Impact of Limb Loading Asymmetry during Walking on Hip and Knee Function in Community-Dwelling Older Adults: A Prospective Cohort Study

Atsunori Kobayashi, Masasyuki Hoshi, Chieri Akiyama, Yuina Kato, Akihiko Asao, Takuma Koho, Toshimi Sato, Yuko Horikoshi, Toshimasa Sone, Yoshitaka Shiba, Tatsuya Nakanowatari
Purpose:

The aim of this study is to determine the impact of limb loading asymmetry while walking on hip and knee function in community-dwelling older adults.

Methods:

Participants aged ≥ 65 years were registered at a community-based health check investigation in Fukushima, Japan They completed questionnaires on their medical history, underwent physical tests at baseline (T0; n = 98 [82 female]; mean age 74.8 ± 5.7 years), and were then prospectively followed for one year (T1; n = 67). The primary outcome measure was assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at T0 and T1, and was defined as the WOMAC delta score (the WOMAC summary score at T0 minus the WOMAC summary score at T1). Limb loading was measured using force sensing insoles capable of measuring three foot regions (rearfoot, midfoot, and forefoot) as well as overall during a ten-meter walking test, and was defined as peak force asymmetry (PFA) and impulse asymmetry (IA) at T0. Associations between changes in WOMAC scores and both PFA and IA on three foot regions and overall were determined using correlation analyses. Multiple linear regression analyses were performed with changes in WOMAC scores as the outcome variable, PFA and/or IA of any region as the explanatory variables, and age, sex, body height and weight, foot posture, and walking speed as confounding variables.


Results:

Overall PFA and midfoot IA were significantly correlated with changes in WOMAC scores (r = 0.244, r = 0.047; r = -0.290, r = 0.017, respectively). Multiple linear regression analysis with overall PFA and midfoot IA identified that the only characteristic retained was midfoot IA (β = -0.290, 95% CI: -0.685 to -0.068, p = 0.017).

Conclusion(s):

Our findings suggest that increased asymmetry of limb loading on midfoot during walking is a predictor of deterioration in hip and knee function. Given that biofeedback of limb loading has been reported to help improve movement patterns, providing biofeedback to patients with OA during exercise may prevent deterioration in hip and knee function.

Implications:

The findings of the present study have important implications for the prevention and management of hip and knee function deterioration in the community-dwelling older adults.

Funding acknowledgements:
This research was supported by a Japan Society for the Promotion of Science KAKENHI Grant (Grant number: 20K19381).
Keywords:
Lower limb joint
WOMAC
Biomechanical loading
Primary topic:
Musculoskeletal: lower limb
Second topic:
Older people
Third topic:
Health promotion and wellbeing/healthy ageing/physical activity
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Fukushima Medical University Ethics committee: The Research Ethics Committee of Fukushima Medical University
Provide the ethics approval number:
2022-123
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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