Current Evidence of Gait Modification with Real-time Biofeedback to Alter Kinetic, Temporospatial, and Function-Related Outcomes: A Review

Oladipo Eddo, Bryndan Lindsey, Shane V. Caswell, Nelson Cortes

Abstract


Background: Gait retraining using real-time biofeedback (RTB) may have positive outcomes in decreasing knee adduction moment (KAM) in healthy individuals and has shown equal likelihood in patients with knee osteoarthritis (OA). Currently, there is no consensus regarding the most effective gait modification strategy, mode of biofeedback or treatment dosage. Objective: The purpose of this review was: i) to assess if gait retraining interventions using RTB are valuable to reduce KAM, pain, and improve function in individuals with knee osteoarthritis, ii) to evaluate the effectiveness of different gait modifications and modes of RTB in reducing KAM in healthy individuals, and iii) to assess the impact of gait retraining interventions with RTB on other variables that may affect clinical outcomes. Methods: Seven electronic databases were searched using five search terms. Studies that utilized any form of gait retraining with RTB to improve one or a combination of the following measures were included: KAM, knee pain, and function. Twelve studies met the inclusion criteria, evaluating eleven distinctive gait modifications and three modes of RTB. Results: All but one study showed positive outcomes. Self-selected and multi-parameter gait modifications showed the greatest reductions in KAM with visual and haptic RTB being more effective than auditory. Conclusions: Current evidence suggests that gait modification using RTB can Positively alter KAM in asymptomatic and symptomatic participants. However, the existing literature is limited and of low quality, with the optimal combination strategies remaining unclear (gait and biofeedback mode). Future studies should employ randomized controlled study designs to compare the effects of different gait modification strategies and biofeedback modes on individuals with knee OA.

Keywords


Gait Retraining, Real-time Biofeedback, Osteoarthritis, Knee Adduction Moment

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References


Allen, K. D., & Golightly, Y. M. (2015). Epidemiology of osteoarthritis: state of the evidence. Curr Opin Rheumatol, 27(3), 276.

Altman, R. D. (1991). Criteria for classification of clinical osteoarthritis. J Rheumatol Suppl, 27, 10-12.

Amin, S., Luepongsak, N., McGibbon, C. A., LaValley, M. P., Krebs, D. E., & Felson, D. T. (2004). Knee adduction moment and development of chronic knee pain in elders. Arthritis Care & Research, 51(3), 371-376.

Andriacchi, T. P., & Mundermann, A. (2006). The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rheumatol, 18(5), 514-518. doi:10.1097/01.bor.0000240365.16842.4e

Andriacchi, T. P., Mündermann, A., Smith, R. L., Alexander, E. J., Dyrby, C. O., & Koo, S. (2004). A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng, 32(3), 447-457.

Barrios, J. A., Crossley, K. M., & Davis, I. S. (2010). Gait retraining to reduce the knee adduction moment through real-time visual feedback of dynamic knee alignment. J Biomech, 43(11), 2208-2213. doi:10.1016/j.jbiomech.2010.03.040

Bellamy, N., Kirwan, J., Boers, M., Brooks, P., Strand, V., Tugwell, P., . . . Lequesne, M. (1997). Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol, 24(4), 799-802.

Bernier, P. M., Chua, R., & Franks, I. M. (2005). Is proprioception calibrated during visually guided movements? Exp Brain Res, 167(2), 292-296.

Browning, R. C., & Kram, R. (2007). Effects of obesity on the biomechanics of walking at different speeds. Med Sci Sports Exerc, 39(9), 1632-1641. doi:10.1249/mss.0b013e318076b54b

Chang, Moisio, K. C., Chmiel, J. S., Eckstein, F., Guermazi, A., Prasad, P. V., . . . Sharma, L. (2015). External knee adduction and flexion moments during gait and medial tibiofemoral disease progression in knee osteoarthritis. Osteoarthr Cartil, 23(7), 1099-1106. doi:http://dx.doi.org/10.1016/j.joca.2015.02.005

Chang, J. Y., Chang, G. L., Chien, C. J. C., Chung, K. C., & Hsu, A. T. (2007). Effectiveness of two forms of feedback on training of a joint mobilization skill by using a joint translation simulator. Phys Ther, 87(4), 418-430.

Chehab, E. F., Favre, J., Erhart-Hledik, J. C., & Andriacchi, T. P. (2014). Baseline knee adduction and flexion moments during walking are both associated with 5 year cartilage changes in patients with medial knee osteoarthritis. Osteoarthr Cartil, 22(11), 1833-1839. doi:10.1016/j.joca.2014.08.009

Control, C. f. D., & Prevention. (2013). Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2010-2012. MMWR. Morbidity and mortality weekly report, 62(44), 869.

