Comparison of gait, functional activities, and patient-reported outcome measures in patients with knee osteoarthritis and healthy adults using 3D motion analysis and activity monitoring: an exploratory case-control analysis

Abstract

Objective: To examine functional performance differences using kinematic and kinetic analysis between participants with and without knee osteoarthritis (OA) to determine which outcomes best characterize persons with and without knee OA.

Methods: Participants with unilateral moderate knee OA (Kellgren-Lawrence grades 2 or 3) and controls without knee pain were matched for age, gender, and body mass index. Primary outcomes included temporal parameters, joint rotations and moments, and ground reaction forces assessed via 3D motion capture during walking and ascending/descending stairs. Secondary outcomes included timed functional activities (sit to stand; tying shoelaces), 48 hrs lower limb activity monitoring, and patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Osteoarthritis Index, European Quality of Life-5 Dimensions).

Results: Eight matched pairs were analyzed. Compared with controls, OA participants exhibited significant reductions in peak frontal hip and sagittal knee moments, and decreased peak anterior ground reaction force with the affected limb while walking. Ascending stairs, OA participants had slower speed, fewer strides per minute, longer cycle and stance times, and increased trunk range of motion (ROM) in assessments of both limbs; longer swing time and reduced ankle ROM in the affected limb; and increased knee frontal ROM in the unaffected limb. Descending stairs, OA participants had fewer strides per minute and decreased trunk transverse ROM in assessments of both limbs; increased knee frontal ROM in the affected limb; and longer strides, shorter stance and cycle times, increased trunk sagittal and decreased knee transverse ROMs in the unaffected limbs vs controls. Compared with controls, OA participants had slower walking cadence (120-130 vs 100-110 steps/min, respectively), took significantly longer on timed functional measures, and had significantly worse scores in patient-reported outcomes.

Conclusion: Several objectives and patient-reported measures examined in this study could potentially be considered as outcomes in pharmacologic or physical therapy OA trials.

Keywords: 3D motion analysis; biomechanics; gait; kinetics; knee; osteoarthritis.

Figure 1

Cadence (steps per minute) measured by ActivPAL in OA participants (n=10) and controls (n=8). This figure graphically shows a categorical analysis of cadence (spm) gathered from the ActivPAL for each group (OA and controls) on days 1 and 2. The different colors indicate the proportion of subjects in each cadence category, spanning a range of approximately 11 spm; dark blue indicates the slowest spm and purple indicates the fastest. Abbreviations: OA, osteoarthritis; spm, steps per minute.

Figure 2

Percentage of OA participants (n=10; blue) and controls (n=7; orange) reporting “Some Problems” or “Extreme Problems” (scores of 2 or 3) on the EQ-5D Questionnaire. The five domains of the EQ-5D are each scored as 1=no problems; 2=some problems; and 3=extreme problems. Abbreviations: EQ-5D, European Quality of Life–5 Dimensions; OA, osteoarthritis.