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Wang M, Zhang C, Yang Z, Cheng T, Lan C, Mo F. Muscle activation patterns and gait changes in unilateral knee osteoarthritis patients: a comparative study with healthy controls. Clin Rheumatol 2024; 43:2963-2972. [PMID: 39088118 DOI: 10.1007/s10067-024-07057-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/23/2024] [Accepted: 07/04/2024] [Indexed: 08/02/2024]
Abstract
The objective of this study was to investigate the differences in muscle activation and kinematic parameters between patients with unilateral knee osteoarthritis (OA) and healthy individuals. Additionally, the study aimed to determine the correlation between muscle activation and kinematic parameters with knee OA symptoms. Participants with unilateral knee OA (n = 32) and healthy individuals (n = 32) completed the gait test. Electromyography (EMG) and motion capture were employed to collect muscle activation data and kinematic parameters. Spearman's correlation coefficient was used to analysis the correlation between BMI, symptomatic side EMG parameters, kinematic parameters, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Furthermore, a multiple linear regression analysis of WOMAC pain was also conducted. The peak root mean square, integrated electromyography, and co-activation index (CCI) were increased bilaterally in the unilateral knee OA group compared to the healthy group. Furthermore, these values were higher on the symptomatic side than on the asymptomatic side. Compared with the healthy group, the knee OA group had lower gait speed, decreased stride length and cadence on bilateral sides, longer total stance time and double-stance time, and shorter single stance time and swing time. The maximum knee flexion angle of the swing phase on the symptomatic side of the knee OA group was smaller than that on the asymptomatic side and healthy group. Changes in EMG and gait parameters on the symptomatic side correlated with WOMAC scores. The main factors influencing WOMAC pain were the CCI values of the lateral femoral and biceps femoris muscles and gait speed. Muscle activation and kinematic parameters in the lower limbs of patients with unilateral knee OA were altered bilaterally during walking. These alterations on the symptomatic side were associated with knee OA-related pain. ChiCTR2200064958. Date of registration: 2022-10-24. Key Points • Unilateral symptomatic knee OA leads to bilateral alterations in muscle activation and gait parameters. • Symptomatic muscle activation and gait parameter changes in knee OA patients are associated with knee OA symptoms. • Correcting abnormal muscle activation conditions and gait training may reduce knee OA-related pain.
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Affiliation(s)
- Meiyi Wang
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Changjie Zhang
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Zhi Yang
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, Hunan, China
| | - Tiefeng Cheng
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, Hunan, China
| | - Chunna Lan
- Department of Rehabilitation, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
| | - Fuhao Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, 410082, Hunan, China.
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Taniguchi T, Tanaka S, Nishigami T, Imai R, Mibu A, Yoshimoto T. Relationship between Fear-Avoidance Beliefs and Muscle Co-Contraction in People with Knee Osteoarthritis. SENSORS (BASEL, SWITZERLAND) 2024; 24:5137. [PMID: 39204834 PMCID: PMC11359681 DOI: 10.3390/s24165137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
Excessive muscle co-contraction is one of the factors related to the progression of knee osteoarthritis (OA). A previous study demonstrated that pain, joint instability, lateral thrust, weight, and lower extremity alignment were listed as factors affecting excessive co-contraction in knee OA. However, this study aimed to assess the association between fear-avoidance beliefs and muscle co-contraction during gait and stair climbing in people with knee OA. Twenty-four participants with knee OA participated in this cross-sectional study. Co-contraction ratios (CCRs) were used to calculate muscle co-contraction during walking and stair climbing, using surface electromyography. Fear-avoidance beliefs were assessed by the Tampa Scale for Kinesiophobia-11 (TSK-11) for kinesiophobia and the Pain Catastrophizing Scale (PCS) for pain catastrophizing. Secondary parameters that may influence co-contraction, such as degree of pain, lateral thrust, weight, and lower extremity alignment, were measured. The relationships between the CCR during each movement, TSK-11, and PSC were evaluated using Spearman's rank correlation coefficient and partial correlation analysis, adjusted by weight and lower extremity alignment. Partial correlation analysis showed a significant correlation only between medial muscles CCR and TSK-11 during stair descent (r = 0.54, p < 0.05). Our study revealed that kinesiophobia could be associated with co-contraction during stair descent in people with knee OA.