Creaby, M. W., Wang, Y., Bennell, K. L., Hinman, R. S., Metcalf, B. R., Bowles, K. A., & Cicuttini, F. M. (2010). Dynamic knee loading is related to cartilage defects and tibial plateau bone area in medial knee osteoarthritis. Osteoarthritis Cartilage, 18(11), 1380-1385. doi:10.1016/j.joca.2010.08.013

Dearborn, J., Eakin, C., & Skinner, H. (1996). Medial compartment arthrosis of the knee. Am J Orthop (Belle Mead NJ), 25(1), 18-26.

Dowling, A. V., Corazza, S., Chaudhari, A. M., & Andriacchi, T. P. (2010). Shoe-surface friction influences movement strategies during a sidestep cutting task: implications for anterior cruciate ligament injury risk. Am J Sports Med, 38(3), 478-485. doi:38/3/478 [pii]

1177/0363546509348374

Dowling, A. V., Fisher, D. S., & Andriacchi, T. P. (2010). Gait modification via verbal instruction and an active feedback system to reduce peak knee adduction moment. J Biomech Eng, 132(7), 071007. doi:10.1115/1.4001584

Dwan, K., Gamble, C., Williamson, P. R., & Kirkham, J. J. (2013). Systematic review of the empirical evidence of study publication bias and outcome reporting bias - an updated review. PloS one, 8(7), e66844. doi:10.1371/journal.pone.0066844

Favre, J., Erhart-Hledik, J. C., Chehab, E. F., & Andriacchi, T. P. (2016). General scheme to reduce the knee adduction moment by modifying a combination of gait variables. J Orthop Res, 34(9), 1547-1556. doi:10.1002/jor.23151

Ferrigno, C., Stoller, I. S., Shakoor, N., Thorp, L. E., & Wimmer, M. A. (2016). The Feasibility of Using Augmented Auditory Feedback From a Pressure Detecting Insole to Reduce the Knee Adduction Moment: A Proof of Concept Study. J Biomech Eng, 138(2), 021014. doi:10.1115/1.4032123

Fitzpatrick, R. B. (2008). PEDro: a physiotherapy evidence database. Med Ref Serv Q, 27(2), 189-198.

Foroughi, N., Smith, R., & Vanwanseele, B. (2009). The association of external knee adduction moment with biomechanical variables in osteoarthritis: a systematic review. The Knee, 16(5), 303-309.

Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015). Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med, 49(24), 1554-1557. doi:10.1136/bjsports-2015-095424

Gerbrands, T. A., Pisters, M. F., & Vanwanseele, B. (2014). Individual selection of gait retraining strategies is essential to optimally reduce medial knee load during gait. Clin Biomech, 29(7), 828-834. doi:10.1016/j.clinbiomech.2014.05.005

Heijink, A., Gomoll, A. H., Madry, H., Drobnič, M., Filardo, G., Espregueira-Mendes, J., & Van Dijk, C. N. (2012). Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc, 20(3), 423-435.

Heuer, H., & Hegele, M. (2008). Constraints on visuo-motor adaptation depend on the type of visual feedback during practice. Exp Brain Res, 185(1), 101-110.

Hinman, R. S., Bowles, K. A., Payne, C., & Bennell, K. L. (2008). Effect of length on laterally‐wedged insoles in knee osteoarthritis. Arthritis Care Res (Hoboken), 59(1), 144-147.

Hunt, M. A., Simic, M., Hinman, R. S., Bennell, K. L., & Wrigley, T. V. (2011). Feasibility of a gait retraining strategy for reducing knee joint loading: Increased trunk lean guided by real-time biofeedback. J Biomech, 44(5), 943-947. doi:S0021-9290(10)00653-6 [pii]

1016/j.jbiomech.2010.11.027

Hunt, M. A., Takacs, J., Hart, K., Massong, E., Fuchko, K., & Biegler, J. (2014). Comparison of mirror, raw video, and real-time visual biofeedback for training toe-out gait in individuals with knee osteoarthritis. Archives of physical medicine and rehabilitation, 95(10), 1912-1917.

Hurwitz, D., Ryals, A., Case, J., Block, J., & Andriacchi, T. (2002). The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain. J Orthop Res, 20(1), 101-107.

Kean, C. O., Bennell, K. L., Wrigley, T. V., & Hinman, R. S. (2013). Modified walking shoes for knee osteoarthritis: mechanisms for reductions in the knee adduction moment. J Biomech, 46(12), 2060-2066.

