Gait retraining interventions for people with knee osteoarthritis

INTERVENTION: Participants allocated to the toe‐in gait retraining group will be set an aim to achieve an altered foot progression angle (FPA) that is 10 degrees more in the toe‐in direction from the participant’s natural FPA. The toe‐out gait retraining group will be instructed to aim to achieve an altered FPA that is 10 degrees more in the toe‐out direction from the participant’s natural FPA. Supervised sessions will be carried out by a final year physiotherapy student (TO). Gait analysis to aid achievement of the target FPA during weekly supervised sessions will be performed using the Zeno walkway at the University of Sydney, Faculty of Health Sciences, Sydney Performance laboratory (N101). The Zeno walkway involves a pressure sensitive walkway connected to a computer to analyse walkway activity through the ProtoKinetics Movement Analysis Software (PKMAS). Participants will be asked to walk at their self‐selected speed along the walkway starting from several steps before the walkway and continuing for several steps beyond the walkway, before coming to a stop. The use of the OPAL system by APDM will also be piloted to aid training of target FPA. It involves wearable sensors consisting of a tri‐axial accelerometer, tri‐axial gyroscope and tri‐axial magnetometer, which can assess gait parameters, including FPA, in outdoor environments outside of the motion analysis laboratory. Feedback on performance will be provided verbally or with visual feedback by the student clinician, who will be guided by data collected using the Zeno walkway or OPALs system. Verbal qualitative feedback regarding movement patters required for the task will also be provided. The relative frequency of feedback will be progressively decreased with progressive weeks. Specifically, this will include reduced frequency of feedback regarding achieved FPA and reduced verbal cueing to assist corrections in FPA. In total, the intervention will be carried out over six weeks. The gait retraining program will CONDITION: knee osteoarthritis ; ; knee osteoarthritis; Musculoskeletal ‐ Osteoarthritis Physical Medicine / Rehabilitation ‐ Physiotherapy PRIMARY OUTCOME: Change in the late stance peak knee adduction moment during self‐selected walking. ; This will be measured using three‐dimensional gait anlaysis at baseline and follow‐up. The late stance peak KAM has been identified to be a proxy measure of medial knee joint load and is associated with knee OA disease severity.[Week 0 and 6] SECONDARY OUTCOME: Foot progression angle ; 3D motion analysis[Week 0 and 6] Knee injury history ; Participants will be asked to indicate whether they have had a previous knee injury (Yes/No)[Week 0 and 6] Knee symptom duration ; Participants will be asked how long they have had their knee symptoms for (e.g. 2 years)[Week 0 and 6] Late stance peak adduction moment (KAM) ; 3D motion analysis[Week 0 and 6] Late stance peak adduction moment (KAM) impulse ; 3D motion analysis[Week 0 and 6] Medication use ; Participants will be asked to complete a survey that asks the name of the medication they use, the dosage, frequency of use, length of use, reasons for using the medications for pain relief, who prescribed the medication and any side effects from the medication. [Week 0 and 6] Pain ; 11‐point Visual Analogue Scale (VAS)[Week 0 and 6] Pain ; Western Ontario and McMaster Universities Osteoarthritis Index [Week 0 and 6] Physical function ; Western Ontario and McMaster Universities Osteoarthritis Index [Week 0 and 6] Spatial temporal gait parameters ; 3D motion analysis[Week 0 and 6] Varus thrust ; 3D motion analysis[Week 0 and 6] ‐ Mostly reporting medial knee pain ‐ Reporting average knee pain of 3 or more (out of 10) on a visual analogue scale with 0 representing no pain and 10 representing worst pain imaginable INCLUSION CRITERIA: ‐ Display clinical signs of knee osteoarthritis according to the National Institute for Health and Care Excellent (NICE) guidelines (2014), which involves being 45 years or older, having activity‐related joint pain, and having either no morning joint‐related stiffness or morning stiffness that lasts no longer than 30 minutes ‐ Able to walk unaided for at least 30 minutes