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Affiliation(s)
- Takanori Taniguchi
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan;
| | - So Tanaka
- Department of Clinical Research Center, Fukuoka Orthopaedic Hospital, Fukuoka 815-0063, Japan;
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Hiroshima 723-005, Japan
| | - Ryota Imai
- Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Osaka 597-0104, Japan;
| | - Akira Mibu
- Department of Physical Therapy, Konan Women’s University, Hyogo 658-0001, Japan;
| | - Takaaki Yoshimoto
- Department of Orthopaedic, Fukuoka Orthopaedic Hospital, Fukuoka 815-0063, Japan;
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Bleuel J, Komnik I, Mittendorfer I, Michel B, Willwacher S. Abnormal gait pattern in downhill hiking is related to muscular deficits of the knee flexors and extensors in active patients with total knee arthroplasty. Clin Biomech (Bristol, Avon) 2024; 111:106150. [PMID: 37979246 DOI: 10.1016/j.clinbiomech.2023.106150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND To assess the in-field walking mechanics during downhill hiking of patients with total knee arthroplasty five to 14 months after surgery and an age-matched healthy control group and relate them to the knee flexor and extensor muscle strength. METHODS Participants walked on a predetermined hiking trail at a self-selected, comfortable pace wearing an inertial sensor system for recording the whole-body 3D kinematics. Sagittal plane hip, knee, and ankle joint angles were evaluated over the gait cycle at level walking and two different negative slopes. The concentric and eccentric lower extremity muscle strength of the knee flexors and extensors isokinetically at 50 and 120°/s were measured. FINDINGS Less knee flexion angles during stance have been measured in patients in the operated limb compared to healthy controls in all conditions (level walking, moderate downhill, steep downhill). The differences increased with steepness. Muscle strength was lower in patients for both muscle groups and all measured conditions. The functional hamstrings to quadriceps ratio at 120°/sec correlated with knee angle during level and downhill walking at the moderate slope in patients, showing higher ratios with lower peak knee flexion angles. INTERPRETATION The study shows that even if rehabilitation has been completed successfully and complication-free, five to 14 months after surgery, the muscular condition was still insufficient to display a normal gait pattern during downhill hiking. The muscle balance between quadriceps and hamstring muscles seems related to the persistence of a stiff knee gait pattern after knee arthroplasty. LoE: III.
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Affiliation(s)
- Judith Bleuel
- Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany.
| | - Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Iris Mittendorfer
- Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Björn Michel
- Institute of Motion Analysis and Sports Medicine, endogap Clinic for Joint Replacement, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany; Institute of Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
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Salis Z, Gallego B, Sainsbury A. Researchers in rheumatology should avoid categorization of continuous predictor variables. BMC Med Res Methodol 2023; 23:104. [PMID: 37101144 PMCID: PMC10134601 DOI: 10.1186/s12874-023-01926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology. METHODS We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes. RESULTS For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association). CONCLUSIONS Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.
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Affiliation(s)
- Zubeyir Salis
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Blanca Gallego
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Perth, WA, 6009, Australia.