Kean, C. O., Hinman, R. S., Bowles, K. A., Cicuttini, F., Davies-Tuck, M., & Bennell, K. L. (2012). Comparison of peak knee adduction moment and knee adduction moment impulse in distinguishing between severities of knee osteoarthritis. Clin Biomech (Bristol, Avon), 27(5), 520-523. doi:10.1016/j.clinbiomech.2011.12.007

Ma, V. Y., Chan, L., & Carruthers, K. J. (2014). Incidence, prevalence, costs, and impact on disability of common conditions requiring rehabilitation in the United States: stroke, spinal cord injury, traumatic brain injury, multiple sclerosis, osteoarthritis, rheumatoid arthritis, limb loss, and back pain. Arch Phys Med Rehabil, 95(5), 986-995. e981.

Manal, K., Gardinier, E., Buchanan, T. S., & Snyder-Mackler, L. (2015). A more informed evaluation of medial compartment loading: the combined use of the knee adduction and flexor moments. Osteoarthritis Cartilage, 23(7), 1107-1111. doi:10.1016/j.joca.2015.02.779

Mayr, A., Kofler, M., Quirbach, E., Matzak, H., Fröhlich, K., & Saltuari, L. (2007). Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair, 21(4), 307-314.

Miyazaki, T., Wada, M., Kawahara, H., Sato, M., Baba, H., & Shimada, S. (2002). Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Ann Rheum Dis, 61(7), 617-622.

Neogi, T., & Zhang, Y. (2013). Epidemiology of osteoarthritis. Rheum Dis Clin North Am, 39(1), 1-19.

Nguyen, U.-S. D., Zhang, Y., Zhu, Y., Niu, J., Zhang, B., & Felson, D. T. (2011). Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med, 155(11), 725-732.

Richards, R., van den Noort, J. C., Dekker, J., & Harlaar, J. (2017). Gait Retraining With Real-Time Biofeedback to Reduce Knee Adduction Moment: Systematic Review of Effects and Methods Used. Arch Phys Med Rehabil, 98(1), 137-150. doi:10.1016/j.apmr.2016.07.006

Riskowski, J. L. (2010). Gait and neuromuscular adaptations after using a feedback-based gait monitoring knee brace. Gait Posture, 32(2), 242-247. doi:10.1016/j.gaitpost.2010.05.002

Robbins, S. M., Birmingham, T. B., Callaghan, J. P., Jones, G. R., Chesworth, B. M., & Maly, M. R. (2011). Association of pain with frequency and magnitude of knee loading in knee osteoarthritis. Arthritis Care Res (Hoboken), 63(7), 991-997. doi:10.1002/acr.20476

Robbins, S. M., & Maly, M. R. (2009). The effect of gait speed on the knee adduction moment depends on waveform summary measures. Gait Posture, 30(4), 543-546. doi:10.1016/j.gaitpost.2009.08.236

Russell, E. M., Braun, B., & Hamill, J. (2010). Does stride length influence metabolic cost and biomechanical risk factors for knee osteoarthritis in obese women? Clin Biomech (Bristol, Avon), 25(5), 438-443. doi:10.1016/j.clinbiomech.2010.01.016

Segal, N. A., Glass, N. A., Teran-Yengle, P., Singh, B., Wallace, R. B., & Yack, H. J. (2015). Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis. Am J Phys Med Rehabil, 94(10 Suppl 1), 848-858. Retrieved from doi:10.1097/PHM.0000000000000264

Sharma, L., Hurwitz, D. E., Thonar, E. J. A., Sum, J. A., Lenz, M. E., & Dunlop, D. D. (1998). Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis. Age, 4, 13.

Sharma, L., Lou, C., Cahue, S., & Dunlop, D. D. (2000). The mechanism of the effect of obesity in knee osteoarthritis: the mediating role of malalignment. Arthritis Rheum, 43(3), 568-575. doi:10.1002/1529-0131(200003)43:3<568::AID-ANR13>3.0.CO;2-E

Shull, P. B., Lurie, K. L., Cutkosky, M. R., & Besier, T. F. (2011). Training multi-parameter gaits to reduce the knee adduction moment with data-driven models and haptic feedback. J Biomech, 44(8), 1605-1609. doi:10.1016/j.jbiomech.2011.03.016

Shull, P. B., Shultz, R., Silder, A., Dragoo, J. L., Besier, T. F., Cutkosky, M. R., & Delp, S. L. (2013). Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis. J Biomech, 46(1), 122-128.

