Eytan M. Debbi

Differences in gait patterns, pain, function and quality of life between males and females with knee osteoarthritis: a clinical trial

BackgroundThe aim of this study was to gain a deeper understanding of the gender differences in knee osteoarthritis (OA) by evaluating the differences in gait spatio-temporal parameters and the differences in pain, quality of life and function between males and females suffering from knee OA.Methods49 males and 85 females suffering from bilateral medial compartment knee OA participated in this study. Each patient underwent a computerized gait test and completed the WOMAC questionnaire and the SF-36 health survey. Independent t-tests were performed to examine the differences between males and females in age, BMI, spatio-temporal parameters, the WOMAC questionnaire and the SF-36 health survey.ResultsMales and females had different gait patterns. Although males and females walked at the same walking speed, cadence and step length, they presented significant differences in the gait cycle phases. Males walked with a smaller stance and double limb support, and with a larger swing and single limb support compared to females. In addition, males walked with a greater toe out angle compared to females. While significant differences were not found in the WOMAC subscales, females consistently reported higher levels of pain and disability.ConclusionThe spatio-temporal differences between genders may suggest underlying differences in the gait strategies adopted by males and females in order to reduce pain and cope with the loads acting on their affected joints, two key aspects of knee OA. These gender effects should therefore be taken into consideration when evaluating patients with knee OA.Trial RegistrationThe study is registered in the NIH clinical trial registration, protocol No. NCT00599729.

Sex and Body Mass Index Correlate With Western Ontario and McMaster Universities Osteoarthritis Index and Quality of Life Scores in Knee Osteoarthritis

OBJECTIVE To examine the associations of sex, body mass index (BMI), and age with knee osteoarthritis (OA) symptomatic severity. DESIGN A cross-sectional retrospective analysis. SETTING Patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Data were acquired from a stored database of a private therapy center. PARTICIPANTS Patients (N=1487) with symptomatic knee OA were evaluated. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES WOMAC questionnaire and SF-36. RESULTS BMI correlated significantly with worse knee OA symptoms for all WOMAC and SF-36 subcategories (all P ≤.001). Age correlated significantly with worse symptoms only for WOMAC function and SF-36 physical functioning (P=.001 and P=.009, respectively). A significant difference across BMI quintiles was found for all WOMAC and SF-36 subcategories (all P ≤.01). Women showed worse knee OA symptoms in all WOMAC and SF-36 subcategories (all P ≤.001). There was a significant interaction of sex by BMI in WOMAC pain and WOMAC function (P=.01 and P=.02, respectively). CONCLUSIONS Based on the results of this analysis, it can be concluded that women and patients with a higher BMI with knee OA are at a greater risk for worse symptoms.

Efficacy of methylsulfonylmethane supplementation on osteoarthritis of the knee: a randomized controlled study.

BackgroundPatients with osteoarthritis (OA) take a variety of health supplements in an attempt to reduce pain and improve function. The aim of this study was to determine the efficacy of methylsulfonylmethane (MSM) in treating patients with knee OA.MethodsThis study was a prospective, randomized, double-blind, controlled clinical trial. Forty nine men and women 45-90 (mean 68 ± SD 7.3) years of age with knee OA according to the American College of Rheumatology clinical criteria for OA of the knee and with radiographic confirmed knee OA were enrolled in the study and randomly assigned into 2 groups: One received MSM in doses of 1.125 grams 3 times daily for 12 weeks and the other received a placebo in the same dosing frequency. The primary outcomes were the WOMAC Osteoarthritis Index for pain, stiffness and physical function, the Aggregated Locomotor Function (ALF) test that evaluates each patients physical function, the SF-36 quality of life health survey and the visual-analogue-scale (VAS) for pain. The secondary outcomes were Knee Society Clinical Rating System for Knee Score (KSKS) and Function Score (KSFS). Patients were assessed at baseline, 6 weeks and 12 weeks. All continuous variables were tested by the Kolmogorov-Smirnov test for Normal distribution. Changes within the groups and differences between the groups were calculated by repeated measures of analysis (ANOVA) with one nested variable.ResultsThere were significant differences between treatment groups over time in WOMAC physical function (14.6 mm [CI: 4.3, 25.0]; p = 0.04) and in WOMAC total score (15.0 mm [CI: 5.1, 24.9]; p = 0.03). Treatment groups did not differ significantly in WOMAC pain (12.4 mm [CI: 0.0, 24.8]); p = 0.08) or WOMAC stiffness (27.2 mm [CI: 8.2, 46.2]; p = 0.08). There was a non-significant difference in SF-36 total score between treatment groups (11.6 [CI: 1.0, 22.1]; p = 0.54). A significant difference was found between groups in VAS for pain (0.7 s [CI: -0.9, 2.4]; p = 0.05). Secondary outcomes showed non-significant differences between the two groups.ConclusionsPatients with OA of the knee taking MSM for 12 weeks showed an improvement in pain and physical function. These improvements, however, are small and it is yet to be determined if they are of clinical significance.Trial RegistrationClinicalTrials.gov: NCT01188213