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Kubota K, Yokoyama M, Onitsuka K, Kanemura N. The investigation of an analysis method for co-activation of knee osteoarthritis utilizing normalization of peak dynamic method. Gait Posture 2023; 101:48-54. [PMID: 36724656 DOI: 10.1016/j.gaitpost.2023.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Assessing co-activation characteristics in knee osteoarthritis (knee OA) using method of quantification of the activity ratio (such as the co-contraction index (CCI) or the directed co-activation ratios (DCAR)) for surface electromyography (EMG) has been reported. However, no studies have discussed the differences in results between non-negative matrix factorization (NNMF) and the DCAR. RESEARCH QUESTION Does DCAR or NNMF reflect the characteristic co-activation pattern of knee OA while using EMG normalized by the peak dynamic method? METHODS Ten elderly control participants (EC) and ten knee OA patients (KOA) volunteered to participate in this study. EMG data from 20 participants were obtained from our previous study. Patients with knee OA were recruited from a local orthopedic clinic. The DCAR of agonist and antagonist muscles and the number of modules using NNMF were calculated to evaluate multiple muscle co-activations. An independent t-test statistical parametric mapping approach was used to compare the DCAR between the two groups. The difference in the number of modules between EC and KOA was evaluated using the Wilcoxon rank-sum test. RESULTS There was no significant difference in the DCAR between the two groups. However, NNMF had significantly fewer modules with KOA than with EC. SIGNIFICANCE The NNMF with the ratio of the amplitude of each muscle and duration of activity as variables reflected the co-activation of KOA, characterized by the high synchronous and prolonged activity of each muscle. Therefore, the NNMF is suitable for extracting characteristic muscle activity patterns of knee OA independent of the normalization method.
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Affiliation(s)
- Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama 343-8540, Japan.
| | - Moeka Yokoyama
- Sportology Center, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan
| | - Katsuya Onitsuka
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan
| | - Naohiko Kanemura
- Graduate Course of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan
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Preece SJ, Alghamdi W, Jones RK. Individuals with knee osteoarthritis demonstrate increased passive stiffness of the hip flexor muscles. Knee 2023; 41:302-310. [PMID: 36801496 DOI: 10.1016/j.knee.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/15/2022] [Accepted: 01/04/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND People with knee osteoarthritis stand and walk with increased trunk flexion. This altered postural alignment increases hamstring activation, elevating mechanical knee loads during walking. Increased hip flexor stiffness may lead to increased trunk flexion. Therefore, this study compared hip flexor stiffness between healthy individuals and individuals with knee osteoarthritis. This study also sought to understand the biomechanical effect of a simple instruction to reduce trunk flexion by 5° during walking. METHODS Twenty individuals with confirmed knee osteoarthritis and 20 healthy individuals participated. The Thomas test was used to quantity passive stiffness of the hip flexor muscles and three-dimensional motion analysis used to quantify trunk flexion during normal walking. Using a controlled biofeedback protocol, each participant was then instructed to decrease trunk flexion by 5°. RESULTS Passive stiffness was greater in the group with knee osteoarthritis (effect size = 1.04). For both groups, there was relatively strong correlation between passive stiffness and trunk flexion in walking (r = 0.61-0.72). The instruction to decrease trunk flexion produced only small, non-significant, reductions in hamstring activation during early stance. CONCLUSIONS This is the first study to demonstrate that individuals with knee osteoarthritis exhibit increased passive stiffness of the hip muscles. This increased stiffness appears to be linked to increased trunk flexion and may therefore underlie the increased hamstring activation which is associated with this disease. As simple postural instruction does not appear to reduce hamstring activity, interventions may be required which can improve postural alignment by reducing passive stiffness of the hip muscles.
