Gait retraining interventions for people with knee osteoarthritis

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 involve weekly supervised sessions (once a week) using the Zeno walkway/OPALs system. Participants will also be required to practice their altered FPA daily at home (unsupervised home-based self-practice), which will be monitored with a logbook. In each session, the participant will be required to achieve certain goals. During the session in weeks 0-1, the participant will walk with the altered FPA using the Zeno walkway and be taught by the physiotherapy student a self-practice strategy using the participants’ smart phone camera. In weeks 2-3, the participant must achieve walking with altered FPA on Zeno walkway whilst also completing simple cognitive tasks (such as counting backwards in 3’s). In weeks 4-5, the participant must achieve walking with altered FPA, whilst walking on grass using the OPALs system. The first training session will run for 1 hour and will involve education of the participant, baseline assessments and commencement of the intervention program (week 0). The following five sessions (week 1 to 5) will be spaced one week apart, consisting of supervised gait retraining sessions of 30 minutes. The final session will be performed one week after the sixth session (week 6) at the completion of the gait retraining program and will involve re-assessment of outcome measures. The participants will also be prescribed a home-based program of 30 minutes per day during this 6-week period. Adverse events from the gait retraining program will also be monitored using the logbook.