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步行干预对膝关节生物力学性骨关节炎结局的影响:一项系统评价与荟萃分析。

The effect of walking interventions on biomechanical knee osteoarthritis outcomes: A systematic review and meta-analysis.

作者信息

Budarick Aleksandra R, Hubley-Kozey Cheryl L, Theou Olga, Stanish William D, Hannigan Meaghan, Moyer Rebecca F

机构信息

School of Physiotherapy, Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2, Canada.

Department of Surgery, Division of Orthopaedics, Dalhousie University, 5849 University Avenue, Halifax, Nova Scotia B3H 4R2, Canada.

出版信息

Semin Arthritis Rheum. 2025 Aug;73:152755. doi: 10.1016/j.semarthrit.2025.152755. Epub 2025 May 14.


DOI:10.1016/j.semarthrit.2025.152755
PMID:40393378
Abstract

PURPOSE: To summarize walking parameters specified in biomechanical analyses for knee osteoarthritis populations, determine the biomechanical effects of walking interventions, and explore associations between walking parameters and biomechanical knee osteoarthritis outcomes. METHODS: Databases (CINAHL, Embase, PubMED, SportDiscus, Scopus) were searched through October 2024. Experimental studies investigating biomechanical effects of walking interventions on knee osteoarthritis were included. Study quality was assessed using the QualSyst tool. Quantitative meta-analyses calculated Hedge's g standardized mean differences (SMD) for first peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment (KFM), and gait speed. Meta-regressions investigated the effect of walking parameters (intervention length; duration, frequency, intensity) on outcomes. RESULTS: Eighteen studies were included. Interventions investigated walking for 19.4 (SD=25.9) weeks, at 24.6 (SD=9.7) minutes per session, and 3.2 (SD=1.7) sessions per week. Most interventions specified self-selected intensity. Meta-analyses of 13 studies indicated walking interventions provide a very small increase in first peak KAM (SMD=0.18), no effect on KAM impulse (SMD=-0.01), small increase in peak KFM (adjusted SMD=0.23), and small increase in gait speed (SMD=0.35). Meta-regressions revealed longer interventions were associated with increased KFM (β=0.02), and higher walking frequency with increased gait speed (β=0.37). No other parameters were associated with biomechanical outcomes. CONCLUSIONS: Walking interventions elicit minimal-to-no change in discrete biomechanical metrics of joint loading for individuals with mild-to-moderate knee osteoarthritis. Longer walking interventions or more frequent walking may provide additional functional benefit. These results may inform walking guidelines for knee osteoarthritis and predominantly support increased walking without detrimental effects to knee joint health.

摘要

目的:总结生物力学分析中针对膝骨关节炎人群规定的步行参数,确定步行干预的生物力学效应,并探索步行参数与膝骨关节炎生物力学结果之间的关联。 方法:检索截至2024年10月的数据库(CINAHL、Embase、PubMed、SportDiscus、Scopus)。纳入研究步行干预对膝骨关节炎生物力学效应的实验性研究。使用QualSyst工具评估研究质量。定量荟萃分析计算了首次峰值膝内收力矩(KAM)、KAM冲量、峰值膝屈曲力矩(KFM)和步速的Hedge's g标准化均值差异(SMD)。荟萃回归研究了步行参数(干预时长;持续时间、频率、强度)对结果的影响。 结果:纳入18项研究。干预措施包括步行19.4(标准差=25.9)周,每次24.6(标准差=9.7)分钟,每周3.2(标准差=1.7)次。大多数干预措施规定的是自我选择的强度。对13项研究的荟萃分析表明,步行干预使首次峰值KAM略有增加(SMD=0.18),对KAM冲量无影响(SMD=-0.01),使峰值KFM略有增加(调整后SMD=0.23),并使步速略有增加(SMD=0.35)。荟萃回归显示,干预时间越长,KFM越高(β=0.02),步行频率越高,步速越快(β=0.37)。没有其他参数与生物力学结果相关。 结论:对于轻至中度膝骨关节炎患者,步行干预对关节负荷的离散生物力学指标产生的变化极小或无变化。更长时间的步行干预或更频繁的步行可能会带来额外的功能益处。这些结果可为膝骨关节炎的步行指南提供参考,并主要支持增加步行量而不对膝关节健康产生不利影响。

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