A Pilot Study on Physical Performance Measures: What is Better for Knee Osteoarthritis Patients, Orthosis or Gait Modifications?

Abstract

Background: Knee osteoarthritis (kOA), the most commonly occurring type of osteoarthritis in the world and one of the key contributors to global burden of disease significantly affects the physical functionality of the patient. The two conservative techniques of kOA include orthoses (knee braces and wedged insoles) and gait modification techniques (toe-in and toe-out gait). Previous studies assessing these two types of techniques do not present a comparison between their effects on physical functionality of the patient. Methods: Five OARSI (Osteoarthritis Research Society International) recommended performance-based tests to measure physical function of kOA patients: (1) 30s chair stand test (2) 40m fast-paced walk test (3) stair climb test (4) timed up and go (TUG) test (5) 6min walk test were applied on a total of 5 kOA patients randomly (Age: 59.2 ± 11.09 years, BMI: 25.94 ± 3.77 kg/m2, Kellgren-Lawrence Grades 1,2 and 4). The test conditions included normal gait, toe-out gait, toe-in gait, use of laterally wedged insoles and use of knee brace. The study was a single visit study assessing immediate effects, however, patients were given enough time and training to get used to the interventions. Data from the tests were analyzed using Repeated-Measures ANOVA. Results: No significant differences were observed among the five test conditions for 30sec chair stand test, 40m fast-paced walk test, TUG test and 6min walk test (p >0.05). Pairwise comparison showed that toe-out differed significantly from toe-in (p = 0.042), insoles (p = 0.037), and brace (p = 0.011) while toe-in differed significantly from toe-out (p = 0.042), insoles (p = 0.035) and brace (p = 0.012). Conclusions: In general, orthoses and gait modifications seemed to have similar physical performance measures for kOA patients. The results however, indicated that gait modifications are affecting stair ascent of the kOA patients differently as compared to orthoses. Larger sample size may reveal a more accurate influence of the test conditions used in this study.