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Affiliation(s)
- Stephen J Preece
- School of Health Sciences, University of Salford, Salford, Manchester M6 6PU, UK.
| | - Wael Alghamdi
- School of Health Sciences, University of Salford, Salford, Manchester M6 6PU, UK; Al Baha University, Al Baha, Saudi Arabia
| | - Richard K Jones
- School of Health Sciences, University of Salford, Salford, Manchester M6 6PU, UK
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Osteoarthritis year in review 2021: mechanics. Osteoarthritis Cartilage 2022; 30:663-670. [PMID: 35081453 DOI: 10.1016/j.joca.2021.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/09/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) has a complex, heterogeneous and only partly understood etiology. There is a definite role of joint cartilage pathomechanics in originating and progressing of the disease. Although it is still not identified precisely enough to design or select targeted treatments, the progress of this year's research demonstrates that this goal became much closer. On multiple scales - tissue, joint and whole body - an increasing number of studies were done, with impressive results. (1) Technology based instrument innovations, especially when combined with machine learning models, have broadened the applicability of biomechanics. (2) Combinations with imaging make biomechanics much more precise & personalized. (3) The combination of Musculoskeletal & Finite Element Models yield valid personalized cartilage loads. (4) Mechanical outcomes are becoming increasingly meaningful to inform and evaluate treatments, including predictive power from biomechanical models. Since most recent advancements in the field of biomechanics in OA are at the level of a proof op principle, future research should not only continue on this successful path of innovation, but also aim to develop clinical workflows that would facilitate including precision biomechanics in large scale studies. Eventually this will yield clinical tools for decision making and a rationale for new therapies in OA.
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Robbins SM, Pelletier JP, Abram F, Boily M, Antoniou J, Martineau PA, Morelli M, Martel-Pelletier J. Gait risk factors for disease progression differ between non-traumatic and post-traumatic knee osteoarthritis. Osteoarthritis Cartilage 2021; 29:1487-1497. [PMID: 34348184 DOI: 10.1016/j.joca.2021.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/18/2021] [Accepted: 07/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine if relationships between knee osteoarthritis (OA) progression with knee moments and muscle activation during gait vary between patients with non-traumatic and post-traumatic knee OA. DESIGN This longitudinal study included participants with non-traumatic (n = 17) and post-traumatic (n = 18) knee OA; the latter group had a previous anterior cruciate ligament rupture. Motion capture cameras, force plates, and surface electromyography measured knee moments and lower extremity muscle activation during gait. Cartilage volume change were determined over 2 years using magnetic resonance imaging in four regions: medial and lateral plateau and condyle. Linear regression analysis examined relationships between cartilage change with gait metrics (moments, muscle activation), group, and their interaction. RESULTS Measures from knee adduction and rotation moments were related to lateral condyle cartilage loss in both groups, and knee adduction moment to lateral plateau cartilage loss in the non-traumatic group only [β = -1.336, 95% confidence intervals (CI) = -2.653 to -0.019]. Generally, lower levels of stance phase muscle activation were related to greater cartilage loss. The relationship between cartilage loss in some regions with muscle activation characteristics varied between non-traumatic and post-traumatic groups including for: lateral hamstring (lateral condyle β = 0.128, 95%CI = 0.003 to 0.253; medial plateau β = 0.199, 95%CI = 0.059 to 0.339), rectus femoris (medial condyle β = -0.267, 95%CI = -0.460 to -0.073), and medial hamstrings (medial plateau; β = -0.146, 95%CI = -0.244 to -0.048). CONCLUSION Findings indicate that gait risk factors for OA progression may vary between patients with non-traumatic and post-traumatic knee OA. These OA subtypes should be considered in studies that investigate gait metrics as risk factors for OA progression.
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Affiliation(s)
- S M Robbins
- Centre for Interdisciplinary Research in Rehabilitation, Lethbridge-Layton-MacKay Rehabilitation Centre, PERFORM Centre, School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
| | - J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada.
| | - F Abram
- Medical Imaging, ArthroLab Inc., Montreal, Canada.
| | - M Boily
- Department of Diagnostic Radiology, McGill University, Royal Victoria Hospital, Montreal, Canada.
| | - J Antoniou
- Division of Orthopaedic Surgery, Jewish General Hospital and McGill University, Montreal, Canada.
| | - P A Martineau
- Division of Orthopaedic Surgery, McGill University Health Centre and McGill University, Montreal, Canada.
| | - M Morelli
- Division of Orthopedic Surgery, St. Mary's Hospital Center and McGill University, Montreal, Canada.
