Evaluation of gait performance of knee osteoarthritis patients after total knee arthroplasty with different assistive devices
Tereso, Ana; Martins, Maria Manuel; Santos, Cristina Peixoto
http://dx.doi.org/10.1590/2446-4740.0729
Res. Biomed. Eng., vol.31, n3, p.208-217, 2015
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Abstract
Introduction: Nowadays Knee Osteoarthritis (KOA) affects a large percentage of the elderly, and one solution is to perform a Total Knee Arthroplasty (TKA). In this paper, one intends to study the gait and posture of these patients after the TKA, while walking with three assistive devices (ADs) (crutches, standard walker (SW) and rollator with forearm supports (RFS)). Methods: Eleven patients were evaluated in 2 phases: 5 days and 15 days after surgery. This evaluation was conducted with two inertial sensors, one attached to the operated leg ankle, to measure spatiotemporal parameters, and the other at the sacrum, to measure posture and fall risk-related parameters. Multivariate analysis of variance (MANOVA) with repeated measures was performed to detect group differences. Results: The MANOVA results show that all spatiotemporal parameters are significantly different (p<0.05) between the two phases of study. So, time has a significant influence on such parameters. In relation to the ADs, one observes that there are statistical significant effects on all spatiotemporal parameters, except for swing duration and step length (p>0.05). The interaction between time and ADs only affects significantly the velocity (p<0.05). In terms of fall risk parameters, time only significantly affects the antero-posterior direction (p<0.05) and ADs affects significantly root mean square in medio-lateral direction (p<0.05). In terms of interaction between time and ADs, there are no statistical significant differences. Conclusion: This study concludes that depending on the state of recovery of the patient, different ADs should be prescribed. On the overall, standard walker is good to give stability to the patient and RFS allows the patient to present a gait pattern closer to a natural gait.
Keywords
Knee osteoarthritis, Total knee arthroplasty, Assistive devices, Elderly, Walkers.
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Wellmon R, Pezzillo K, Eichhorn G, Lockhart W, Morris J. Changes in dual-task voice reaction time among elders who use assistive devices. Journal of Geriatric Physical Therapy. 2006; 29(2):74-80. http://dx.doi.org/10.1519/00139143-200608000-00006. PMid:16914064.
Youdas JW, Kotajarvi BJ, Padgett DJ, Kaufman KR. Partial weight-bearing gait using conventional assistive devices. Archives of Physical Medicine and Rehabilitation. 2005; 86(3):394-8. http://dx.doi.org/10.1016/j.apmr.2004.03.026. PMid:15759217.
Bradley SM, Hernandez CR. Geriatric assistive devices. American Family Physician. 2011; 84(4):405-11. PMid:21842786.
Debi R, Mor A, Segal G, Segal O, Agar G, Debbi E, Halperin N, Haim A, Elbaz A. Correlation between single limb support phase and self-evaluation questionnaires in knee osteoarthritis populations. Disability and Rehabilitation. 2011; 33(13-14):1103-9. http://dx.doi.org/10.3109/09638288.2010.520805. PMid:21208029.
Doheny EP, McGrath D, Greene BR, Walsh L, McKeown D, Cunningham C, Crosby L, Kenny RA, Caulfield B. Displacement of centre of mass during quiet standing assessed using accelerometry in older fallers and non-fallers. In: Conference Proceedings Annual International Conference IEEE Engineering Medical & Biology Society; 2012; San Diego, CA. IEEE; 2002. p. 3300-3.
Fernandes V. Desenvolvimento de um sistema para análise de equilibrio baseado em sensores inerciais [dissertation]. Braga: Universidade do Minho; 2013.
Henriksen M, Lund H, Moe-Nilssen R, Bliddal H, Danneskiod-Samsøe B. Test-retest reliability of trunk accelerometric gait analysis. Gait & Posture. 2004; 19(3):288-97. http://dx.doi.org/10.1016/S0966-6362(03)00069-9. PMid:15125918.
Hollman JH, McDade EM, Petersen RC. Normative spatiotemporal gait parameters in older adults. Gait & Posture. 2011; 34(1):111-8. http://dx.doi.org/10.1016/j.gaitpost.2011.03.024. PMid:21531139.
Huisinga JM, George RJS, Horak FB. Variability measures of trunk and pelvis acceleration during walking and quiet stance are related in patients with multiple sclerosis and in healthy controls. In: The American Society of Biomechanics Annual Meeting; 2011; Long Beach, CA. ASB; 2011. p. 1-2.
Ishikura T. Biomechanical analysis of weight bearing force and muscle activation levels in the lower extremities during gait with a walker. Acta Medica Okayama. 2001; 55(2):73-82. PMid:11332202.
