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The effect of bilateral knee osteoarthritis on spatial-temporal gait parameters during walking on different inclines: an implication for future rehabilitation in gait performance

kinesiology
biomechanics

Abstract

Background: Gait abnormalities in knee osteoarthritis (KOA) patients are established, yet the majority of the evidence base exists for level ground walking and in unilateral KOA patients. The gait adaptations of bilateral KOA on different terrain, especially in the presence of an incline, are important to establish in the pursuit of more comprehensive rehabilitation programming. Purpose: We aim to describe spatiotemporal adaptations to gait in KOA patients relative to age-matched controls during incline treadmill walking, especially during downhill walking across five conditions.
Methods: Fifteen KOA patients and fifteen age-matched healthy controls were recruited. The groups were matched in age, height, weight, and self-selected walking speed (p>0.05). Gait parameters were collected using a motion analysis system while walking at a self-selected speed on a treadmill across five inclines: +6%, +3%, 0%, -3%, and -6%. Statistical analysis was performed with a mixed two-way repeated measures ANOVA.
Results: The group by incline interaction was significant for several dependent variables. The KOA group had a significantly shorter step and stride length (p<0.001) and longer double support time during downhill walking compared to the control group (p<0.001). The KOA group had a significant U-shaped trend of gait variability across the five inclines (increased variability in uphill and downhill walking) while the control group had a significant linear trend of reduced variability with increasing incline. Effect sizes were large for double support time (partial eta squared = 0.42) and step width (partial eta squared = 0.18).
Conclusion: Bilateral KOA patients have different gait patterns on an incline compared to age-matched controls. They use a shorter step, longer double support phase, and their gait variability has an adaptive U-shaped response. Gait measures on varied terrain may need to be considered when developing rehabilitation programs for KOA patients, and downhill walking may need to be avoided.
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