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada.
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Costello KE, Astephen Wilson JL, Hubley-Kozey CL. Association of Low Physical Activity Levels With Gait Patterns Considered at Risk for Clinical Knee Osteoarthritis Progression. ACR Open Rheumatol 2021; 3:753-763. [PMID: 34687176 PMCID: PMC8593810 DOI: 10.1002/acr2.11319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Although gait analysis provides an estimate of joint loading magnitude and patterns during a typical step, accelerometry provides information about loading frequency. Understanding the relationships between these components of loading and knee osteoarthritis (OA) progression may improve conservative management, as gait interventions may need to account for physical activity levels or vice versa. The primary objective was to examine relationships between gait patterns that have previously been associated with OA progression and accelerometer‐derived metrics of loading frequency. The secondary objective examined the association of accelerometer‐derived metrics and total knee arthroplasty (TKA) at a mean follow‐up of 3.5 years. Methods Fifty‐seven individuals with knee OA underwent gait analysis and 1 week of accelerometer wear. Spearman correlations were calculated between accelerometer‐derived metrics and gait patterns. Differences across quartiles of step count were examined with Jonckheere‐Terpstra tests. In a subsample, baseline differences between TKA and no TKA groups were examined with Mann‐Whitney U‐tests. Results Gait variables previously related to progression were correlated to both step count and moderate‐ to vigorous‐intensity, but not lower‐intensity, physical activity. Individuals in the lowest quartile (~4000 steps/day) exhibited gait patterns previously related to progression. There were no differences in any baseline accelerometer‐derived metrics between those that did and did not undergo TKA at follow‐up. Conclusion Complex relationships exist between gait, physical activity, and OA progression. Accelerometer‐derived metrics may contribute unique information about overall loading for individuals above a certain activity threshold, but for those with lower activity levels, gait may be sufficient to predict clinical progression risk, at least over the short term.
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Affiliation(s)
- Kerry E Costello
- Dalhousie University, Halifax, Nova Scotia, Canada, Boston University, Boston, Massachusetts
| | - Janie L Astephen Wilson
- Dalhousie University, Halifax, Nova Scotia, Canada, and McMaster University, Hamilton, Ontario, Canada
| | - Cheryl L Hubley-Kozey
- Dalhousie University, Halifax, Nova Scotia, Canada, and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Hatfield GL, Costello KE, Astephen Wilson JL, Stanish WD, Hubley-Kozey CL. Association Between Knee Joint Muscle Activation and Knee Joint Moment Patterns During Walking in Moderate Medial Compartment Knee Osteoarthritis: Implications for Secondary Prevention. Arch Phys Med Rehabil 2021; 102:1910-1917. [PMID: 33965394 DOI: 10.1016/j.apmr.2021.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine associations between knee moment features linked to osteoarthritis (OA) progression, gait muscle activation patterns, and strength. DESIGN Cross-sectional secondary analysis. SETTING Gait laboratory. PARTICIPANTS Convenience sample of 54 patients with moderate, medial knee OA (N=54). INTERVENTIONS None. MAIN OUTCOME MEASURES Knee moments and quadriceps and hamstrings activation were examined during walking. Knee extensor and flexor strength were measured. Waveform patterns were extracted using principal component analysis. Each measured waveform was scored against principal components (PCs) that captured overall magnitude (PC1) and early to midstance difference (PC2) features, with higher PC2 scores interpreted as greater moment differential and more prolonged muscle activity. Correlations were calculated between moment PC scores and muscle PC and strength scores. Regression analyses determined moment PC score variance explained by muscle PC scores and strength. RESULTS All correlations for knee adduction moment difference feature (KAMPC2) and prolonged muscle activity (PC2) were significant (r=-0.40 to -0.54). Knee flexion moment difference feature (KFMPC2) was significantly correlated with all quadriceps and medial hamstrings PC2 scores (r=-0.47 to -0.61) and medial hamstrings magnitude feature (PC1) (r=-0.52). KAMPC2 was significantly correlated with knee flexor strength (r=0.43), and KFMPC2 was significantly correlated with knee extensor (r=0.60) and flexor (r=0.55) strength. Regression models including muscle PC2 scores and knee flexor strength explained 46% of KAMPC2 variance, whereas muscle PC2 scores and knee extensor strength explained 59% of KFMPC2 variance. CONCLUSIONS Muscle activation patterns and strength explained significant variance in moment difference features, highest for the knee flexion moment. This supports that exercises such as neuromuscular training, focused on appropriate muscle activation patterns, and strengthening have the potential to alter dynamic loading gait patterns associated with knee OA clinical progression.
