Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Department of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada.
Osteoarthritis Cartilage. 2018 Jul;26(7):903-911. doi: 10.1016/j.joca.2018.04.010. Epub 2018 Apr 27.
To compare changes in knee pain, function, and loading following a 4-month progressive walking program with or without toe-out gait modification in people with medial tibiofemoral knee osteoarthritis.
Individuals with medial knee osteoarthritis were randomized to a 4-month program to increase walking activity with (toe-out) or without (progressive walking) concomitant toe-out gait modification. The walking program was similar between the two groups, except that the gait modification group was trained to walk with 15° more toe-out. Primary outcomes included: knee joint pain (WOMAC), foot progression angles and knee joint loading during gait (knee adduction moment (KAM)). Secondary outcomes included WOMAC function, timed stair climb, and knee flexion moments during gait.
Seventy-nine participants (40 in toe-out group, 39 in progressive walking group) were recruited. Intention-to-treat analysis showed no between-group differences in knee pain, function, or timed stair climb. However, the toe-out group exhibited significantly greater changes in foot progression angle (mean difference = -9.04° (indicating more toe-out), 95% CI: -11.22°, -6.86°; P < 0.001), late stance KAM (mean difference = -0.26 %BWht, 95% CI: -0.39 %BWht, -0.12 %BWht, P < 0.001) and KAM impulse (-0.06 %BWhts, 95% CI: -0.11 %BWhts, -0.01 %BWht*s; P = 0.031) compared to the progressive walking group at follow-up. The only between-group difference that remained at a 1-month retention assessment was foot progression angle, with greater changes in the toe-out group (mean difference = -6.78°, 95% CI: -8.82°, -4.75°; P < 0.001).
Though both groups experienced improvements in self-reported pain and function, only the toe-out group experienced biomechanical improvements.
NCT02019108.
比较在伴有或不伴有足外展步态矫正的情况下，接受为期 4 个月的渐进性步行方案治疗后，内侧胫骨股骨膝骨关节炎患者的膝关节疼痛、功能和负荷的变化。
将内侧膝骨关节炎患者随机分为两组，一组接受为期 4 个月的增加步行活动的方案（足外展），另一组接受（渐进性步行）或不接受（单纯渐进性步行）同时进行的足外展步态矫正。两组的步行方案相似，只是步态矫正组被训练以 15°的足外展角度行走。主要结局指标包括：膝关节疼痛（WOMAC）、步态时的足部推进角度和膝关节负荷（膝关节内收力矩（KAM））。次要结局指标包括 WOMAC 功能、计时爬楼梯和步态时的膝关节弯曲力矩。
共招募了 79 名参与者（足外展组 40 名，单纯渐进性步行组 39 名）。意向治疗分析显示，两组间膝关节疼痛、功能或计时爬楼梯无差异。然而，足外展组的足部推进角度变化明显更大（平均差异=-9.04°（表明足外展角度更大），95%可信区间：-11.22°，-6.86°；P<0.001），站立后期 KAM（平均差异=-0.26%BWht，95%可信区间：-0.39%BWht，-0.12%BWht，P<0.001）和 KAM 冲量（-0.06%BWhts，95%可信区间：-0.11%BWhts，-0.01%BWht*s；P=0.031）与单纯渐进性步行组相比，随访时的变化更大。在 1 个月的保留评估中，唯一的组间差异是足部推进角度，足外展组的变化更大（平均差异=-6.78°，95%可信区间：-8.82°，-4.75°；P<0.001）。
尽管两组患者的自我报告疼痛和功能均有改善，但只有足外展组的生物力学指标有改善。
NCT02019108。
