Intensive Gait Training for Older Adults with Symptomatic Knee Osteoarthritis

Objective: The objective of this study was to determine whether individualized gait training is more effective than usual care for reducing mobility disability and pain in individuals with symptomatic knee osteoarthritis. Design: Adults aged 60 yrs or older with symptomatic knee osteoarthritis and mobility limitations were randomized to physical therapist-directed gait training on an instrumented treadmill, with biofeedback individualized to optimize knee movements, biweekly for 3 mos or usual care (control). Mobility disability was defined using Late Life Function and Disability Index Basic Lower Limb Function score (primary); mobility limitations, using timed 400-m walk, chair-stand, and stair-climb tests; and symptoms, using the Knee Injury/Osteoarthritis Outcome Score at baseline, as well as at 3, 6, and 12 mos. The analyses used longitudinal mixed models. Results: There were no significant intergroup differences between the 35 gait-training (74.3% women; age, 69.7 +/- 8.2 yrs) and 21 control (57.1% women; age, 68.9 +/- 6.5 yrs) participants at baseline. At 3 mos, the gait-training participants had greater improvement in mobility disability (4.3 +/- 1.7; P = 0.0162) and symptoms (8.6 +/- 4.1; P = 0.0420). However, there were no intergroup differences detected for pain, 400-m walk, chair-stand, or stair-climb times at 3 mos or for any outcomes at 6 or 12 mos. Conclusions: Compared with usual care, individualized gait training resulted in immediate improvements in mobility disability knee symptoms in adults with symptomatic knee osteoarthritis, but these effects were not sustained.