Gait Retraining with real-time Biofeedback to reduce Knee adduction moment: systematic review of effects and methods used

Publication date: Available online 30 July 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Rosie. Richards, Josien. C. van den Noort, Joost. Dekker, Jaap. Harlaar
ObjectiveTo 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 knee osteoarthritis (KOA) patients.Data sourcesSearches were conducted in MEDLINE, EMBASE, CINAHL, SportDiscus, Web of Science and the Cochrane Database for gait, feedback and knee osteoarthritis from inception to May 2015.Study SelectionTitles and abstracts were screened by one individual for studies aiming to reduce KAM. Full text articles were assessed by two individuals against pre-defined criteria.Data extractionData were extracted by one individual according to a pre-defined list, including participant demographics and training methods and effects.Data synthesisElectronic searches resulted in 190 potentially eligible studies, from which 12 met all inclusion criteria. Within group standardised mean differences (SMDs) for reduction of KAM in healthy controls ranged from 0.44 to 2.47 and from 0.29 to 0.37 in KOA patients. In KOA patients, improvements were reported in pain and function, with SMDs ranging from 0.55 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.ConclusionsThis review suggests that biofeedback gait training is effective primarily for reducing KAM but also for reducing pain and improving function in KOA patients. The review was limited by the small number of studies featuring KOA patients and the lack of controlled studies. The results suggest there is value as well as 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.



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