James Khara A, Corrigan Patrick, Huang Chun-Hao, Lanois Corey, LaValley Michael P, Davis Irene S, Stefanik Joshua J
Northeastern University and Brigham and Women's Hospital, Boston, Massachusetts.
Cleveland Clinic, Cleveland, Ohio.
ACR Open Rheumatol. 2025 Aug;7(8):e70079. doi: 10.1002/acr2.70079.
To assess the feasibility of a randomized controlled trial evaluating a gait retraining program to reduce peak tibial acceleration on knee pain and impact loading in adults with knee osteoarthritis.
Participants (n = 44) were randomized to a gait retraining or standard walking program. Walking duration increased from 10 to 30 minutes as feedback faded over eight sessions. Gait retraining participants received real-time biofeedback to reduce peak tibial acceleration by 20%. Feasibility criteria included rates of recruitment, enrollment, and retention and number of adverse events. Knee pain and overground impact loading were assessed at baseline and one week after the last treadmill session. Analysis of covariance models compared group differences in peak tibial acceleration, pain, and impact loading after the walking program, controlling for baseline values.
Most feasibility criteria were met. From 2019 to 2023, 867 individuals were screened (~22 individuals per month), and 46 were enrolled and randomized (n = 23 per group). No adverse events were identified. Peak tibial acceleration reduced by 0.13g and 0.09g (gravitational equivalents) for the gait retraining and standard walking groups, respectively. Greater reductions in pain were observed for the standard walking group compared to the gait retraining group. Changes in impact loading were not significant in either group. No between-group differences were observed for peak tibial acceleration, knee pain, or impact loading.
A full-scale randomized clinical trial is feasible with modification. However, gait retraining to reduce peak tibial acceleration was no more effective than a standard walking program for reducing knee pain and impact loading.
评估一项随机对照试验的可行性，该试验旨在评估一种步态再训练计划，以降低成人膝骨关节炎患者的胫骨峰值加速度、膝关节疼痛和冲击负荷。
参与者（n = 44）被随机分配到步态再训练组或标准步行组。随着反馈在八个疗程中逐渐消失，步行时间从10分钟增加到30分钟。步态再训练组的参与者接受实时生物反馈，以使胫骨峰值加速度降低20%。可行性标准包括招募率、入组率、保留率和不良事件数量。在基线和最后一次跑步机训练后一周评估膝关节疼痛和地面冲击负荷。协方差分析模型比较了步行计划后胫骨峰值加速度、疼痛和冲击负荷的组间差异，并对基线值进行了控制。
大多数可行性标准得到满足。2019年至2023年，共筛查了867人（约每月22人），46人入组并随机分组（每组n = 23）。未发现不良事件。步态再训练组和标准步行组的胫骨峰值加速度分别降低了0.13g和0.09g（重力当量）。与步态再训练组相比，标准步行组的疼痛减轻更为明显。两组的冲击负荷变化均无统计学意义。在胫骨峰值加速度、膝关节疼痛或冲击负荷方面，未观察到组间差异。
经过修改，大规模随机临床试验是可行的。然而，在减轻膝关节疼痛和冲击负荷方面，步态再训练降低胫骨峰值加速度的效果并不比标准步行计划更有效。
