Strong independent associations between gait biomechanics and pain in patients with knee osteoarthritis |
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| Affiliation: | 1. Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, ON N6A 3K7, Canada;2. School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada;3. Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre - University Hospital, London, ON N6A 5B5, Canada;4. Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, St. Joseph''s Health Care London, London, ON N6A 4V2, Canada;1. Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Martensstrasse 3, 91058 Erlangen, Germany;2. Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany;3. Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058 Erlangen, Germany;2. Division of Rehabilitation Sciences, Department of Orthopedic Surgery & Rehabilitation, University of Texas Medical Branch-Galveston, 301 University Blvd. Route 0165, Rebecca Sealy 2.804, Galveston, TX 77555, United States;3. School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219-3130, United States;1. Department of Kinesiology, Recreation, and Sports Studies, The University of Tennessee, United States;2. Department of Human Movement Sciences, Old Dominion University, United States;3. School of Physical Therapy and Athletic Training, Old Dominion University, United States;1. Clinic for Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland;2. Department of Biomedical Engineering, University of Basel, Basel, Switzerland;3. Clinic for Spinal Surgery, University Hospital Basel, Basel, Switzerland;2. Musculoskeletal Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA;3. Department of Physical Therapy, University of California, San Francisco, San Francisco, CA, USA;1. Human Movement Research Laboratory, Departments of Physical Therapy and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA;2. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA;3. Physical Therapy Clinical and Translational Research Center, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA |
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| Abstract: | We investigated the simple and multivariate associations between knee pain and gait biomechanics. 279 patients with medial knee osteoarthritis (OA) and discordant changes in pain between limbs after walking completed bilateral three-dimensional gait analysis. For each limb, patients rated their pain before and after a 6-min walk and the change in pain was recorded as an increase (≥1 points) or not (≤0 points). Among paired limbs, the simple and multivariate associations between an increase in pain and the external moments in each orthogonal plane were evaluated using conditional logistic regression. The analyses were then repeated for knee angles. Univariate analyses demonstrated associations in each plane that varied in both magnitude and direction, with larger associations for the knee moments [Odds Ratio (95% confidence interval) = first peak adduction moment: 2.80 (2.02, 3.88), second peak adduction moment: 2.36 (1.73, 3.24), adduction impulse: 6.65 (3.50, 12.62), flexion moment: 0.46 (0.36, 0.60), extension moment: 0.56 (0.44, 0.71), internal rotation moment: 7.54 (3.32, 17.13), external rotation moment: 0.001 (0.00, 0.04)]. Multivariate analyses with backward elimination resulted in a model including only the adduction impulse [5.35 (2.51, 11.42)], flexion moment [0.32 (0.22, 0.46)] and extension moment [0.28 (0.19, 0.42)]. The varus, flexion and extension angles were included in the final multivariate model for the knee angles. When between-person confounding is lessened by comparing limbs within patients, there are strong independent associations between knee pain and multiple external knee moments that vary in magnitude and direction. While controlling for other knee moments, a greater adduction impulse and lower flexion and extension moments were independently associated with greater odds of an increase in pain. |
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| Keywords: | Osteoarthritis Pain Biomechanics |
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