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Affiliation(s)
- Gillian L Hatfield
- School of Kinesiology, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Kerry E Costello
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA; Section of Rheumatology, Boston University School of Medicine, Boston, MA
| | - Janie L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - William D Stanish
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cheryl L Hubley-Kozey
- School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Surgery, Affiliated Scientist Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.
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Preece SJ, Brookes N, Williams AE, Jones RK, Starbuck C, Jones A, Walsh NE. A new integrated behavioural intervention for knee osteoarthritis: development and pilot study. BMC Musculoskelet Disord 2021; 22:526. [PMID: 34103040 PMCID: PMC8188786 DOI: 10.1186/s12891-021-04389-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/30/2021] [Indexed: 01/04/2023] Open
Abstract
Background Exercise-based approaches have been a cornerstone of physiotherapy management of knee osteoarthritis for many years. However, clinical effects are considered small to modest and the need for continued adherence identified as a barrier to clinical efficacy. While exercise-based approaches focus on muscle strengthening, biomechanical research has identified that people with knee osteoarthritis over activate their muscles during functional tasks. Therefore, we aimed to create a new behavioural intervention, which integrated psychologically informed practice with biofeedback training to reduce muscle overactivity, and which was suitable for delivery by a physiotherapist. Methods Through literature review, we created a framework linking theory from pain science with emerging biomechanical concepts related to overactivity of the knee muscles. Using recognised behaviour change theory, we then mapped a set of intervention components which were iteratively developed through ongoing testing and consultation with patients and physiotherapists. Results The underlying framework incorporated ideas related to central sensitisation, motor responses to pain and also focused on the idea that increased knee muscle overactivity could result from postural compensation. Building on these ideas, we created an intervention with five components: making sense of pain, general relaxation, postural deconstruction, responding differently to pain and functional muscle retraining. The intervention incorporated a range of animated instructional videos to communicate concepts related to pain and biomechanical theory and also used EMG biofeedback to facilitate visualization of muscle patterns. User feedback was positive with patients describing the intervention as enabling them to “create a new normal” and to be “in control of their own treatment.” Furthermore, large reductions in pain were observed from 11 patients who received a prototype version of the intervention. Conclusion We have created a new intervention for knee osteoarthritis, designed to empower individuals with capability and motivation to change muscle activation patterns and beliefs associated with pain. We refer to this intervention as Cognitive Muscular Therapy. Preliminary feedback and clinical indications are positive, motivating future large-scale trials to understand potential efficacy. It is possible that this new approach could bring about improvements in the pain associated with knee osteoarthritis without the need for continued adherence to muscle strengthening programmes. Trial registration ISRCTN51913166 (Registered 24-02-2020, Retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04389-0.
