Randomize Controlled Trial - Knee OA

First peak knee adduction moment (PKAM) is commonly used as a surrogate measure of medial compartment knee joint load and has been repeatedly associated with medial compartment knee osteoarthritis (KOA) severity and progression. Prior studies have investigated various gait modifications designed to decrease KAM, with the end goal of reducing the symptoms and slowing the progression of KOA. While initial results have been positive, the majority of these studies have employed short-term quasi-experimental designs using healthy participants, severely limiting the generalizability of their findings. Additionally, recent evidence suggests that there is large inter-subject variability in responses to different gait modifications, and therefore, future interventions should attempt to screen for the suitability of modifications for each participant. The purpose of this study is to address these limitations by comparing the effects of two previously studied gait modifications [lateral trunk lean (TL), and reduced foot progression (FP)] on KAM in KOA patients using an 8-week randomized controlled trial. Individual screening of modifications will be performed at baseline to determine which is most beneficial for each patient, and ability to learn and retain new gait strategy will be determined by completing retention tests at 1 week, 1, 3, and 6 months. Clinical Trial Registration NCT03663790

1. Determine the effects of an 8-week gait modification intervention on knee loading, pain, and function in KOA patients. We hypothesize that patients in either gait modification group will show greater improvements in all outcome measures compared to the control. We also hypothesize that participants will retain the learned gait and show sustained improvements at retention tests 1, 3, and 6 months post-intervention a. We hypothesize that patients will be able to significantly modify their gait in response to the 8-week training and will be able to replicate the learned modification during retention testing.

2. Evaluate if lateral trunk lean and reduced foot progression modifications significantly reduce PKAM and improve self-reported pain and function in individuals with medial compartment KOA compared to a control group that completes a program of normal walking. Will potential reductions in PKAM immediately following training persist at follow-up testing (up to a year post-test)? a. We hypothesize that both lateral trunk lean and reduced foot progression modifications will significantly reduce PKAM in KOA patients compared to the control group and that reductions will persist during retention tests.