Bowd Jake, Biggs Paul, Holt Cathy, Whatling Gemma
College of Physical Sciences and Engineering, Cardiff University, Cardiff, United Kingdom.
Biomechanics and Bioengineering Research Centre Versus Arthritis, Cardiff University, Cardiff, United Kingdom.
Arch Rehabil Res Clin Transl. 2019 Sep 5;1(3-4):100022. doi: 10.1016/j.arrct.2019.100022. eCollection 2019 Dec.
To review the literature regarding gait retraining to reduce knee adduction moments and their effects on hip and ankle biomechanics.
Twelve academic databases were searched from inception to January 2019. Key words "walk*" OR "gait," "knee" OR "adduction moment," "osteoarthriti*" OR "arthriti*" OR "osteo arthriti*" OR "OA," and "hip" OR "ankle" were combined with conjunction "and" in all fields.
Abstracts and full-text articles were assessed by 2 individuals against a predefined criterion.
Of the 11 studies, sample sizes varied from 8-40 participants. Eight different gait retraining styles were evaluated: hip internal rotation, lateral trunk lean, toe-in, toe-out, increased step width, medial thrust, contralateral pelvic drop, and medial foot weight transfer. Using the Black and Downs tool, the methodological quality of the included studies was fair to moderate ranging between 12 of 25 to 18 of 28. Trunk lean and medial thrust produced the biggest reductions in first peak knee adduction moment. Studies lacked collective sagittal and frontal plane hip and ankle joint biomechanics. Generally, studies had a low sample size of healthy participants with no osteoarthritis and assessed gait retraining during 1 laboratory visit while not documenting the difficulty of the gait retraining style.
Gait retraining techniques may reduce knee joint loading; however, the biomechanical effects to the pelvis, hip, and ankle is unknown, and there is a lack of understanding for the ease of application of the gait retraining styles.
回顾关于步态再训练以减少膝关节内收力矩及其对髋部和踝关节生物力学影响的文献。
检索了12个学术数据库，时间跨度从建库至2019年1月。关键词“walk*”或“gait”、“knee”或“adduction moment”、“osteoarthriti*”或“arthriti*”或“osteo arthriti*”或“OA”以及“hip”或“ankle”在所有字段中与连词“and”组合。
由两名研究人员根据预先确定的标准对摘要和全文进行评估。
11项研究中，样本量从8至40名参与者不等。评估了8种不同的步态再训练方式：髋关节内旋、躯干向外侧倾斜、脚尖内扣、脚尖外展、步幅增加、内侧推力、对侧骨盆下降和足部内侧负重转移。使用Black和Downs工具，纳入研究的方法学质量为中等，得分在25分中的12分至28分中的18分之间。躯干倾斜和内侧推力使首次峰值膝关节内收力矩降低幅度最大。研究缺乏对矢状面和额状面髋部及踝关节生物力学的综合分析。总体而言，研究中健康参与者且无骨关节炎的样本量较小，仅在一次实验室访视期间评估步态再训练，且未记录步态再训练方式的难度。
步态再训练技术可能会降低膝关节负荷；然而，其对骨盆、髋部和踝关节的生物力学影响尚不清楚，并且对于步态再训练方式的应用难易程度缺乏了解。
