Feasibility of personalised hip load modification using real-time biofeedback in hip osteoarthritis: A pilot study
Laura E. Diamond, Daniel Devaprakash, Bradley M. Cornish, Melanie L. Plinsinga, Andrea Hams, Michelle Hall, Rana S. Hinman, Claudio Pizzolato, David J. Saxby
Abstract
Objective: (i) Compare the feasibility of three load modification strategies to immediately increase hip contact force in people with hip osteoarthritis (OA) using real-time visual biofeedback during walking, and (ii) prospectively evaluate changes in pain and physical function following 6-weeks of walking using a prescribed personalised load modification strategy. Design: Twenty participants with symptomatic mild-to-moderate hip OA walked on an instrumented treadmill while motion capture and electromyographic data were recorded (normal walk), then under three conditions: (i)neutral trunk lean; (ii)neutral pelvic obliquity; (iii)increased step length. The biomechanical parameter of interest and corresponding target value were displayed in real-time. Hip contact forces were subsequently computed using a calibrated electromyography-informed neuromusculoskeletal model. A decision tree was used to prescribe a personalised load modification strategy to each participant for integration into walking over 6-weeks. Results: Only the step length modification significantly increased peak hip contact force compared to normal walking when performed by all participants (11.34 [95%CI 4.54,18.13]%, P < 0.01). After participants were prescribed a personalised load modification strategy, both neutral pelvis (n = 5, 11.88[95%CI -0.49,24.24]%) and step length (n = 10, 12.79[95%CI 0.49,25.09]%) subgroups increased peak hip contact force >10%. After 6-weeks, 77% and 46% of participants reported a clinically important improvement in hip pain during walking and physical function, respectively. Conclusion: Most participants with hip OA could immediately increase hip contact force through personalised movement retraining by a magnitude estimated to promote cartilage heath and reported an improvement in symptoms after 6-weeks. Findings provide preliminary support for a personalised load modification-based intervention for hip OA.