Gait retraining interventions for medial knee osteoarthritis.

• Participants will be randomly allocated to either a toe-in, toe-out, or postural re-education gait retraining program for six weeks, followed by a booster session between the end of the intervention and the 3-month follow-up. The intervention program will be delivered by either a physiotherapist or podiatrist with a minimum of three years of experience. • Participants will be required to attend the 3D gait analysis laboratory three times for the biomechanics assessment. The biomechanical assessment will involve the placement of reflective markers on the upper body and lower limb anatomical landmarks followed by the completion of five successful gait trials (clean foot strike for the most symptomatic limb). This assessment will be conducted at baseline, immediately following the 6-week intervention program and three months following the 6-week program. • The first session will run for 1.5-2 hours as this will involve baseline biomechanical assessments, education for the participant, and commencement of the intervention program (week 0). Overall, participants will be receiving 4-6 supervised sessions over the initial 6 weeks, with the frequency determined by the therapist delivering the intervention. • These sessions will consist of supervised one-on-one gait retraining sessions of 30 minutes, motivational interviewing, goal-setting, and walking with the altered foot progression angle (FPA)/ upright trunk. Sessions outline: In weeks 1-2, participants in all groups will aim to walk with altered foot progression angle (FPA) using the spatiotemporal Zeno Walkway or the OPAL wearable sensors. In weeks 2-4, participants will achieve walking with altered FPA or more upright trunk while dual-tasking (simple cognitive tasks involving counting backward in 3's). In weeks 5-6, participants will achieve walking with altered FPA, or more upright trunk whilst walking outdoors/various terrain using the OPAL wearable sensors. In addition to these supervised sessions during the 6- week period, participants will also be prescribed 30 minutes of their allocated gait strategy to practice each day at home. A logbook will be provided for participants to record adherence and any adverse events. Attendance will also be recorded by the physiotherapist or podiatrist delivering the intervention. • Participants will be invited to a gait retraining session between finishing the intervention period and their final assessment (3 months post-intervention). Participants will be asked to attend a gait retraining booster session at week 12 but can be completed between weeks 9-15. During this session, participants will get a chance to obtain qualitative and quantitative feedback from the therapist regarding their prescribed gait change.