First steps in the development of a biofeedback device to monitor gait retraining kinematics in patients with knee osteoarthritis
MetadataShow full item record
Background: A higher external knee adduction moment (EKAM) is associated with an increased progression of knee osteoarthritis (KOA). Gait modifications, such as medial thrust (MT) and trunk lean (TL), reduce EKAM, reduce pain and improve knee function. MT and TL can only be monitored accurately using expensive three-dimensional (3D) gait analysis, which makes this unsuitable for application in clinical practice. Furthermore, the end-users’ needs, values, and requirements are essential in developing technology. Studies have suggested to use an Inertial Measurement Unit (IMU) to monitor gait kinematics. This study aims: 1) to identify the needs, values, and requirements of the end-users of a biofeedback gait monitoring device, 2) to determine the validity of the IMU for quantifying the tibia and trunk angle during MT and TL, respectively, in patients with KOA. Methods: A mixed methods study design was used. Focus groups were conducted to identify the end-users needs, values and requirements on a gait monitoring device. Themes were identified using multiple data analysis. Validation was conducted by comparing the tibia and trunk angle between the IMU and 3D gait analysis. Pearson correlation coefficient and Bland and Altman plots were used for statistical analysis. Results: Identified themes of needs, values and requirements are: type of biofeedback, performance features, material, time investment, and fitting of the device. For validation, 28 patients with KOA were analysed. A correlation (r=0,899, p<0,001) and good agreement was found between the IMU and 3D for measuring the trunk angle. No correlation (r=0,075, p=0,741) and agreement was found between the IMU and 3D for measuring the tibia angle. Conclusion: Identified themes for a biofeedback device can guide development of future technology to monitor gait retraining. IMU seems to be a valid and useful technology for quantifying of the trunk angle to monitor TL kinematics in patients with KOA. MT cannot be measured accurately by quantifying the tibia angle with an IMU. It is recommended that future studies focus on multiple IMUs to measure the MT accurately. Clinical Relevance: First steps in the development of a biofeedback device to monitor gait kinematics in patients with KOA.