Gait Analysis and Falls between Persons with Knee Osteoarthritis

and Non-Knee Osteoarthritis

Laras Hapsari, Widjajalaksmi Kusumaningsih, Tirza Z. Tamin

Department of Physical Medicine and Rehabilitation, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine,

University of Indonesia, Jakarta, Indonesia

Keywords: Gait Analysis, Falls, Non-Obesity, Knee Osteoarthritis.

Abstract: Persons with knee osteoarthritis have a twenty-five percent higher risk of falling. It is important to evaluate

the change of the walking pattern that leads to inadequate balance. This is a preliminary study with a cross-

sectional design in 20 subjects men and women aged 50-70 years old. By consecutive sampling, the subjects

were divided into 2 groups, non-obesity knee osteoarthritis (NOKO) group, and non obesity non

osteoarthritis (NONO) group. TUG test and temporospatial gait analysis without EMG reading were done

on each subject. An independent T-test is used to determine the difference of the two groups. NOKO group

has differences in temporospatial gait parameters and TUG time, than NONO group. NOKO group have

prolonged TUG, smaller step length, smaller stride length and more steps per minute than NONO group, but

not statistically significant (p > 0.05). There were differences in Gait Patterns and Fall Risk between Non

Obesity Knee OA and Non Obesity Non Knee OA patients.

1 INTRODUCTION

Falls can lead to major health problems. Around 30-

40% of people have a history of falling. One of the

many factors for falling risk is Osteoarthritis (OA).

In Indonesia, the prevalence of OA reached 74,48%

from all rheumatic cases in 2004, where 69% is a

woman and 87% are knee OA cases (IRA, 2014).

Osteoarthritis (OA), known as joint degenerative

disease, is typical of biochemical and morphological

changes in synovial membranes, joint cartilages, and

bones. The knee is a weight-bearing joint, that is

why the knee is the most commonly affected by OA.

The etiology of OA is multifactorial and a

combination of local and systemic factors. Old age,

overweight to obesity, knee injury, overuse of joints,

bone density, muscle weakness, and joint laxity

plays an important role in knee OA

(Losina, 201).

Around 50% of 65 years of people and over give

radiological features according to osteoarthritis,

where 10% of men and 18% of women show clinical

symptoms of OA, and about 10% experience

disabilities because of their OA, and older the

possibility to get OA is higher. (Losina et al.,

2011).

The knee OA population has a 25% higher risk

of falling. Several factors such as balance deficit and

weakness of the lower limb muscles which

ultimately cause changes in walking patterns can

contribute to the risk of falling in knee OA (Pater

ML et al., 2019). That is why the purpose of this

study is to observe changes in walking patterns and

see if there is a balance disturbance that can be seen

through step length, stride length, step width,

number of steps in certain time and track, and

walking speed. So that medical staff can determine

the abnormalities of the walking pattern and help

them to correct it to reduce the risk of falling on

knee OA patients.

2 METHODS

2.1 Ethical statement

This study was approved by the Medical Ethics

Committee of the faculty of medicine, University of

Indonesia (19-08-0953/Aug 2019). All participants

read and signed a written consent form.

248

Hapsari, L., Kusumaningsih, W. and Tamin, T.

Gait Analysis and Falls between Persons with Knee Osteoarthritis and Non-Knee Osteoarthritis.

DOI: 10.5220/0009088902480251

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 248-251

ISBN: 978-989-758-409-1

2.2 Participants

This study uses a cross-sectional design approach.

Around 20 patients (male and female) were

participated and evaluated. Selected patients were

those who meet the following criteria; age between

50 to 70, Normoweight BMI

(< 23 kg/m2, WHO for Asia Pacific BMI

Classification), knee OA (grade 1-3) and non-knee

OA without other lower limb abnormality or

problem, able to walk as far as 10 m.

2.3 Measurements

Balance and risk of falls were assessed with Time

Up and Go (TUG) and gait analysis through the

walking test. The first test requires the patients to sit

on a chair and when instructed start to stand, walk

forward along the 3 m track, turn at the end of the

track, walk back to the chair, and finally sit on the

chair again, while the examiner measures the time

needed to complete the task using a stopwatch

(Barry E et al., 2014).

