Discriminant validity and reproducibility of spatiotemporal and kinetic parameters during treadmill walking in patients with knee osteoarthritis

doi:10.1016/j.gaitpost.2020.04.002

Gait & Posture

Volume 80, July 2020, Pages 77-79

https://doi.org/10.1016/j.gaitpost.2020.04.002 Get rights and content

Highlights

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Measurement properties of an instrumented treadmill were evaluated in KOA patients.
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Discriminant validity was good, particularly for single-limb support duration.
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Test-retest reproducibility was acceptable for most of the gait parameters.
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The treadmill may have potential clinical utility for quantitative gait analysis.

Abstract

Background

Instrumented treadmills are potentially useful tools for the assessment of gait parameters in orthopaedic clinical settings, but their measurement properties remain uncertain.

Research question

What is the discriminant validity and reproducibility of spatiotemporal and kinetic gait parameters measured by a pressure-instrumented treadmill at different speeds and inclinations in patients with knee osteoarthritis (KOA)?

Methods

A total of 54 patients with unilateral KOA and 23 healthy controls took part in the study. Step length, single-limb support duration and ground reaction force were recorded during level and uphill walking at 3 and 4 km/h using a commercially-available treadmill instrumented with an integrated pressure platform. We examined discriminant validity (difference between involved and uninvolved side as well as against healthy controls) and test-retest reproducibility (reliability and agreement).

Results

Significant side differences were observed for single-limb support duration and ground reaction force at touchdown in all conditions (P < 0.05). All the investigated gait parameters showed acceptable reliability and agreement, except step length at 4 km/h uphill.

Significance

We conclude that the pressure-instrumented treadmill used in this study may have good clinical utility for quantitative gait analysis in patients with KOA under different experimental conditions.

Introduction

Patients with knee osteoarthritis (KOA) show marked impairments in walking capabilities [[1], [2], [3], [4]], therefore accurate and reproducible measurements of the main spatial, temporal and kinetic gait parameters are fundamental in clinical settings. Quantitative analysis of gait patterns in orthopaedic patients is usually conducted during level walking at self-selected [1,4,5] or pre-defined velocities [2,6]. Nevertheless, evaluating gait parameters at various speeds or inclinations may reveal otherwise undetected alterations of the normal walking pattern [7]. Pressure-instrumented treadmills offer a controlled and convenient environment for collecting large amounts of data in the clinic. These tools provide an objective assessment of spatial, temporal and kinetic parameters at different walking speeds and inclinations throughout an integrated pressure platform. Spatiotemporal and kinetic gait variables provided by these devices revealed good reproducibility in healthy individuals for level walking [8,9] and at different speeds and inclinations [10,11]. However, because the measurement properties of the parameters provided by an instrumented treadmill have never been verified in KOA patients, the clinical utility of these potentially-useful diagnostic tools remains uncertain.

The aim of this study was to evaluate the validity and reproducibility of spatial, temporal and kinetic parameters during treadmill walking at different speeds and inclinations in KOA patients. More precisely, we investigated discriminant validity, as the capacity to detect a significant difference between the involved and uninvolved side as well as between patients and healthy controls, and reproducibility (reliability and agreement) using a test-retest design.

Section snippets

Participants

A total of 54 patients with unilateral symptomatic KOA (scheduled for knee replacement) and 23 matched healthy controls were included in this study (Table 1). Patients had a pain level ≥ 2 on a 0-10 visual analogue scale and evidence of medial/lateral KOA based on Kellgren/Lawrence grade ≥ 2 (mean ± SD: 3.4 ± 0.6). Exclusion criteria were surgery to the lower limbs in the prior 12 months, symptomatic osteoarthritis in lower limb joints other than the involved knee or any neuromuscular,

Discriminant validity

Significant differences between the involved and uninvolved side were observed for SLS duration and first GRF peak in all conditions, for step length at 4 km/h level and for second GRF peak at 4 km/h (p < 0.05; Table 2). Step length (except for 3 km/h level) and SLS duration were significantly lower for patients compared to controls (p < 0.05).

Test-retest reproducibility

No systematic bias was observed between the two test sessions for the ensemble of the variables, except first GRF peak at 3 km/h uphill that showed a

Discussion

The main findings of the present methodological study were that the main spatial, temporal and kinetic gait parameters measured by a pressure-instrumented treadmill at two different speeds and inclinations showed good discriminant validity, particularly for SLS duration, and test-retest reproducibility in patients with KOA.

Several measurement devices (such as body mounted accelerometers, walking mats, motion capture systems) can be used for the evaluation of gait characteristics in orthopaedic

Acknowledgements

The authors thank Daniel Agostino, Inès Kramers, Karin Mani, Benedikt Mündle and Alessandra Ventura for help with data collection and manuscript preparation.

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Discriminant validity and reproducibility of spatiotemporal and kinetic parameters during treadmill walking in patients with knee osteoarthritis

Highlights

Abstract

Background

Research question

Methods

Results

Significance

Introduction

Section snippets

Participants

Discriminant validity

Test-retest reproducibility

Discussion

Acknowledgements

Gait Posture

J. Electromyogr. Kinesiol.

Gait Posture

Gait Posture

Osteoarthr. Cartil.

J. Clin. Epidemiol.

Clin. Biomech. (Bristol, Avon)