Foot Progression Angle Modification: an Exploratory Six-week Telerehabilitation Intervention in People With Knee Osteoarthritis
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Osteoarthritis, Knee
- Sponsor
- University of British Columbia
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- Lab-measured Performance of Gait Modification
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
Excessive knee joint loads during walking can contribute to knee osteoarthritis progression. Changing the rotation of the foot (in-toeing or out-toeing) while walking can lower knee joint loads and improve pain and function. Telerehabilitation (using video or telephone communication to delivery rehabilitation) has shown promise in delivering exercise therapy for knee osteoarthritis, but it is unknown if walking modifications can be delivered using this method. This study consists of a six-week walking modification program in people with knee osteoarthritis. Performance of the modification will be measured using motion capture and wearable sensors during practice and daily life.
Detailed Description
Loads on the knee joint during walking are related to worsening of knee osteoarthritis. Changing walking motions to lower these knee joint loads is an emerging management strategy for knee osteoarthritis. Multiple studies have targeted a change in the position of the foot relative to the direction of walking (toe-in or toe-out walking) and have shown this walking modification to lower knee joint loads and improve symptoms (e.g. pain) related to knee osteoarthritis within the context of a walking program. Building off the many studies that have found telerehabilitation to be an effective method of providing exercise and pain-coping physical therapy, the investigators will use this method to provide walking modification treatment. Telerehabilitation (using video or teleconferencing to conduct the physical therapy appointment) provides a convenient and cost-effective method to work with patients and coordinate their treatment plan. To monitor progress with learning the walking modification, the investigators will use a custom sensor shoe that the participants will wear during daily walking activities over the six-week intervention. Overall, this study will investigate the feasibility and effectiveness of a walking modification program delivered using video- or teleconference.
Investigators
Michael Hunt
Professor, Assoc Dean
University of British Columbia
Eligibility Criteria
Inclusion Criteria
- •50 years of age or older
- •Exhibit signs of tibiofemoral osteoarthritis based on a score of ≥2 on the Kellgren and Lawrence grading scale predominantly in the medial compartment.
- •Self-reported knee pain ≥ 3 / 10 on a numerical rating scale of pain (NRS; 0 = "no pain" and 10 = "worst pain imaginable") during most days of the previous month
- •Comfortable walking intermittently for 30 minutes
- •Fit into the available sizes of sensor shoes (between US women's 5 to men's 13)
- •Exhibits ≥2% reduction in knee adduction moment impulse at 10 degrees of change in toe-in or toe-out during the screening appointment.
Exclusion Criteria
- •Any knee surgery or intraarticular injections within the past 6 months
- •A history of joint replacement surgery or high tibial osteotomy
- •Current or recent (within 6 weeks) corticosteroid injections
- •Use of a gait aid
- •Currently on a wait list for joint replacement surgery or high tibial osteotomy
- •Any inflammatory arthritic condition
- •Any other conditions that may affect normal gait or participation in an aerobic exercise program
- •Cannot attend all required appointments
Outcomes
Primary Outcomes
Lab-measured Performance of Gait Modification
Time Frame: Baseline, Week 6
Change in foot rotation angle between baseline and week 6 (follow-up) appointments measured using marker-based motion capture. Foot rotation is defined as the angle between the long axis of the foot and the walking direction. Measures of central tendency and variability will be extracted.
Real-world Performance of Gait Modification
Time Frame: Baseline, Week 1&2, Week 3&4, Week 5&6, Follow up (Week 6/12), Retention (Week 10/16)
Change in absolute median foot rotation from baseline to each real-world walking bout (represented as a single data file on the sensor module), follow-up, and retention measured via the sensor shoe. Foot rotation is defined as the angle between the long axis of the foot and the walking direction. Measures of central tendency and variability will be extracted, in addition to the proportion of steps with a greater than or equal to 7 degree change.
Intervention Adherence
Time Frame: Week 6
Adherence will be measured by the ratio of telerehabilitation sessions the participant attends relative to the total sessions (5 total).
Compliance With Gait Modification
Time Frame: Week 6
Compliance will be estimated by self-reported confidence in performing the gait modification (where 0 = "no confidence" and 10 = "complete confidence") at follow up. Acceptable confidence ratings by week 6 are greater than or equal to 7/10.
Difficulty in Performing the Modification
Time Frame: Week 6
Difficulty of performing the modification at week 6. Difficulty measured on an NRS scale (0 = no difficulty and 10 = most difficulty possible). Acceptable difficulty by week 6 is less than or equal to 4/10.
Satisfaction With the Treatment Program
Time Frame: Week 6
Satisfaction with the gait modification program on a 7-point Likert scale where -3 = "extremely unsatisfied" and +3 = "extremely satisfied". Scores of +2 or +3 will be considered "satisfied" and acceptable.
Secondary Outcomes
- Knee-osteoarthritis Related Symptoms(Baseline, Week 6)
- Knee Joint Moments(Baseline, Week 6)
- Knee Joint Moment Impulse(Baseline, Week 6)