difference was found for roll-lag between subjects (HEA 37.8xa0±xa010.6%; OA 29.5xa0±xa09.8%, P r xa0>xa00.24, P r xa0=xa0−0.27, P xa0=xa00.013 for Lesquene index). Discussion–conclusion Pelvis-shoulder coordination outcomes showed excellent reliability. Roll-lag was related to clinical scores whereas yaw-lag did not. As only non-severe patients were included, these outcomes need to be addressed in population with higher impairment. It could be then proposed as an objective outcome to evaluate deficit in hip osteoarthritis patients.

THU0201 Biomechanical and Functional Benefits during GAIT of A New Knee Brace That Combines A Valgus and Tibial External Rotation Effect in Medial Osteoarthritis Patients

Background Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate the mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. Methods 20 patients with unilateral symptomatic medial knee osteoarthritis were included and performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5 weeks (W5) of wearing the brace. VAS-Pain, Satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phase, step width), biomechanical data of the ipsilateral lower limb (hip, knee ankle and foot progression angle) were recorded at each session Results VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. Conclusions This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.1930