Gait Biomechanics and Patient-Reported Function as Predictors of Response to a Hip Strengthening Exercise Intervention in Patients with Knee Osteoarthritis

• Published in: PloS one Vol. 10; no. 10; p. e0139923
• Main Authors: Kobsar, Dylan, Osis, Sean T., Hettinga, Blayne A., Ferber, Reed
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.10.2015; Public Library of Science (PLoS)
• Subjects: Adults; Age; Analysis; Ankle; Arthritis; Biocompatibility; Biomechanical Phenomena - physiology; Biomechanics; Care and treatment; Classification; Complications and side effects; Data analysis; Discriminant analysis; Exercise therapy; Female; Gait; Gait - physiology; Gait recognition; Gender differences; Gene expression; Hip; Humans; Intervention; Kinematics; Kinesiology; Knee; Male; Middle Aged; Muscle Strength - physiology; Muscles; Osteoarthritis; Osteoarthritis, Knee - therapy; Pain; Parameters; Patients; Physiological aspects; Principal components analysis; Resistance Training - methods; Rheumatism; Subgroups; Systematic review; Walking; Canada; Alberta Canada; Calgary Alberta Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0139923

Muscle strengthening exercises have been shown to improve pain and function in adults with mild-to-moderate knee osteoarthritis, but individual response rates can vary greatly. Predicting individuals who respond and those who do not is important in developing a more efficient and effective model of care for knee osteoarthritis (OA). Therefore, the purpose of this study was to use pre-intervention gait kinematics and patient-reported outcome measures to predict post-intervention response to a 6-week hip strengthening exercise intervention in patients with mild-to-moderate knee OA. Thirty-nine patients with mild-to-moderate knee osteoarthritis completed a 6-week hip-strengthening program and were subgrouped as Non-Responders, Low-Responders, or High-Responders following the intervention based on their change in Knee injury Osteoarthritis Outcome Score (KOOS). Predictors of responder subgroups were retrospectively determined from baseline patient-reported outcome measures and kinematic gait parameters in a discriminant analysis of principal components. A 3-4 year follow-up on 16 of the patients with knee OA was also done to examine long-term changes in these parameters. A unique combination of patient-reported outcome measures and kinematic factors was able to successfully subgroup patients with knee osteoarthritis with a cross-validated classification accuracy of 85.4%. Lower patient-reported function in daily living (ADL) scores and hip frontal plane kinematics during the loading response were most important in classifying High-Responders from other sub-groups, while a combination of hip, knee, ankle kinematics were used to classify Non-Responders from Low-Responders. Patient-reported outcome measures and objective biomechanical gait data can be an effective method of predicting individual treatment success to an exercise intervention. Measuring gait kinematics, along with patient-reported outcome measures in a clinical setting can be useful in helping make evidence-based decisions regarding optimal treatment for patients with knee OA.