Abstract
Objective
To review the current literature regarding methods and effects of real-time biofeedback
used as a method for gait retraining to reduce knee adduction moment (KAM), with intended
application for patients with knee osteoarthritis (KOA).
Data Sources
Searches were conducted in MEDLINE, Embase, CINAHL, SPORTDiscus, Web of Science, and
Cochrane Central Register of Controlled Trials with the keywords gait, feedback, and knee osteoarthritis from inception to May 2015.
Study Selection
Titles and abstracts were screened by 1 individual for studies aiming to reduce KAM.
Full-text articles were assessed by 2 individuals against predefined criteria.
Data Extraction
Data were extracted by 1 individual according to a predefined list, including participant
demographics and training methods and effects.
Data Synthesis
Electronic searches resulted in 190 potentially eligible studies, from which 12 met all
inclusion criteria. Within-group standardized mean differences (SMDs) for reduction
of KAM in healthy controls ranged from .44 to 2.47 and from .29 to .37 in patients
with KOA. In patients with KOA, improvements were reported in pain and function, with
SMDs ranging from .55 to 1.16. Methods of implementation of biofeedback training varied
between studies, but in healthy controls increased KAM reduction was noted with implicit,
rather than explicit, instructions.
Conclusions
This review suggests that biofeedback gait training is effective primarily for reducing
KAM but also for reducing pain and improving function in patients with KOA. The review
was limited by the small number of studies featuring patients with KOA and the lack
of controlled studies. The results suggest there is value and a need in further researching
biofeedback training for reducing KAM. Future studies should include larger cohorts
of patients, long-term follow-up, and controlled trials.
Keywords
List of abbreviations:
FPA (foot progression angle), KAM (knee adduction moment), KOA (knee osteoarthritis), PROM (patient-reported outcome measure), RCT (randomized controlled trial), SMD (standardized mean difference)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 30, 2016
Footnotes
Supported by the European Union Marie Curie Actions-Initial Training Networks (FP7-PEOPLE-2013-ITN) (grant no. 607510).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
