Clinical Trial Details
— Status: Completed
Administrative data
NCT number |
NCT05580640 |
Other study ID # |
IRB: 21053 |
Secondary ID |
|
Status |
Completed |
Phase |
N/A
|
First received |
|
Last updated |
|
Start date |
August 30, 2021 |
Est. completion date |
September 30, 2022 |
Study information
Verified date |
September 2022 |
Source |
Midwestern University |
Contact |
n/a |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
For patients with a history of knee surgery, especially knee arthroplasty, the persistence of
abnormal gait kinematics is a frequently encountered issue that can hinder their ability to
return to normal daily living.
Muscular imbalances and leg length discrepancy (LLD) following knee arthroplasty can impact a
patient's ability to return to a normal gait pattern. In a study of 98 patients who underwent
total knee arthroplasty, leg lengthening on the side of the operative knee was reported in
83% of patients as determined by comparing pre- and postoperative leg-length radiographs
(Lang JE et al; J. Arthroplasty. 2012;27(3):341-346). LLD can lead to compensations in
surrounding joints, muscles, and myofascial structures. Compensatory musculoskeletal changes,
including changes in pelvic tilt and curvature of the lumbar spine can alter gait mechanics,
lead to mechanical low back pain, and increase the risk of degenerative disc disease (Sheha
EDM et al; J. Bone and Joint Surgery, Inc. 2018;6(8)(e6)). In addition, neurologic
compensations can occur and include changes in muscular timing and muscular activation
patterns. The mainstay of gait rehabilitation following knee surgery is physical therapy (PT)
(O'Connor DP et al; J Orthop Sports Phys Ther. 2001;31(7):340-352), where LLD can be
addressed with heel lift therapy. The use of Osteopathic Manipulative Treatment (OMT) to
address chronic compensatory musculoskeletal changes following knee surgery in order to
improve gait has not been extensively studied. Both OMT and PT have been shown to improve
gait imbalances in a variety of neurological conditions such as Parkinson's disease, multiple
sclerosis, and Prader-Willi syndrome. Previous studies of these neurologic conditions have
demonstrated increases in walking velocity, step length, stride length and range of motion of
the lower extremities following OMT. It remains to be determined whether OMT can improve gait
pattern abnormalities caused by compensatory musculoskeletal patterns that persistent after
traditional postoperative knee rehabilitation.
The purpose of this study is to determine if OMT of chronic, compensatory, musculoskeletal
issues associated with knee surgery improves gait parameters. In addition to providing
objective parameters to assess and validate OMT, future patients recovering from knee surgery
might benefit from OMT
Description:
Study Design: For this proof-of-concept study we will use a series of case studies. This will
allow us to determine if a single session of OMT can improve gait in subjects with prior knee
surgery, whether multiple sessions are required to change chronic compensatory
musculoskeletal issues, and whether subtle gait anomalies (or improvements), in patients with
knee arthroscopy can be detected with the gait analysis system. If the data support our
hypothesis, we will request an amendment to the IRB to expand subject numbers and include a
control group. Location: MWU Multi-Specialty Clinic Overall Protocol: Informed consent
participants will first complete a Knee Outcome Survey, undergo preintervention evaluation of
quadriceps strength, knee range of motion, and leg length. Participants will then undergo
gait analysis. An Osteopathic physician (KPH) will then diagnose and treat somatic
dysfunction.
After OMT, subjects will repeat clinical measures (quadriceps strength, knee ROM, and leg
length) and gait analysis to determine the acute effects of OMT. Because chronic compensatory
musculoskeletal issues may not be resolved with one session of OMT, subjects will return to
the Multi-Specialty Clinic (MSC) for OMT
1x/wk for 2wks. During the fourth week, subjects will repeat the pre-intervention evaluation
and gait analysis before and after the fourth and final OMT session. In total, subjects will
undergo four gait analysis sessions: two evaluations during the first encounter and two
during the fourth week of the study. Detailed protocols for data collection are listed below.
Knee Outcome Survey - Activities of Daily Living (KOS-ADL) will be used to measure each
subject's current symptoms and functional limitations before and after participation in the
study. The KOS-ADL is a