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Study Description

Knee osteoarthritis (OA) is a major public health problem, causing substantial pain and functional limitations and affects ~12% of older adults. There are few effective non-invasive treatments to prevent disease progression or decrease pain. The current proposal will provide evidence-based information in order to design novel and effective rehabilitation treatments for knee osteoarthritis.

Non-invasive treatments are needed to improve quality of life and decrease the need for total knee arthroplasty. Abnormal mechanical loading is a well-recognized cause of knee OA and many rehabilitation treatments aim to improve abnormal loading. Impact loading is one such factor that can be intervened upon to potentially improve pain and function. While gait retraining strategies have been shown to improve the knee adduction moment, it is unknown if gait retraining can change impact loading and improve knee pain in older individuals with knee OA. Individuals with painful knee OA also demonstrate a heightened response to normally non-painful stimuli (i.e., sensitization) and impaired descending inhibition of pain, both of which contribute to greater pain severity. It is unknown, however, whether these alterations in the sensory nervous system also affect the motor efferent nervous system, with resulting adverse effects on motor function. Furthermore, the presence of altered pain processing may modify the effect of traditional rehabilitation strategies. Such insights would provide opportunities for tailoring individual rehabilitation strategies. The specific aims of the proposed work are: 1) To evaluate the relation of altered pain processing, independent of knee pain severity, to impact loading (e.g., peak impact force and loading rate from the ground reaction force) during walking, 2) To determine whether a gait retraining program decreases impact loading and knee pain in individuals with knee OA, and 3) To determine whether altered pain processing modifies the effect of gait retraining on impact loading.

Subjects will be randomized to either a control walking intervention or a walking program with gait retraining. The retraining will involve verbal feedback to soften footfalls and real-time visual feedback to decrease tibial acceleration (a correlate of knee loading) using an accelerometer while walking on a treadmill. Primary and secondary outcomes include measures of impact loading and knee pain, respectively. The proposed research is highly significant in that it will directly affect the clinical management of individuals with knee OA.

ELIGIBILITY CRITERIA:

Ages Eligible for Study:           45 Years and older (Adult, Older Adult)

Sexes Eligible for Study:          All

Accepts Healthy Volunteers:  No

Inclusion Criteria:

Subjects with a clinical definition of knee OA using NICE guidelines:

• Age ≥ 45
• Walking related joint pain in the last week that averages ≥ 4 on 11-point numeric rating scale, where 0 = no pain and 10 = worst pain possible
• History of knee pain for at least 3 months
• Morning stiffness in the morning lasting less than 30 minutes

Exclusion Criteria:

• Walk with an assistive device
• Current use of oral opiates or centrally acting pain medications
• History of lower extremity surgery
• Underwent an intra-articular knee joint injection in the past 3 months
• Suffer from inflammatory arthritis or other conditions that affect lower extremity functions
• Currently receiving treatment for their knee and unwilling to stop this treatment for the duration of the study
• Currently pregnant
• Skin allergies to adhesives

Study Design:

Allocation: Randomized

Intervention Model: Parallel Assignment

Masking: Triple (Participant, Investigator, Outcomes Assessor)

Primary Purpose: Treatment

Study Location(s):

Northeastern University, Boston, Massachusetts, United States, 02115

Study Website:

https://clinicaltrials.gov/ct2/show/NCT04148807?term=Stefanik%2C+Joshua&draw=2&rank=1