Rynne Rebecca, Le Tong Gia, Cheung Roy T H, Constantinou Maria
School of Allied Health, Australian Catholic University, Brisbane, QLD 4014, Australia.
School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia.
Gait Posture. 2022 Jun;95:164-175. doi: 10.1016/j.gaitpost.2022.04.013. Epub 2022 Apr 18.
Osteoarthritis is a chronic synovial joint disease leading to pain, stiffness, and gait dysfunction, resulting in a significant health and economic burden. Gait retraining strategies and tools are used to address biomechanical gait dysfunction and symptoms in individuals with osteoarthritis. However, there is limited evidence relating to their effectiveness.
Do gait retraining strategies and tools improve gait biomechanics and symptoms in individuals with hip or knee osteoarthritis compared to control or alternate intervention?
Seven databases were searched using key words relating to osteoarthritis, gait retraining, and biomechanics. A best evidence synthesis was conducted on included studies. Where available, a meta-analysis was performed, and the standardised mean difference (SMD) and 95% confidence internals (CI) were reported.
Eighteen studies were included. One study investigated gait retraining in participants with hip osteoarthritis and demonstrated limited evidence for improving gait biomechanics. Seventeen studies on knee osteoarthritis were included in the best evidence synthesis with six included in the meta-analysis. Gait retraining strategies which incorporated a real-time biofeedback tool, appear to have strong evidence for effectively modifying walking biomechanics. Moderate evidence was identified to support kinesiology taping improving pain scores. The meta-analysis pooled effect demonstrated significant improvements for knee adduction moment [SMD, -1.10; 95% CI. -1.85, -0.35] and the Western Ontario and McMaster Osteoarthritis Index in favour of gait retraining than a control intervention [SMD, -0.86; 95% CI. -1.33, -0.39]. All other interventions demonstrated evidence that was conflicting, limited, or not in favour of gait retraining.
Gait retraining may be beneficial for improving biomechanics and symptoms in knee osteoarthritis, however due to the high heterogeneity and limited studies in the analysis, further research is required. Further high quality randomised controlled trials for knee and especially hip osteoarthritis investigating the effects of gait retraining on biomechanics and symptoms are required.
骨关节炎是一种慢性滑膜关节疾病，会导致疼痛、僵硬和步态功能障碍，造成重大的健康和经济负担。步态再训练策略和工具用于解决骨关节炎患者的生物力学步态功能障碍和症状。然而，关于其有效性的证据有限。
与对照或替代干预相比，步态再训练策略和工具能否改善髋或膝骨关节炎患者的步态生物力学和症状？
使用与骨关节炎、步态再训练和生物力学相关的关键词检索了七个数据库。对纳入的研究进行了最佳证据综合分析。如有可能，进行了荟萃分析，并报告了标准化平均差（SMD）和95%置信区间（CI）。
纳入了18项研究。一项研究调查了髋骨关节炎患者的步态再训练，结果显示改善步态生物力学的证据有限。最佳证据综合分析纳入了17项关于膝骨关节炎的研究，荟萃分析纳入了6项。结合实时生物反馈工具的步态再训练策略似乎有充分证据表明能有效改变行走生物力学。有中等证据支持肌内效贴布可改善疼痛评分。荟萃分析的汇总效应表明，与对照干预相比，膝内收力矩[SMD，-1.10；95%CI，-1.85，-0.35]以及西安大略和麦克马斯特大学骨关节炎指数在步态再训练方面有显著改善[SMD，-0.86；95%CI，-1.33，-0.39]。所有其他干预措施的证据相互矛盾、有限或不支持步态再训练。
步态再训练可能有助于改善膝骨关节炎的生物力学和症状，然而，由于分析中的高度异质性和研究有限，需要进一步研究。需要针对膝骨关节炎，尤其是髋骨关节炎进行进一步高质量的随机对照试验，以研究步态再训练对生物力学和症状的影响。
