Pereira LC1, Schweizer C1, Moufarrij S1, Krähenbühl SM1, Favre J1, Gremion G1, Applegate LA1,2, Jolles BM1,2
1University Hospital of Lausanne, Lausanne, Switzerland, 2University of Lausanne (UNIL), Lausanne, Switzerland
Background: The scope of practice of physiotherapists has been evolving in domains such as direct access or intraarticular injections. Fist line of treatment for knee osteoarthritis (KOA) is a conservative approach delivered by physiotherapists. To control symptomatic OA flares, patients worldwide seek for approaches such as articular injections. However, despite the fact that injections are recommended as an auxiliary treatment, there is scarce investment from physiotherapists in improving the knowledge within the field. There is a new generation of hyaluronic acid (HA) viscosupplements containing a polyol that are expected to be more effective than traditional cross-linked HA in reducing joint inflammation in patients with KOA. This may have a rapid impact on symptoms and basic overall function such as gait.
Purpose: This 3-arm, prospective, randomised, controlled, double-blind, feasibility pilot study investigated which gait parameters are more sensitive following a single bolus injection of polyol-containing HA for knee osteoarthritis.
Methods: Twenty-two patients with Ahlbäck grade II-III knee osteoarthritis were randomly allocated into three groups:
(1) HA+mannitol (n=9),
(2) HA+sorbitol (n=5), and
(3) saline placebo (n=8). Patients were assessed by blinded observers prior to injection and at 4 weeks post-injection (4W).
Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society score (KSS), EuroQol in five-dimensions (EQ-5D), VAS pain and VAS stiffness. Gait was assessed by a physiotherapist over 30m using a portable inertial-based data logger (Physilog®).
Results: Differences between 4W and baseline were statistically significant for the mannitol-containing viscosupplement, with a median increase of 0.076m/s on gait speed (p=0.039), 0.055m on stride length (P=0.027) and 15 points on the KSS (P=0.047). There were no significant changes from baseline to 4W in any gait parameters or self-reported outcome measures for the HA+sorbitol and saline groups (all p>0.3). The observed mean increase in gait speed is approximately 13% greater than the mean difference between healthy subjects and those with knee osteoarthritis and is considered clinically important.
Conclusion(s): Gait analysis is a complementary outcome measure to standard patient-reported scores and physical measures when testing the effectiveness of HA injection, with gait speed and stride length as the most relevant parameters for investigation.
Implications: Physiotherapists can and should play a role during the therapeutic prescription for KOA patients. This study supports the need for a larger, randomised, controlled, clinical trial to assess the effectiveness of a single-bolus HA injection versus multiple injections in people with knee osteoarthritis using both gait performance and self-reported parameters of knee function.
Keywords: knee, osteoarthritis, gait
Funding acknowledgements: Self-funded study.
Purpose: This 3-arm, prospective, randomised, controlled, double-blind, feasibility pilot study investigated which gait parameters are more sensitive following a single bolus injection of polyol-containing HA for knee osteoarthritis.
Methods: Twenty-two patients with Ahlbäck grade II-III knee osteoarthritis were randomly allocated into three groups:
(1) HA+mannitol (n=9),
(2) HA+sorbitol (n=5), and
(3) saline placebo (n=8). Patients were assessed by blinded observers prior to injection and at 4 weeks post-injection (4W).
Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society score (KSS), EuroQol in five-dimensions (EQ-5D), VAS pain and VAS stiffness. Gait was assessed by a physiotherapist over 30m using a portable inertial-based data logger (Physilog®).
Results: Differences between 4W and baseline were statistically significant for the mannitol-containing viscosupplement, with a median increase of 0.076m/s on gait speed (p=0.039), 0.055m on stride length (P=0.027) and 15 points on the KSS (P=0.047). There were no significant changes from baseline to 4W in any gait parameters or self-reported outcome measures for the HA+sorbitol and saline groups (all p>0.3). The observed mean increase in gait speed is approximately 13% greater than the mean difference between healthy subjects and those with knee osteoarthritis and is considered clinically important.
Conclusion(s): Gait analysis is a complementary outcome measure to standard patient-reported scores and physical measures when testing the effectiveness of HA injection, with gait speed and stride length as the most relevant parameters for investigation.
Implications: Physiotherapists can and should play a role during the therapeutic prescription for KOA patients. This study supports the need for a larger, randomised, controlled, clinical trial to assess the effectiveness of a single-bolus HA injection versus multiple injections in people with knee osteoarthritis using both gait performance and self-reported parameters of knee function.
Keywords: knee, osteoarthritis, gait
Funding acknowledgements: Self-funded study.
Topic: Musculoskeletal: lower limb; Orthopaedics
Ethics approval required: Yes
Institution: CHUV
Ethics committee: CER-VD
Ethics number: No 273/13
All authors, affiliations and abstracts have been published as submitted.
