Börjesson Margareta, Weidenhielm Lars, Elfving Britt, Olsson Elisabeth
Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden.
Physiother Res Int. 2007 Jun;12(2):115-21. doi: 10.1002/pri.360.
Measurements of walking speeds are commonly used as an objective measure of functional performance in patients with knee osteoarthritis (OA) and are easily performed in a clinical setting. However, the choice in which the walking speed evaluation should be performed is controversial. The aim of this study was to identify the most discriminating walking speed after surgical interventions in patients with knee osteoarthritis, and to compare the responsiveness of the different gait speeds.
A prospective clinical one-year follow-up study involving 54 patients with knee osteoarthritis (63 (+/-5) years of age) who were operated with either a unicompartmental knee arthroplasty or a high tibial osteotomy was undertaken. Thirty-nine patients had unilateral knee OA and 15 patients had bilateral knee OA or other symptoms from the lower extremities that could influence walking. The patients were examined at a gait laboratory before surgery, and one year after surgery. The patients were instructed to walk at slow, normal and fast walking speed.
All patients (n=54) walked.faster one year after the surgical intervention compared to before surgery (p = 0.001) at slow (+15%), normal (+8%) and fast (+7%) walking speed. This increase was similar for the three walking speeds (p = 0.171). Patients with unilateral knee OA (n=39) reached an average change of +0.12 m/s, which was considered clinically important, while patients with bilateral knee OA (n=15) did not increase their walking speed > 0.12 m/s. Effect size was moderate for slow walking speed and small for normal and fast walking speeds, respectively.
The different walking speeds were equally good in detecting changes one year after surgical interventions. In this study, responsiveness favoured slow walking speed, however, the advantages of normal walking speed are discussed.
步行速度测量通常被用作评估膝骨关节炎（OA）患者功能表现的客观指标，且易于在临床环境中进行。然而，进行步行速度评估的方式选择存在争议。本研究的目的是确定膝骨关节炎患者手术干预后最具区分度的步行速度，并比较不同步态速度的反应性。
对54例膝骨关节炎患者（年龄63（±5）岁）进行了一项前瞻性临床一年随访研究，这些患者接受了单髁膝关节置换术或高位胫骨截骨术。39例患者为单侧膝OA，15例患者为双侧膝OA或有下肢其他可能影响步行的症状。患者在手术前及手术后一年在步态实验室接受检查。患者被要求以慢、正常和快步行速度行走。
与手术前相比，所有患者（n = 54）在手术后一年以慢（+15%）、正常（+8%）和快（+7%）步行速度行走时速度均加快（p = 0.001）。三种步行速度的增加相似（p = 0.171）。单侧膝OA患者（n = 39）平均变化为+0.12 m/s，被认为具有临床意义，而双侧膝OA患者（n = 15）步行速度增加未超过0.12 m/s。慢步行速度的效应量中等，正常和快步行速度的效应量分别较小。
不同的步行速度在检测手术干预一年后的变化方面同样有效。在本研究中，反应性有利于慢步行速度，不过也讨论了正常步行速度的优势。
