Full length articleAccelerometer-based determination of gait variability in older adults with knee osteoarthritis
Introduction
As individuals age, changes in gait patterns become apparent, and are often influenced by the effects of aging itself. However, knee osteoarthritis (KOA) can have an even more pronounced effect on gait alterations with a subsequent negative impact on an older adult’s level of independent living. The degenerative effects of KOA have been shown to impact several of the age-related changes in the mean spatiotemporal parameters of gait (e.g., shorter stride lengths, longer stance phases, reduced speed, longer stride time and increased double support time) [1], [2], [3], [4], which may reflect compensation strategies to minimize joint pain and protect the knee [4].
These compensations can also affect the variability of gait [5], [6], [7], and recently the subject of gait variability (i.e., the magnitude of stride-to-stride fluctuations and their changes with respect to time) has become a more thoroughly investigated aspect of gait analysis. It provides important information about the rhythmic pattern of the gait cycle that is overlooked when more traditional measures such as the average speed, mean stride time, and mean step length are determined [8]. In non-linear biological systems, variability is related to complexity, wherein a certain amount of variability in the gait cycle is considered to be healthy and represents adaptability and efficient gait control in response to unstable environmental conditions [9]. However, as people age and/or experience different pathologies, the behavioural complexity of the neuromusculoskeletal system can change. Too much or too little variability can affect the stability of the system, as has been shown by studies that have found increased values for the standard deviation (SD) of stride time [10], [11].
Normal gait cycles also possess fractal properties that can be quantified using the fractal-scaling index (FSI), which provides a measure of the long-range, self-similar stride patterns that are associated with gait stability8. Studies show that the FSI can discriminate between healthy gait patterns and those affected by disease and aging, such that lower values (i.e., more random uncorrelated patterns of strides) are associated with impaired health [8], [12], [13]. More random gait patterns are often associated with rhythmic impairments in the neuromuscular control system, but the literature also indicates that increased randomness (less complexity) and gait instability are also associated with joint pathology [5], [6], [7]. This suggests that patients with KOA may express decreased complexity as demonstrated by lower FSI values. Although it is evident that KOA can negatively affect the basic parameters of gait compared to healthy individuals, there has been limited research on the effects of KOA on gait variability. Kiss [14] and Kiss et al. [15] have shown a relationship between KOA and increased gait variability for parameters such as step length and double-support phase duration. However, it has been suggested that different gait variability parameters represent different constructs [16], and as such additional research is needed to fully understand the gait variability characteristics that are associated with KOA. Determining the effects of KOA on stride pattern variability and the fractal structure of the gait cycle will provide a better understanding of the extent to which changes in complexity are associated with the degenerative nature of KOA. To our knowledge, the effect of KOA on stride time variability and the fractal dynamics of the gait cycle has not previously been investigated.
Therefore, the purpose of this study was to investigate the effect of KOA on gait variability (linear and non-linear measures) in a group of older adults, and to compare these results to a healthy, age- and sex-matched control group. It was hypothesized that gait variability (i.e., stride time SD and step time SD) would be greater and the pattern of strides would be more random/uncorrelated (i.e., lower stride time FSI) in the KOA group compared to the healthy older adult control group.
Section snippets
Participants
Thirty older adults (KOA: n = 15; Control: n = 15) matched for age and sex participated in the study (see Table 1). Test participants were admitted to the study if they received a medical diagnosis of KOA, were ≥55 years of age, and could walk for ten minutes without the use of an assistive device and without pain. All participants in the KOA group had bilateral KOA. Based on radiographic assessments of the participants’ knees, the Kellgren-Lawrence (K-L) grading scale was used to categorize the
Results
Demographics, KOOS score, and gait speed results for both groups are shown in Table 1. The two groups were matched according to age as closely as possible, and the results show that the small difference was not significant. KOA group participants had a significantly greater mass, BMI, and KOOS score, and walked at a significantly slower self-selected walking speed than control group participants.
There was an average of 1081 ± 76.07 and 1030.8 ± 65.48 steps taken by the control group and KOA group,
Discussion
This study investigated gait variability in older adults with and without KOA and we hypothesized that gait variability would be significantly different between age and sex-matched participants in the KOA group and control group. The results showed that the participants with KOA walked significantly slower than the healthy control group participants, which is consistent with findings in the literature [1], [2], [3], [26]. The KOA group also had a significantly greater mean stride time and mean
Conclusion
The complex gait characteristics of patients with KOA can make it difficult for clinicians to administer meaningful, objective assessments of their KOA patients’ mobility patterns. This is the first study that has investigated the effect of KOA on certain temporal aspects (i.e., stride time and step time) of the variability and fractal dynamics of the gait pattern. Although the differences in gait variability for this study were not statistically significant, KOA was associated with increased
Acknowledgements
We would like to acknowledge Dr. Megan Dash, Dr. Jeremy Reed, the Centre on Aging and Health, and the University of Regina Fitness and Lifestyle Centre for their assistance with this project.
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