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Alghadir AH, Anwer S, Sarkar B, et al. Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord. 2019 Apr 9;20(1):159. doi: 10.1186/s12891-019-2537-9. (Original study)
Abstract

BACKGROUND: Previous studies reported the beneficial effects of walking in individual with mild to moderate knee osteoarthritis (OA). The current study aimed to compare the effect of 6-week retro versus forward walking program versus control group on pain, functional disability, quadriceps muscle strength and physical performance in individuals with knee OA.

METHODS: A three-arm single-blinded, randomized, controlled trial and intention-to-treat analysis was conducted in outpatient physiotherapy department, King Saud University, Saudi Arabia. Sixty-eight individuals (mean age, 55.6 years; 38 female) with knee OA participated. The participants in the retro or forward walking group completed 10 min of supervised retro or forward walking training in addition to usual care, 3 days/week for 6 weeks. The control group received a routine physiotherapy program. This program comprises a combination of closed and open kinematic chain exercises, including straight leg raising, isometric quadriceps, isometric hip adduction, terminal knee extension, semi-squat, and leg press. The primary outcomes were mean pain and knee function score measured by the numerical rating scale and the Western Ontario and McMaster Universities Osteoarthritis Index, respectively. The secondary outcomes were mean score of quadriceps muscle strength and timed up and go test scores. All the outcomes were analyzed at baseline and week 6.

RESULTS: In total, 68 subjects participated in this 6-week randomized, controlled trial. The completion rates of the primary and secondary outcome measures at week 6 were 91, 87, and 82% in the retro walking, forward walking, and control groups, respectively. In the intention-to-treat analysis, the retro walking group had a greater reduction in pain intensity (mean changes, 1.8 versus 1; p = 0.01) and functional disability (mean changes, 4.8 versus 2.2; p = 0.008) than the control group. Similarly, the retro walking group had a greater improvement in the quadriceps muscle strength (mean changes, 1.7 kg versus 0.7 kg; p = 0.008) and the timed up and go test (mean changes, 0.6 s versus 0.1 s; p = 0.003) than the control group.

CONCLUSIONS: The 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee OA.

TRIAL REGISTRATION: Controlled Trials ISRCTN12850845 , Registered 26 January 2015.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Comments from MORE raters

Rehab Clinician (OT/PT) rater

A 3-armed trial requires either an adjustment of the p-value because of the inclusion of the post hoc paired comparisons or recruitment of 1;1;2 (control). The trial is underpowered so it is possible had they continued to recruit, any significant changes would flip.

Rehab Clinician (OT/PT) rater

The conclusions show that a 6-week retro walking program compared with forward walking or control groups resulted in greater reduction in pain and functional disability and improved quadriceps muscle strength and performance in individuals with knee OA. These results, combined with an article providing a comprehensive literature including a wide variety of outcome measures, are very useful for researchers in this area.

Rehab Clinician (OT/PT) rater

This article supports the current advice given to patients that walking is advisable to patients with moderate OA. It also fits into the model of chronic pain where "motion is lotion". What is interesting is that retro walking seems to be more beneficial in terms of parametres measured; this is advice I will surely pass on to my patients!
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