Differences in gait features in patients with lumbar spinal stenosis and knee osteoarthritis, do they change during a 6-minute walk? — The International Society for the Study of the Lumbar Spine
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Differences in gait features in patients with lumbar spinal stenosis and knee osteoarthritis, do they change during a 6-minute walk? (#1040)

Junichi Kushioka 1 , Ruopeng Sun 1 2 , Wei Zhang 3 , Amir Muaremi 4 , Heike Leutheuser 5 , Charles A. Odonkor 6 7 , Matthew Smuck 1 2
  1. Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
  2. Division of Physical Medicine and Rehabilitation, Stanford University, Stanford, CA, USA
  3. Department of Essential Medicine and Health Product, World Health Organization, Geneva, Switzerland
  4. Novartis Institutes for BioMedical Research, Basel, Switzerland
  5. Central Institute for Medical Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
  6. Department of Orthopedics and Rehabilitation, Division of Physiatry, Yale School of Medicine, New Haven, CT, USA
  7. Orthopedics and Rehabilitation, Interventional Pain Medicine and Physiatry, Yale New Haven Hospital, New Haven, CT, USA

INTRODUCTION

Patients with lumbar spinal stenosis (LSS) and knee osteoarthritis (KOA) suffer from mobility impairment. Clinical observation suggests that the pain from LSS causes gait to deteriorate with time, whereas the pain and stiffness from KOA are more pronounced at the beginning of a walk. However, there is no specific report on the differences in gait disturbance between LSS and KOA over time. In this study, we investigate if changes in gait features during a 6-min walk test (6MWT) can distinguish LSS and KOA.


METHODS

We collected foot-mounted inertial measurement unit (IMU) data during a 6MWT for patients with LSS, KOA, and matched healthy controls ( N = 30, 10 for each group). Spatiotemporal gait characteristics were extracted. In total, 11 parameters in 4 domains were evaluated during each minute of the 6MWT; Rhythm domain (cadence, double support, swing), Pace domain (strike length, speed), Asymmetry domain (symmetry Index for strike length, swing), Variability domain (coefficient variation [CV] for double support, swing, strike length, stride time).

Differences in parameters among the 3 groups from the entire 6MWT were analyzed by one-way ANOVA followed by the Tukey test. In addition, differences in parameters between LSS and KOA groups were analyzed for each minute of the 6MWT using the Mann-Whitney U test.


RESULTS

In the analysis of the entire 6MWT, both LSS and KOA groups showed significantly lower cadence and speed compared to the control group. The KOA group showed significantly higher asymmetry, and the LSS group showed significantly higher variability compared to controls. However, there were no significant differences between the LSS and KOA groups in any of the parameters.

In the analysis of the 6MWT per minute, the LSS group showed a significantly higher CV for strike length (Variability domain) compared to the KOA group during the middle portion of the 6MWT ( 4.29 ± 0.94 in LSS group, 3.40 ± 0.45 in KOA group, p=0.01). No other parameter revealed a significant difference at any timepoint between the two groups.


DISCUSSION

When the entire 6MWT is considered, multi spatiotemporal gait parameters distinguished between healthy controls and LSS or KOA, yet the LSS and KOA groups demonstrated no statistical differences in any of the 11 gait parameters. Comparing LSS to KOA minute-by-minute we did observe higher variability in strike length in LSS group during the middle of the walk. Gait variability is described as a potential biomarker for gait impairment and loss of gait rhythmicity1, 2. The high variability in the LSS group may represent changes in gait rhythm due to intermittent claudication. Yet, in this study no other parameters distinguished LSS from KOA over time during the 6MWT. Likely, larger studies are required to observe the spatiotemporal gait parameters that distinguish these two patient populations.

 

References:

  1. Moon Y, et al. Gait variability in people with neurological disorders: A systematic review and meta-analysis. Hum Mov Sci. 2016 Jun;47:197-208.
  2. Brach JS, et al. Stance time and step width variability have unique contributing impairments in older persons. Gait Posture. 2008 Apr;27(3):431-9.
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