Predicting knee adduction moment response to gait retraining with minimal clinical data

PLoS Comput Biol. 2022 May 16;18(5):e1009500. doi: 10.1371/journal.pcbi.1009500. eCollection 2022 May.

Abstract

Knee osteoarthritis is a progressive disease mediated by high joint loads. Foot progression angle modifications that reduce the knee adduction moment (KAM), a surrogate of knee loading, have demonstrated efficacy in alleviating pain and improving function. Although changes to the foot progression angle are overall beneficial, KAM reductions are not consistent across patients. Moreover, customized interventions are time-consuming and require instrumentation not commonly available in the clinic. We present a regression model that uses minimal clinical data-a set of six features easily obtained in the clinic-to predict the extent of first peak KAM reduction after toe-in gait retraining. For such a model to generalize, the training data must be large and variable. Given the lack of large public datasets that contain different gaits for the same patient, we generated this dataset synthetically. Insights learned from a ground-truth dataset with both baseline and toe-in gait trials (N = 12) enabled the creation of a large (N = 138) synthetic dataset for training the predictive model. On a test set of data collected by a separate research group (N = 15), the first peak KAM reduction was predicted with a mean absolute error of 0.134% body weight * height (%BW*HT). This error is smaller than the standard deviation of the first peak KAM during baseline walking averaged across test subjects (0.306%BW*HT). This work demonstrates the feasibility of training predictive models with synthetic data and provides clinicians with a new tool to predict the outcome of patient-specific gait retraining without requiring gait lab instrumentation.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Biomechanical Phenomena
  • Gait* / physiology
  • Humans
  • Knee Joint / physiology
  • Osteoarthritis, Knee*
  • Walking / physiology

Grants and funding

NR is supported by the United States National Science Foundation Graduate Research Fellowship Program under grant numbers DGE1745016 and DGE2140739 (https://www.nsfgrfp.org/). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.