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Affiliation(s)
- Stephen J Preece
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK.
| | - Nathan Brookes
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK.,Physiotherapy Department, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - Anita E Williams
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK
| | - Richard K Jones
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK
| | - Chelsea Starbuck
- Centre for Health Sciences Research, University of Salford, Manchester, M6 6PU, UK
| | - Anthony Jones
- Human Pain Research Group, University of Manchester, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - Nicola E Walsh
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1DD, UK
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12
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Astephen Wilson JL, Kobsar D. Osteoarthritis year in review 2020: mechanics. Osteoarthritis Cartilage 2021; 29:161-169. [PMID: 33421562 DOI: 10.1016/j.joca.2020.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023]
Abstract
The mechanical environment of the joint during dynamic activity plays a significant role in osteoarthritis processes. Understanding how the magnitude, pattern and duration of joint-specific loading features contribute to osteoarthritis progression and response to treatment is a topic of on-going relevance. This narrative review synthesizes evidence from recent papers that have contributed to knowledge related to three identified emerging subthemes: 1) the role of the joint mechanical environment in osteoarthritis pathogenesis, 2) joint biomechanics as an outcome to arthroplasty treatment of osteoarthritis, and 3) methodological trends for advancing our knowledge of the role of biomechanics in osteoarthritis. Rather than provide an exhaustive review of a broad area of research, we have focused on evidence this year related to these subthemes. New research this year has indicated significant interest in using biomechanics investigations to understand structural vs clinical progression of osteoarthritis, the role and interaction in the three-dimensional loading environment of the joint, and the contribution of muscle activation and forces to osteoarthritis progression. There is ongoing interest in understanding how patient variability with respect to gait biomechanics influences arthroplasty surgery outcomes, and subgroup analyses have provided evidence for the potential utility in tailored treatment approaches. Finally, we are seeing a growing trend in the application of translational biomechanics tools such as wearable inertial measurement units for improved integration of biomechanics into clinical decision-making and outcomes assessment for osteoarthritis.
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Affiliation(s)
- J L Astephen Wilson
- Department of Surgery, McMaster University, 1280 Main St West, Hamilton, ON, Canada.
| | - D Kobsar
- Department of Kinesiology, McMaster University, 1280 Main St West, Hamilton, ON, Canada.
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Gait Variability and IEMG Variation in Gastrocnemius and Medial Hamstring Muscles on Inclined Even and Uneven Planes. Ing Rech Biomed 2021. [DOI: 10.1016/j.irbm.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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14
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Alghamdi W, Preece SJ. How does normal variability in trunk flexion affect lower limb muscle activity during walking? Hum Mov Sci 2020; 72:102630. [PMID: 32452386 DOI: 10.1016/j.humov.2020.102630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/27/2022]
Abstract
A large proportion of the mass of the body is contained within the trunk segment. Therefore, small changes in the inclination of this segment have the potential to influence the direction of the ground reaction force and alter lower limb joint moments and muscle activation patterns during walking. The aim of this study was to investigate if variability in sagittal trunk inclination in healthy participants is associated with differences in lower limb biomechanics. Gait analysis data was collected on 41 healthy participants during walking. Two groups were defined based on habitual trunk flexion angle during normal walking, a forward lean group (n = 18) and a backward lean group (n = 17). Lower limb moments, muscle activation patterns and co-contraction levels were compared between the two groups using independent t-tests. The forward lean group walked with 5° more trunk flexion than the backward lean group. This difference was associated with a larger peak hip moment (effect size = 0.7) and higher activation of the lateral gastrocnemius (effect size =0.6) and the biceps femoris (effect size =0.7) muscles. The forward lean group also exhibited greater co-contraction in late stance (effect size =0.7). This is the first study to demonstrate that small differences in trunk flexion are associated with pronounced alterations in the activation of the lateral knee flexor muscles. This is important because people with knee osteoarthritis have been observed to walk with increased trunk flexion. It is possible that increased sagittal trunk inclination may be associated with elevated joint loads in people with knee osteoarthritis.
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Affiliation(s)
| | - Stephen J Preece
- Centre for Health Sciences Research, University of Salford, Salford, Manchester, M6 6PU, UK.
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