Shull, P. B., Silder, A., Shultz, R., Dragoo, J. L., Besier, T. F., Delp, S. L., & Cutkosky, M. R. (2013). Six-Week Gait Retraining Program Reduces Knee Adduction Moment, Reduces Pain, and Improves Function for Individuals with Medial Compartment Knee Osteoarthritis. J Orthop Res, 31(7), 1020-1025. doi:10.1002/jor.22340

Sigrist, R., Rauter, G., Riener, R., & Wolf, P. (2013). Augmented visual, auditory, haptic, and multimodal feedback in motor learning: a review. Psychon Bull Rev, 20(1), 21-53. doi:10.3758/s13423-012-0333-8

Simic, M., Hinman, R. S., Wrigley, T. V., Bennell, K. L., & Hunt, M. A. (2011). Gait modification strategies for altering medial knee joint load: a systematic review. Arthritis Care Res (Hoboken), 63(3), 405-426. doi:10.1002/acr.20380

Simic, M., Hunt, M. A., Bennell, K. L., Hinman, R. S., & Wrigley, T. V. (2012). Trunk lean gait modification and knee joint load in people with medial knee osteoarthritis: The effect of varying trunk lean angles. Arthritis Care Res (Hoboken), 64(10), 1545-1553. doi:10.1002/acr.21724

Simon, D., Mascarenhas, R., Saltzman, B. M., Rollins, M., Bach, B. R., & MacDonald, P. (2015). The relationship between anterior cruciate ligament injury and osteoarthritis of the knee. Adv Orthop, 2015, 928301.

Snodgrass, S. J., Rivett, D. A., Robertson, V. J., & Stojanovski, E. (2010). Real-time feedback improves accuracy of manually applied forces during cervical spine mobilisation. Manual therapy, 15(1), 19-25.

Sülzenbrück, S., & Heuer, H. (2011). Type of visual feedback during practice influences the precision of the acquired internal model of a complex visuo-motor transformation. Ergonomics, 54(1), 34-46.

Tate, J. J., & Milner, C. E. (2010). Real-time kinematic, temporospatial, and kinetic biofeedback during gait retraining in patients: a systematic review. Phys Ther, 90(8), 1123-1134. doi:10.2522/ptj.20080281

Thomas, R. H., Resnick, D., Alazraki, N. P., Daniel, D., & Greenfield, R. (1975). Compartmental Evaluation of Osteoarthritis of the Knee: A Comparative Study of Available Diagnostic Modalities 1. Radiology, 116(3), 585-594.

van den Noort, J. C., Steenbrink, F., Roeles, S., & Harlaar, J. (2014). Real-time visual feedback for gait retraining: toward application in knee osteoarthritis. Med Biol Eng Comput, 53(3), 275-286.

Walter, J. P., D'Lima, D. D., Colwell, C. W., Jr., & Fregly, B. J. (2010). Decreased knee adduction moment does not guarantee decreased medial contact force during gait. J Orthop Res, 28(10), 1348-1354. doi:10.1002/jor.21142

Wheeler, J. W., Shull, P. B., & Besier, T. F. (2011). Real-time knee adduction moment feedback for gait retraining through visual and tactile displays. J Biomech Eng, 133(4), 041007. doi:10.1115/1.4003621

Wishart, L. R., Lee, T. D., Cunningham, S. J., & Murdoch, J. E. (2002). Age-related differences and the role of augmented visual feedback in learning a bimanual coordination pattern. Acta Psychol, 110(2), 247-263.

Zalecki, T., Gorecka-Mazur, A., Pietraszko, W., Surowka, A. D., Novak, P., Moskala, M., & Krygowska-Wajs, A. (2013). Visual feedback training using WII Fit improves balance in Parkinson's disease. Folia Med Cracov, 53(1), 65-78.

Zhang, W., Moskowitz, R. W., Nuki, G., Abramson, S., Altman, R. D., Arden, N., . . . Tugwell, P. (2007). OARSI recommendations for the management of hip and knee osteoarthritis, part I: critical appraisal of existing treatment guidelines and systematic review of current research evidence. Osteoarthr Cartil, 15(9), 981-1000. doi:10.1016/j.joca.2007.06.014

Zhao, D., Banks, S. A., Mitchell, K. H., D'Lima, D. D., Colwell, C. W., & Fregly, B. J. (2007). Correlation between the knee adduction torque and medial contact force for a variety of gait patterns. J Orthop Res, 25(6), 789-797.




DOI: https://doi.org/10.7575/aiac.ijkss.v.5n.3p.35

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