The second test consisted of patients walking

along a 10-meter long pathway of cloth on a flat

floor. Patients were asked to sit in a chair, immerse

their feet in blue ink, and were instructed to stand up

and start walking along the pathway at their normal

speed while the examiner calculated their walking

time using a stopwatch. Meanwhile step width, step

length, and stride length can be obtained by

measuring the distance on the footprints using a

ruler and number of steps by counting the number of

steps in the first minute (Xiangping Li et al., 2012).

2.4 Statistical Analysis

All the data that have been obtained are processed,

presented, and then analyzed using the SPSS

program and performed using the independent t-test.

The SPSS Statistics version 21 was used for all

statistical analyses. A P-value ≤0.05 was considered

significant. Besides, descriptive analysis was used to

assess the mean and standard deviation (SD) of all

variables.

3 RESULTS

Table 1 illustrates the means of characteristics of

subjects used in this study. Among 20 people who

have participated in this study, there were 3 (30%)

men and 7 (70%) woman from non obesity non

osteoarthritis (NONO) group, and 2 (20%) men and

8 (80%) woman from non obesity knee osteoarthritis

(NOKO) group. The mean age from all the

participants in both groups was 58 and 64 years old.

The mean score for BMI was 20.71kg/m2 and

21.87kg/m2. From table 1, it can be concluded that

the subject dominantly female, with non obesity

knee osteoarthritis (NOKO) group, KL mostly

grades 2 and 3.

Meanwhile, Table 2 illustrates the mean values

of the Gait features on non obesity non osteoarthritis

(NONO) group and non obesity knee osteoarthritis

(NOKO) group subjects and the result of

Independent t-test. The TUG test results of non-

obesity non osteoarthritis (NONO) group mean

scores were 10.026 seconds and now obesity knee

osteoarthritis (NOKO) group were longer 11.98

seconds.

There were some differences in the mean score

between the two groups. For step width in non

obesity non osteoarthritis (NONO) group was

16.1cm and non obesity knee osteoarthritis (NOKO)

group was 14.7cm. Step length in non obesity non

osteoarthritis (NONO) group was 49.9cm and non

obesity knee osteoarthritis (NOKO) group was

45cm, stride length in non obesity non osteoarthritis

(NONO) was group 104.5cm and non obesity knee

osteoarthritis (NOKO) group was 93.95cm, cadence

73x/min in non obesity non osteoarthritis (NONO)

group and 77.7x/min for non obesity knee

osteoarthritis (NOKO) group , and walking speed for

non obesity non osteoarthritis (NONO) group was

0.63m/s and 0.61m/s for non obesity knee

osteoarthritis (NOKO) group.

Table 1: Characteristics of subjects.

Variable

Groups

Non-knee OA

N=10

Knee-OA

N=10

Gender Man 30% 20%

Gender

Woman

70% 80%

Age (years) 58.30 ± (7.33) 64.30 ± (5.25)

Weight (kg) 50.15 ± (6.37) 53.80 ± (4.04)

Height (m) 1.55 ± (0.07) 1.56 ± (0.05)

BMI (kg/m

) 20.71 ± (2.36) 21.87 ± (1.06)

Based on the data shown in table 2, there were

differences between non obesity knee osteoarthritis

(NOKO) group and non obesity non osteoarthritis

(NONO) group. It can be seen that non obesity knee

osteoarthritis (NOKO) group have prolonged TUG,

smaller step length, smaller stride length, and more

steps per minute (cadence) than non obesity non

Gait Analysis and Falls between Persons with Knee Osteoarthritis and Non-Knee Osteoarthritis

249

osteoarthritis (NONO) group, although not

statistically significant (p > 0.05).

Table 2: Gait features and Independent t-test result in

Non-knee OA and knee OA patients.

