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Impact of a personalized care approach on 3D gait impairments in knee osteoarthritis patients (a cluster randomized controlled trial) [r-libre/2862]

Cagnin, Alix; Choinière, Manon; Bureau, Nathalie J.; Durand, Madelaine; Mezghani, Neila; Gaudreault, Nathaly, & Hagemeister, Nicola (2020). Impact of a personalized care approach on 3D gait impairments in knee osteoarthritis patients (a cluster randomized controlled trial). Paper published in Osteoarthritis and Cartilage, 28, S25.

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Content : Published Version
Item Type: Papers in Conference Proceedings
Refereed: Yes
Status: Published
Abstract: Purpose: Knee osteoarthritis (OA) often leads to gait kinematic impairments. The knee kinesiography exam, measuring three-dimensional (3D) knee kinematics during gait on a treadmill, allows to objectively identify gait impairments (GIs) in order to provide recommendations for a personalized care approach (targeted home-based exercises, bracing, etc.) to correct these impairments. A clinical trial showed that this approach can lead to significant improvement in function and pain reduction after 6 months compared to a control group. The aim of this study was to assess the impact of this personalized care approach (PCA) on 3D mechanical GIs in knee OA patients compared to a control group. Methods: Primary care physicians in this cluster randomized controlled trial in the Province of Quebec (Canada) were asked to recruit patients with a clinical diagnosis of knee OA. Patients were included if 1) knee OA was the main cause of their knee pain, 2) they rated their worst pain in the past 7 days ≥ 4 on a 0-10 pain intensity scale, 3) they had a Kellgren-Lawrence grade ≥ 2 on radiographs. Eligible patients from a same primary care clinic were randomized to the same group: 1- a control group (usual care), 2- a group with the PCA, and 3- a group with the PCA + an educational program. In all of the three groups, primary care physicians managed their patients according to their individual needs, but only physicians from groups 2- and 3- had access to the recommendations for the PCA. These were treatment recommendations (e.g. bracing, specific activities, etc.) and tailored home exercises targeting the GIs identified with the knee kinesiography results. Patients from group 3- also had a one-hour educational session on knee OA self-management and two follow-up group meetings with a therapist (to answer their questions, regulate the nature and intensity of their exercises, etc.). For all patients, we assessed the presence of 14 known GIs in knee OA at baseline and 6-month follow-up (see Table 1). If a GI changed from “Present” at baseline to “Absent” at 6 months, we considered it as improved. If it changed from “Absent” to “Present”, it was considered deteriorated. In order to summarize all GIs’ evolution in a single outcome, we calculated for each patient a global evolution ratio (GER) corresponding to the ratio of the sum of improved GIs over the sum of deteriorated GIs. The GER status was defined as “DETERIORATION” (≤0.5), “STABILIZATION” (0.5<GER<1.5), or “IMPROVEMENT” (≥1.5). Chi-square tests were used to assess between-group differences on the GER status. Results: 221 patients from 55 clinics participated. There were 61.1% women, the mean age was 63 years (95%CI: 62;64), and the mean BMI was 29.5 kg/m2 (95%CI: 28.7;30.2). There were no differences between groups at baseline on sociodemographic characteristics and patients were equally distributed between the three groups (1-Control: N=71; 2-PCA: N=72; 3-PCA+Education: N=78). There was a significant difference between the three groups on the GER status (p=0.03). Post-hoc analysis showed that both groups who received the PCA significantly differed from the control group (both p<0.05). As shown in Figure 1, the proportion of patients with an improved GER was higher in both groups with the PCA (Group 1: 28.2% vs Group 2: 37.5% and Group 3: 38.5%), and the proportion of patients with a deteriorated GER was lower (Group 1: 50.7% vs Group 2: 26.4% and Group 3: 30.8%) compared to the control group. There was no significant difference between the two groups with the PCA (p=0.75). Conclusions: Results suggest that a personalized care approach including tailored treatment recommendations (e.g. exercises, orthoses, etc.) to correct GIs can have a positive impact on 3D knee kinematics during gait after 6 months. Patients from both groups who had access to this PCA showed significantly less deterioration, and more stabilization and improvement of their gait impairments compared to the control group. There was no difference between groups 2- and 3-, suggesting that this approach may have an effect on gait impairments even without an additional education program. The proposed global evolution ratio showed interesting results but further analyses are needed to specifically identify which GIs’ evolutions have the most impact on patient outcomes.
Official URL: https://www.oarsijournal.com/article/S1063-4584(20...
Depositor: Ayena, Johannes
Owner / Manager: Johannes Ayena
Deposited: 16 Jan 2023 19:29
Last Modified: 16 Jan 2023 19:29

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