Gerbrands T A, Pisters M F, Verschueren S, Vanwanseele B
Fontys Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Human Movement Biomechanics Research Group, Department of Kinesiology, KU Leuven, Belgium.
Fontys Allied Health Professions, Fontys University of Applied Sciences, Eindhoven, the Netherlands; Physical Therapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands.
Gait Posture. 2023 May;102:1-9. doi: 10.1016/j.gaitpost.2023.02.017. Epub 2023 Feb 26.
The gait modification strategies Trunk Lean and Medial Thrust have been shown to reduce the external knee adduction moment (EKAM) in patients with knee osteoarthritis which could contribute to reduced progression of the disease. Which strategy is most optimal differs between individuals, but the underlying mechanism that causes this remains unknown.
Which gait parameters determine the optimal gait modification strategy for individual patients with knee osteoarthritis?
Forty-seven participants with symptomatic medial knee osteoarthritis underwent 3-dimensional motion analysis during comfortable gait and with two gait modification strategies: Medial Thrust and Trunk Lean. Kinematic and kinetic variables were calculated. Participants were then categorized into one of the two subgroups, based on the modification strategy that reduced the EKAM the most for them. Multiple logistic regression analysis with backward elimination was used to investigate the predictive nature of dynamic parameters obtained during comfortable walking on the optimal modification gait strategy.
For 68.1 % of the participants, Trunk Lean was the optimal strategy in reducing the EKAM. Baseline characteristics, kinematics and kinetics did not differ significantly between subgroups during comfortable walking. Changes to frontal trunk and tibia angles correlated significantly with EKAM reduction during the Trunk Lean and Medial Thrust strategies, respectively. Regression analysis showed that MT is likely optimal when the frontal tibia angle range of motion and peak knee flexion angle in early stance during comfortable walking are high (R = 0.12).
Our regression model based solely on kinematic parameters from comfortable walking contained characteristics of the frontal tibia angle and knee flexion angle. As the model explains only 12.3 % of variance, clinical application does not seem feasible. Direct assessment of kinetics seems to be the most optimal strategy for selecting the most optimal gait modification strategy for individual patients with knee osteoarthritis.
步态修正策略“躯干前倾”和“内侧推力”已被证明可降低膝骨关节炎患者的膝关节外展力矩（EKAM），这可能有助于减缓疾病进展。哪种策略最为优化因人而异，但其背后的原因尚不清楚。
哪些步态参数决定了膝骨关节炎个体患者的最佳步态修正策略？
47名有症状的膝关节内侧骨关节炎患者在自然步态以及两种步态修正策略（内侧推力和躯干前倾）下接受三维运动分析。计算运动学和动力学变量。然后根据对患者降低EKAM效果最佳的修正策略，将参与者分为两个亚组之一。采用向后逐步回归的多因素逻辑回归分析，研究自然行走时获得的动态参数对最佳修正步态策略的预测性质。
对于68.1%的参与者，躯干前倾是降低EKAM的最佳策略。自然行走时，亚组间的基线特征、运动学和动力学无显著差异。躯干前倾和内侧推力策略中，躯干额状面角度和胫骨角度的变化分别与EKAM降低显著相关。回归分析表明，当自然行走时胫骨额状面角度运动范围和早期站立时膝关节屈曲峰值角度较大时，内侧推力可能是最佳策略（R = 0.12）。
我们仅基于自然行走运动学参数的回归模型包含了胫骨额状面角度和膝关节屈曲角度的特征。由于该模型仅解释了12.3%的方差，临床应用似乎不可行。直接评估动力学似乎是为膝骨关节炎个体患者选择最佳步态修正策略的最优化策略。