Correlation between single limb support phase and self-evaluation questionnaires in knee osteoarthritis populations

Purpose. To investigate the correlation between single limb support (SLS) phase (%% of gait cycle) and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) questionnaire and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36 Health Survey) in patients with knee osteoarthritis (OA). Method. A prospective observational study was employed with 125 adults with bilateral medial compartment symptomatic knee OA who underwent a physical and radiographic evaluation. Velocity, step length and SLS were assessed by a computerised mat (GAITRite). Patients completed the WOMAC and SF-36 Health Survey questionnaires. Results. Statistical analysis examined the correlations between SLS and both questionnaires, between Kellgren & Lawrence (K&L) scores and both questionnaires and between SLS correlations and K&L correlations. We found significantly stronger correlations between SLS and WOMAC-pain, WOMAC-function, the SF-36 pain sub-category, velocity and step length than between K&L scores and these parameters (Pearsons r  ==  0.50 vs. 0.26, 0.53 vs. 0.34, 0.50 vs. 023, 0.81 vs. 0.33, 0.77 vs. 0.37, respectively; all p  <  0.05). Significant differences in SLS were found over WOMAC-pain, WOMAC-function and SF-36 overall score quartiles (p  <  0.05 for all). Conclusion. We recommend integrating SLS as an objective parameter in the comprehensive evaluation of patients with knee OA.

APOS therapy improves clinical measurements and gait in patients with knee osteoarthritis

BACKGROUND The purpose of the study was to investigate the changes in gait patterns and clinical measurements following treatment with a novel biomechanical device on patients with knee osteoarthritis. METHODS Forty six patients with bilateral knee osteoarthritis were analyzed. Patients completed a gait test, Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and SF-36 Health Survey at baseline and after 12 weeks. The biomechanical device was individually calibrated to each patient at baseline to allow training under reduced pain. FINDINGS Gait velocity, step length and single limb support improved significantly and toe out angle decreased significantly (10%, 6%, 1% and 2%, respectively). WOMAC-Pain and WOMAC-Function significantly decreased (26% and 34%, respectively), and SF-36 score significantly increased following the 12 weeks of treatment. INTERPRETATION Our results suggest an overall improvement in the gait patterns, level of pain and level of function of patients with knee osteoarthritis following 12 weeks of treatment with the novel biomechanical device.

A novel biomechanical device improves gait pattern in patient with chronic nonspecific low back pain.

Study Design. A retrospective study on patients with chronic nonspecific low back pain (NSLBP). Objective. To describe the gait stride characteristics of patients with chronic NSLBP, and to examine the effect of a novel biomechanical device on the gait stride characteristics of these patients. Summary of Background Data. Patient with NSLBP alters their gait patterns. This is considered a protective mechanism as patients try to avoid extensive hip and spine ranges of motion and minimize forces and moments acting on the body. In addition, there are changes in the neuromuscular control system in patients with LBP that could possibly be attributed to the effects of pain on motor control. Methods. Nineteen patients underwent a gait test, using an electronic walkway, at baseline and after 12 weeks of treatment. Spatiotemporal parameters were used to identify changes in gait pattern. A novel biomechanical device comprised of 4 modular elements attached to foot-worn platforms was used in the study. The modules are 2 convex shaped biomechanical elements attached to each foot, one is located under the hindfoot region and the other is located under the forefoot region. The device was individually calibrated to each patient. The patients were instructed to walk with the calibrated biomechanical device on a daily basis for a period of 12 weeks. Results. Significant differences were found at baseline and after 12 weeks in normalized velocity (P = 0.03), cadence (P < 0.01), left normalized step length (P = 0.02), right normalized step length (P = 0.02), right swing (P < 0.01), right stance (P < 0.01), left single limb support (P = 0.01), left double limb support (P = 0.02), and right double limb support (P = 0.02). Conclusion. Patients with NSLBP treated with the novel biomechanical device for 3 months increased walking speed through longer step length and eliminated asymmetrical differences.

