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Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.

ABSTRACT: The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis.Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models.There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 ± 8.2 yrs) and 21 control (57.1% women; age, 68.9 ± 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 ± 1.7; P = 0.0162) and symptoms (8.6 ± 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos.Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained.

SUBMITTER: Segal NA

PROVIDER: S-EPMC4567520 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.

Segal Neil A NA Glass Natalie A NA Teran-Yengle Patricia P Singh Bhupinder B Wallace Robert B RB Yack H John HJ

American journal of physical medicine & rehabilitation 20151001 10 Suppl 1

<h4>Objective</h4>The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis.<h4>Design</h4>Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 m ...[more]

PMID: 25768068

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Project description:Background and purposeKnee osteoarthritis (KOA) is a common disease that hinders activity participation in older adults. Associated symptoms and physiological changes can increase risk of falling in individuals with KOA. Balance training can decrease fall risks in older adults. Limited evidence exists regarding utilization of balance training in physical therapy (PT) for this population. This secondary data analysis investigated the proportion of participants at high risk for falling in the PhysicAl THerapy vs. INternet-based Exercise Training for Patients with Osteoarthritis (PATH-IN) study and the frequency with which balance training was utilized as an intervention in PT.MethodsPATH-IN study participants (N = 344) performed the Four-Stage Balance Test and the Timed Up and Go (TUG) test during baseline assessment. Participants were randomly allocated to PT, an Internet-based exercise program, or a control group. Participants were classified as being at high risk for falling if they did not progress to the single-leg stance (SLS) during the Four-Stage Balance Test, were unable to maintain SLS for 5 seconds, or took longer than 13.5 seconds to complete the TUG test. The proportion of participants at high risk for falling was calculated for all participants and separately for those allocated to PT. In addition, PT notes were coded for balance training and the frequency of balance training utilization was calculated.Results and discussionUpon enrollment, 35.5% (N = 122) of all participants and 36.2% (N = 50) of those allocated to PT were at high risk for falling. Of participants allocated to PT with documentation available for coding (N = 118), 35.5% (N = 42) were at high risk for falling. Balance training was provided to 62.7% (N = 74) during at least one PT session. Of those classified as being at high risk for falling, 33.3% (N = 14) did not receive balance training.ConclusionsThe finding of high fall risks in more than one-third of all participants with KOA is consistent with previous reports of a higher risk of falling in this population. Many PT participants did receive some balance training; however, one-third of participants at high risk for falling did not. Balance training for individuals with KOA at high risk for falling may be underutilized.

Project description:Objective: Physical and cognitive impairments are common with aging and often coexist. Changes in the level of physical and mental activity are prognostic for adverse health events and falls. Dual-task (DT) training programs that can improve mobility and cognition simultaneously can bring significant improvements in rehabilitation. The objective of this mixed methods exploratory RCT was to provide evidence for the feasibility and therapeutic value of a novel game-assisted DT exercise program in older adults. Methods: Twenty-two community dwelling participants, between the ages of 70-85 were randomized to either dual-task treadmill walking (DT-TR) or dual-task recumbent bicycle (DT-RC). Both groups viewed a standard LED computer monitor and performed a range of cognitive game tasks while walking or cycling; made possible with the use of a "hands-free", miniature, inertial-based computer mouse. Participants performed their respective 1-h DT exercise program twice a week, for 12 weeks at a community fitness centre. Semi-structured interviews and qualitative analysis was conducted to evaluate the participant's experiences with the exercise program. Quantitative analysis included measures of standing balance, gait function (spatiotemporal gait variable), visuomotor and executive cognitive function, tested under single and DT walking conditions. Results: Compliance was 100% for all 22 participants. Four themes captured the range of participant's experiences and opinions: 1) reasons for participation, 2) difficulties with using the technologies, 3) engagement with the computer games, and 4) positive effects of the program. Both groups showed significant improvements in standing balance performance, visuomotor and visuospatial executive function. However, significant improvement in dual task gait function was observed only in the DT-TR group. Medium to large effect sizes were observed for most balance, spatiotemporal gait variables, and cognitive performance measure. Conclusion: With only minor difficulties with the technology being reported, the findings demonstrate feasible trial procedures and acceptable DT oriented training with a high compliance rate and positive outcomes. These findings support further research and development, and will direct the next phase of a full-scale RCT.

Project description:The purpose of this study was to determine the efficacy of a home-based kinesthesia, balance and agility (KBA) exercise program to improve symptoms among persons age ? 50 years with knee osteoarthritis (OA). Forty-four persons were randomly assigned to 8-weeks, 3 times per week KBA, resistance training (RT), KBA + RT, or Control. KBA utilized walking agility exercises and single-leg static and dynamic balancing. RT used elastic resistance bands for open chain lower extremity exercises. KBA + RT performed selected exercises from each technique. Control applied inert lotion daily. Outcomes included the OA specific WOMAC Index of Pain, Stiffness, and Physical Function (PF), community activity level, exercise self-efficacy, self-report knee stability, and 15m get up & go walk (GUG). Thirty-three participants [70.7 (SD 8.5) years] completed the trial. Analysis of variance comparing baseline, mid-point, and follow-up measures revealed significant (p < 0.05) improvements in WOMAC scores among KBA, RT, KBA + RT, and Control, with no differences between groups. However, Control WOMAC improvements peaked at mid-point, whereas improvement in the exercise conditions continued at 8-weeks. There were no significant changes in community activity level. Only Control improved exercise self-efficacy. Knee stability was improved in RT and Control. GUG improved in RT and KBA+RT. These results indicate that KBA, RT, or a combination of the two administered as home exercise programs are effective in improving symptoms and quality of life among persons with knee OA. Control results indicate a strong placebo effect in the short term. A combination of KBA and RT should be considered as part of the rehabilitation program, but KBA or RT alone may be appropriate for some patients. Studies with more statistical power are needed to confirm or refute these results. Patient presentation, preferences, costs, and convenience should be considered when choosing an exercise rehabilitation approach for persons with knee OA.

Dataset Information

Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.

Publications

Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis.

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