Kegelmeyer DA, Parthasarathy S, Kostyk SK, White SE, Kloos AD. Assistive devices alter gait patterns in Parkinson disease: advantages of the four-wheeled walker. Gait & Posture. 2013; 38(1):20-4. http://dx.doi.org/10.1016/j.gaitpost.2012.10.027. PMid:23237981.
Kloos AD, Kegelmeyer DA, White SE, Kostyk SK. The impact of different types of assistive devices on gait measures and safety in Huntington’s disease. PLoS One. 2012; 7(2):e30903. http://dx.doi.org/10.1371/journal.pone.0030903. PMid:22363511.
Lee J-A, Cho SH, Lee Y-J, Yang H-K, Lee J-W. Portable activity monitoring system for temporal parameters of gait cycles. Journal of Medical Systems. 2010; 34(5):959-66. http://dx.doi.org/10.1007/s10916-009-9311-8. PMid:20703612.
Liu HH, McGee M, Wang W, Persson M. Comparison of gait characteristics between older rolling walker users and older potential walker users. Archives of Gerontology and Geriatrics. 2009; 48(3):276-80. http://dx.doi.org/10.1016/j.archger.2008.02.004. PMid:18359111.
Liu HH. Assessment of rolling walkers used by older adults in senior-living communities. Geriatrics & Gerontology International. 2009; 9(2):124-30. http://dx.doi.org/10.1111/j.1447-0594.2008.00497.x. PMid:19740354.
Martins M, Santos CP, Costa L, Frizera A. Multivariate analysis of walker-assisted ambulation. In: IEEE 3rd Portugal Meeting Bioengineering (ENBENG); 2013; Braga, Portugal. IEEE; 2013. p. 23-6.
Melis EH, Torres-Moreno R, Barbeau H, Lemaire ED. Analysis of assisted-gait characteristics in persons with incomplete spinal cord injury. Spinal Cord. 1999; 37(6):430-9. http://dx.doi.org/10.1038/sj.sc.3100850. PMid:10432263.
Priebe JR, Kram R. Why is walker-assisted gait metabolically expensive? Gait & Posture. 2011; 34(2):265-9. http://dx.doi.org/10.1016/j.gaitpost.2011.05.011. PMid:21665475.
Roomi J, Yohannes AM, Connolly MJ. The effect of walking aids on exercise capacity and oxygenation in elderly patients with chronic obstructive pulmonary disease. Age and Ageing. 1998; 27(6):703-6. http://dx.doi.org/10.1093/ageing/27.6.703. PMid:10408664.
Sabatini AM, Martelloni C, Scapellato S, Cavallo F. Assessment of walking features from foot inertial sensing. IEEE Transactions on Biomedical Engineering. 2005; 52(3):486-94. http://dx.doi.org/10.1109/TBME.2004.840727. PMid:15759579.
Smidt GL, Mommens MA. System of reporting and comparing influence of ambulatory aids on gait. Physical Therapy. 1980; 60(5):551-8. PMid:7384225.
Tereso A, Martins M, Santos CP, Vieira da Silva M, Gonçalves L, Rocha L. Detection of gait events and assessment of fall risk using accelerometers in assisted gait. In: Proceedings 11th International Conference Informatics Control and Automation Robotics; 2014; Vienna, Austria. IEEE; 2014. p. 788-93.
Tung JY, Gage WH, Poupart P, McIlroy WE. Upper limb contributions to frontal plane balance control in rollator-assisted walking. Assistive Technology. 2014; 26(1):15-21, quiz 22-3. http://dx.doi.org/10.1080/10400435.2013.789456. PMid:24800450.
Van Hook FW, Demonbreun D, Weiss BD. Ambulatory devices for chronic gait disorders in the elderly. American Family Physician. 2003; 67(8):1717-24. PMid:12725450.
Vogt L, Lucki K, Bach M, Banzer W. Rollator use and functional outcome of geriatric rehabilitation. Journal of Rehabilitation Research and Development. 2010; 47(2):151-6. http://dx.doi.org/10.1682/JRRD.2009.09.0148. PMid:20593328.
Wellmon R, Pezzillo K, Eichhorn G, Lockhart W, Morris J. Changes in dual-task voice reaction time among elders who use assistive devices. Journal of Geriatric Physical Therapy. 2006; 29(2):74-80. http://dx.doi.org/10.1519/00139143-200608000-00006. PMid:16914064.
Youdas JW, Kotajarvi BJ, Padgett DJ, Kaufman KR. Partial weight-bearing gait using conventional assistive devices. Archives of Physical Medicine and Rehabilitation. 2005; 86(3):394-8. http://dx.doi.org/10.1016/j.apmr.2004.03.026. PMid:15759217.
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