Can single limb support objectively assess the functional severity of knee osteoarthritis

There is a lack in objective measurements that can assess the symptoms of knee osteoarthritis (KOA). In a previous study it was shown that pain and function are in higher correlation with the single-limb support gait parameter than with radiographic KOA stage. Single limb support represents a phase in the gait cycle when the body weight is entirely supported by one limb, while the contra-lateral limb swings forward. The purpose of this study was to further examine the relationship between single-limb support and the level of pain and function in patients with KOA. 125 adults with bilateral KOA underwent a physical and radiographic evaluation, and completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the SF-36 health survey. Patients walked barefoot at a self-selected speed on a computerized mat. Statistical analysis was used to divide the patients into quintiles based on single-limb support phase value and determine the differences in WOMAC and SF-36 scores between quintiles. Significant differences were found in WOMAC and SF-36 sub-category scores between the single-limb support quintiles. The means of the WOMAC-pain and WOMAC-function sub-categories decreased gradually over single-limb support quintiles (P<0.001), and the means of the SF-36 sub-categories increased gradually over the quintiles (P<0.001). Results show that single-limb support quintiles can help determine the level of pain, function and quality of life in patients with KOA. These results suggest that single-limb support quintiles may be added as an additional scale for generally assessing the symptomatic stage of KOA.

The effect of manipulation of the center of pressure of the foot during gait on the activation patterns of the lower limb musculature

BACKGROUND Therapeutic devices that manipulate the center of pressure (COP) of the foot can induce kinetic and kinematic changes in gait. Appropriate changes in joint moments and muscle activation during gait have been proven to be beneficial for patients with neuromuscular and orthopedic disorders. The purpose of this study was to investigate the effect of different COP positions during gait on the activity of the lower limb musculature of healthy subjects. METHODS A novel foot-worn biomechanical device that allows controlled manipulation of the COP during gait was used. Twelve healthy males underwent EMG analyses of the key muscles of the leg while wearing the device. The trials were carried out at six COP positions relative to neutral configuration: anterior, posterior, medial, lateral, dorsi flexion and plantar flexion. RESULTS The EMG activity of the lateral gastrocnemius varied significantly with COP during terminal stance (p=0.023) and preswing (p=0.020), the tibialis anterior during load response (p=0.019) and midstance (p=0.004), the biceps femoris during terminal stance (p=0.009) and the vastus lateralis during initial contact (p=0.010). CONCLUSION There are significant changes in the muscle activity of the lower limb in response to manipulation of the COP of the foot during gait.

Detecting and quantifying global instability during a dynamic task using kinetic and kinematic gait parameters

OBJECTIVES Instability during gait can be identified in many different ways. Recent studies have suggested utilizing spatiotemporal parameters to detect instability during gait. Detecting instability using kinetic and kinematic gait parameters has not yet been examined fully. In addition, these studies have not yet identified measures that are capable of assessing the magnitude of instability. The objective of the present study was to identify kinetic and kinematic gait parameters that can best identify instability and quantify its magnitude. METHODS Ten healthy men underwent successive gait analysis testing under three controlled settings: (1) Stage 0 instability (control setting), (2) Stage 1 instability and (3) Stage 2 instability. The levels of instability were precisely applied with the use of a controlled perturbation device (AposTherapy System). Differences between all stages and between stages were identified using Friedman and Wilcoxon tests. RESULTS Stride-to-stride variability (STSV) in kinetic and kinematic measures increased significantly between stages 0 and 1 or between stages 0 and 2 for almost all parameters (all P<0.05). A significant increase between stage 0 and both stages 1 and 2 was found for knee flexion moment, knee varus moment, knee flexion angle and hip adduction angle. The increase between stages 1 and 2 was variable. Only the knee varus moment parameter showed a significant increase in STSV between stages 1 and 2 (P=0.026). CONCLUSIONS Almost all kinetic and kinematic gait parameters are sensitive to changes in global instability in a dynamic task. The most sensitive are parameters measured at the knee. Of these, STSV in knee varus moment can be used to quantify the magnitude of dynamic instability.

Foot Center of Pressure Trajectory Alteration by Biomechanical Manipulation of Shoe Design

Background: Footwear-generated biomechanical manipulations have been shown to alter lower limb kinetics. It has been suggested that this is due to altered trajectory of the foot’s center of pressure (COP), conveying a shift in location of the ground reaction force and modifying moments and forces acting on proximal body segments. However, past studies have focused on qualitative association between footwear design and the COP locus. Moreover, this association was calculated via indirect analysis. The purpose of the present study was to directly examine and quantify the correlation between measured footwear biomechanical manipulation and the location of the COP trajectory during gait. Methods: A novel biomechanical device allowing flexible positioning of 2 convex-shaped elements attached to its sole was utilized. A total of 20 healthy male adults underwent direct in-shoe pressure measurements while walking with the device set at 7 mediolateral configurations. COP data were collected during gait and analyzed with respect to different stance subphases. Results: COP location significantly correlated with a shift of the elements medially or laterally. The linear model describing this correlation was found to be statistically significant. Conclusion: There was significant correlation between the plantar orientation of the shoe device configuration and the COP. Clinical Relevance: Changes in COP trajectory may be valuable in patients suffering from multiple foot disorders elevating pressure on the foot. Accurate COP control could aid in the manipulation of the forces acting on the proximal joints during gait. In addition, these findings may have implications in the field of biomechanical apparatus design and practice.