Variable

Gait features

Groups

p-value

Non-knee

N=10

Knee-OA

N=10

TUG (second)

10.026 ±

2.12

11.98 ±

2.23

0.545

Width (cm)

16.1 ±

3.85

14.7 ±

3.32

0.396

Step Length

(cm)

49.9 ±

8.97

45 ±

11.74

0.308

Stride Length

(cm)

104.5 ±

12.03

93.95 ±

19.85

0.168

Cadence

(x/minutes)

73 ±

19.22

77.7 ±

13.66

0.536

Walking

Speed (m/s)

0.636 ±

0.19

0.613 ±

0.15

0.773

4 DISCUSSIONS

This study is preliminary. And according to our

knowledge, there are still very few studies discuss

this topic. The results in this study show that there

was a difference in Gait Patterns and Fall Risk in

Non-Obese Knee OA and Non-obese non Knee OA

patients, althoughnotstatisticallysignificant. This is

not in line with Khalaj N et al. (2014) study, where

total of 60 subjects participated in the study (20

male, 40 female) with the age of participants ranged

from 50 to 69 years showed that there is a significant

difference between three groups (healthy, mild knee

OA, and moderate knee OA) in all the test. In

general, the findings of Khalaj study supported that

individuals with bilateral knee OA had impaired

balanced compared to healthy controls, and this

impairment was more pronounced in moderate knee

OA patients (Khalaj N et al. 2014).

One of the explanatory factors for the variation

of gait patterns in individuals with knee OA is the

severity of knee pain. Pain associated with

osteoarthritis of the knees increased the propensity

to trip on an obstacle, and the greater the pain is

associated with greater risk of falls. However, one

study illustrated that knee pain is associated with

poor balance in individuals with muscle weakness

(Khalaj N et al. 2014). This can be measured

through TUG test, where the subjects on the knee-

OA group will take a longer time to complete the

task compared to the non-OA group.

The differences in the result are because the

subjects in this study were non-obese, which means

there was no burden on the knees which plays the

role of weight-bearing joints. So it will not be that

hard to support the weight of the body and results.

There is a weakness or limitation on this study, it

is the lack of subjects, when all the subject needed

were 20 in each group subject which is 40 subjects

in total, however, this study can only collect 20

subjects in total (10 each), so that the results are not

as expected. The low participation in this study is

influenced by many things including the difficulty of

finding participants who met all inclusion criteria.

Another disadvantage of this study is the use of

calico cloth in the 10 m pathway test which is less

sensitive in assessing walking parameters when

compared to the gait analyzer.

5 CONCLUSIONS

The purpose of this study is to see gait patterns in

patients to reduce the high risk of falling. Improving

the postural stability of older adults with knee OA

has become an important challenge for the medical

practitioner. Establishing these data have

implications in planning rehabilitation programs and

will enable the practitioner to customize their

rehabilitation strategies.

The results in this study show that there was a

difference in Gait Patterns and Fall Risk between

two groups with every 10 subjects, although not

statistically significant. Therefore further study with

more subjects needed to determine the difference in

gait patterns and the risk of falling in the subjects.

REFERENCES

Indonesian Rheumatology Association, 2014. Diagnosis

dan Penatalaksanaan Osteoartritis. Rekomendasi IRA

untuk Diagnosis dan Penatalaksanaan Osteoartritis.

Losina E, Walensky RP, Reichmann WM, Holt HL,

Gerlovin H, Solomon DH, et al, 2011. Original

Research Impact of Obesity and Knee Osteoarthritis

on Morbidity and Mortality in Older Americans. Ann

Intern Med. 26(154):217–26.

Khalaj N., et al, 2014. Balance, and Risk of Fall in

Individuals with Bilateral Mild and Moderate Knee

Osteoarthritis. Plos One. vol 9.

Pater ML, Rosenblatt NJ, Grabiner MD, 2019. Knee

osteoarthritis negatively affects the recovery step

following large forward-directed postural

perturbations. J Biomech [Internet]. 49(7):1128–33.

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

250

Available

from:http://dx.doi.org/10.1016/j.jbiomech.2016.02.048

Barry E, Galvin R, Keogh C, Horgan F FT, 2014. Is the

Timed Up and Go test a useful predictor of the risk of

falls in community-dwelling older adults: A

systematic review and meta-analysis. BMC Geriatr.

14(1):1–14.

Xiangping Li, Bin Shu, Dingguo Miu, Wangling Jiang

DT, 2012. Review on the Clinical Application of Gait

Analysis. Forensic Sci. 2(1):36–9.

Gait Analysis and Falls between Persons with Knee Osteoarthritis and Non-Knee Osteoarthritis

251