Identifying changes in gait waveforms following a strengthening intervention for women with knee osteoarthritis using principal components analysis

Abstract

Lower limb strengthening exercise is pivotal for the management of symptoms related to knee osteoarthritis (OA). Though improvement in clinical symptoms is well documented, concurrent changes in gait biomechanics are ill-defined. This may occur because discrete analyses miss changes following an intervention, analyses limited to the knee undermine potential mechanical trade-offs at other joints, or strengthening interventions not been designed based on biomechanical principles. The purpose of this study was to characterize differences in entire gait waveforms for sagittal plane ankle, knee, and hip angles and external moments; the knee adduction moment; and frontal plane hip angle and moment following 12-weeks of a previously designed novel lower limb strengthening program. Forty women with knee OA completed two laboratory visits: one at baseline and one immediately following intervention (follow-up). Self-report measures, strength, and gait analyses were completed at each visit. Principal components analyses were completed for sagittal angles and external moments at the ankle, knee, and hip joints, as well as frontal plane angle and moment for the hip. Participants improved self-report and strength (p≤0.004). Two significant, yet subtle differences in principal components were identified between baseline and follow-up waveforms (p<0.05) pertaining to the knee and hip sagittal external moments. The subtle changes in concert with the lack of differences in other joints and planes suggest the lower limb strengthening program does not translate to changes in the gait waveform. It is likely this program is improving symptoms without worsening mechanics.