Inter-segment coordination amplitude and variability during gait in patients with knee osteoarthritis and asymptomatic adults

Background: Inter-segment coordination examines the timing and coupling of multiple body segments and provides a complex understanding of how the neuromuscular system controls the body. Research is required to examine if inter-segment coordination during gait differs between individuals with different knee osteoarthritis (OA) severities and asymptomatic adults.

Research question: Do inter-segment coordination amplitude and between-trial variability during gait differ between individuals with varying levels of knee OA severity and asymptomatic adults?

Methods: This observational, cross-sectional study included participants with mild/moderate knee OA (n = 38), severe knee OA (n = 24), and asymptomatic adults (n = 51). Participants ambulated overground at self-selected speeds. Data were collected with an eight-camera motion capture system and two force plates. Continuous relative phase (CRP) was used to quantify sagittal plane inter-segment coordination amplitude and between-trial variability for the thigh-shank and shank-foot pairs. Hierarchical linear models examined if CRP variables were related to the group (asymptomatic, mild/moderate OA, severe OA) after accounting for gait speed and gait phase.

Results: Thigh-shank CRP amplitude was significantly associated with group variables. The severe OA group had lower CRP amplitudes than both asymptomatic (b=8.57, 95 % confidence interval=2.75-14.38) and mild/moderate OA (b=5.69, 95 % confidence interval=-0.25 to 11.62) groups. Thigh-shank CRP variability was also associated with group. The severe OA group had lower CRP variability than the asymptomatic group (b=0.45, 95 % confidence interval=0.12-0.78); there were no differences between severe and mild/moderate OA groups (p > 0.050). There were no significant associations between any of the shank-foot CRP measures and the groups.

Significance: Lower thigh-shank CRP amplitude and variability in individuals with severe knee OA represents a more rigid motor system. These individuals could be attempting to stabilize their knee in response to a loss of passive stability or in response to pain. They might have difficulty adapting their gait to perturbations.