Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective?

Richards, R.; Noort, Josien C. van den; Esch, M. van der; Booij, M.J.; Harlaar, Jaap

doi:10.1016/j.clinbiomech.2017.07.004

Cited by 49 publications

(79 citation statements)

References 34 publications

(55 reference statements)

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“…representing true MCF and LCFs. This is of great importance considering so many studies stray beyond simple linear scaling (Fregly 2007;Shull et al 2013a;Ogaya et al 2014;Miller et al 2015;van Den Noort et al 2015;Liu et al 2016;Richards et al 2017). Two of the main limitations of this study were the small sample size and not randomizing the order of gait alterations, although beyond the scope of this study, this restricted detection of meaningful clinical results.…”

Section: Discussionmentioning

confidence: 96%

“…Directing researchers to tailor treatments to the individual patient (Gerbrands et al 2014;Shull et al 2015;Favre et al 2016). One such study has shown that more patient-specifically assigned toe-in and toe-out walking can better reduce the peak KAM, a controversial surrogate for the medial contact force (Creaby 2015;Manal et al 2015;Richards et al 2018), when compared to uniformly assigned modifications (Uhlrich et al 2018).…”

Section: Introductionmentioning

confidence: 99%

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Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Dzialo

Mannisi

Halonen

et al. 2019

International Biomechanics

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Gait modifications and laterally wedged insoles are non-invasive approaches used to treat medial compartment knee osteoarthritis. However, the outcome of these alterations is still a controversial topic. This study investigates how gait alteration techniques may have a unique effect on individual patients; and furthermore, the way we scale our musculoskeletal models to estimate the medial joint contact force may influence knee loading conditions. Five patients with clinical evidence of medial knee osteoarthritis were asked to walk at a normal walking speed over force plates and simultaneously 3D motion was captured during seven conditions (0°-, 5°-, 10°-insoles, shod, toe-in, toe-out, and wide stance). We developed patient-specific musculoskeletal models, using segmentations from magnetic resonance imaging to morph a generic model to patientspecific bone geometries and applied this morphing to estimate muscle insertion sites. Additionally, models were created of these patients using a simple linear scaling method. When examining the patients' medial compartment contact force (peak and impulse) during stance phase, a 'one-size-fits-all' gait alteration aimed to reduce medial knee loading did not exist. Moreover, the different scaling methods lead to differences in medial contact forces; highlighting the importance of further investigation of musculoskeletal modeling methods prior to use in the clinical setting. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Dzialo

Mannisi

Halonen

et al. 2019

International Biomechanics

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show abstract

“…This study uses data collected for a previous study 27 with forty participants with medial KOA. Data from 35 of 40 participants were analyzed; demographics are presented in Table I.…”

Section: Participantsmentioning

confidence: 99%

“…Ethical approval was granted by the VUmc Medical Ethics committee and all participants provided written consent. Inclusion and exclusion criteria for the study are described in Richards et al 27 .…”

Section: Participantsmentioning

confidence: 99%

Relationship between knee joint contact forces and external knee joint moments in patients with medial knee osteoarthritis: effects of gait modifications

Richards

Andersen

Harlaar

et al. 2018

Osteoarthritis and Cartilage

121

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At the first peak, KAM is a reasonable substitute for the medial contact force, but not at the second peak. First peak KFM is also a significant contributor to the medial KCF. At the first peak, walking with a modified gait reduced the ratio of the medial to total KCF but not the medial KCF itself. To determine the effects of gait modifications on cartilage loading and disease progression, longitudinal studies and individualized modeling, accounting for motion control, would be required.

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“…Recent research suggests remote observations may differ than those made in the lab or clinic [10][11][12], and thus may provide additional information for informing clinical decision making. Additionally, remote observation could be used as an endpoint for assessing efficacy of interventions designed to target specific biomechanical indices (e.g., using biofeedback to reduce knee loading [13]). Taken together, these developments suggest that remote observation of patient biomechanics during daily life is emerging as an important tool for improving human health.…”

Section: Introductionmentioning

confidence: 99%

Estimating Biomechanical Time-Series with Wearable Sensors: A Systematic Review of Machine Learning Techniques

Gurchiek¹,

Cheney²,

McGinnis³

2019

Preprint

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Wearable sensors have the potential to enable comprehensive patient characterization and optimized clinical intervention. Critical to realizing this vision is accurate estimation of biomechanical time-series in daily-life, including joint, segment, and muscle kinetics and kinematics, from wearable sensor data. The use of physical models for estimation of these quantities often requires many wearable devices making practical implementation more difficult. However, regression techniques may provide a viable alternative by allowing the use of a reduced number of sensors for estimating biomechanical time-series. Herein, we review 46 articles that used regression algorithms to estimate joint, segment, and muscle kinematics and kinetics. We present a high-level comparison of the many different techniques identified and discuss the implications of our findings concerning practical implementation and further improving estimation accuracy. In particular, we found that several studies report the incorporation of domain knowledge often yielded superior performance. Further, most models were trained on small datasets in which case nonparametric regression often performed best. No models were open-sourced, and most were subject-specific and not validated on impaired populations. Future research should focus on developing open-source algorithms using complementary physics-based and machine learning techniques that are validated in clinically impaired populations. This approach may further improve estimation performance and reduce barriers to clinical adoption.

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Effect of real-time biofeedback on peak knee adduction moment in patients with medial knee osteoarthritis: Is direct feedback effective?

Abstract: Real-time biofeedback directly on the knee adduction moment is a promising option for encouraging gait modifications to reduce knee loading, however only when combined with specific instructions on how to modify the gait.

Cited by 49 publications

References 34 publications

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Gait alteration strategies for knee osteoarthritis: a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques

Relationship between knee joint contact forces and external knee joint moments in patients with medial knee osteoarthritis: effects of gait modifications

Estimating Biomechanical Time-Series with Wearable Sensors: A Systematic Review of Machine Learning Techniques

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