Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Dicky Hui (1) Dorothy Fong (1) Joseph Man (1)
Affiliation :
(1) Department of Physiotherapy, Caritas Medical Centre
Introduction :
Patient with osteoarthritis (OA) knee commonly shows gait disorders during walking such as inadequate ankle dorsiflexion at initial contact and loading response which impair the function of ankle rocker during weight-acceptance. Therefore, the shock absorption ability of the ankle and knee will be significantly reduced. Furthermore, excessive knee flexion during mid-stance causes increase in activation of quadriceps muscles so that knee pain will be exaggerated due to more pressure acting on the knee joint. These gait deviations often last even though patient received total knee replacement (TKR). Observational gait analysis (OGA) is a simple and cost-effective tool for identifying potential gait deviation and impairment. Furthermore, conventional physiotherapy treatment for patients with TKR emphasizes on pain management, muscle strengthening and stretching exercises, seldom mentions gait analysis and training. To fill in the gap, a new rehabilitation program including OGA analysis and gait training was launched in CMC physiotherapy department.
Objectives :
1. To introduce OGA as a new functional outcome to monitor the rehabilitation progress for the patient with TKR 2.To improve the outcome of conventional physiotherapy treatment for OA knee patient received TKR by restoring their normal gait pattern through an adjunctive gait training program at post-op 1 month
Methodology :
13 OA knee patients (8 females and 5 males) with mean age 69.5 years pending for total knee replacement were recruited in the program. Gait deviations were identified by visual analysis of the gait video and recorded on the standardized OGA assessment form. Walking quality was assessed by the Bath Walking Assessment Inventory (BWAI). Moreover, range of motion of ankle and knee joints was also assessed. OGA and physical assessments were conducted at pre-op, post-op 1 and 2 months respectively. All patient received conventional pre- and post-op physiotherapy group training. Based on the gait deviations identified in the OGA, the gait training program including gait re-education and home exercise was provided to patients at post-op 1 month.
Result & Outcome :
In general, all outcome measures showed a similar pattern which slightly deteriorated at post-op 1 month compared to baseline (pre-op) and significantly improved at post-op 2 months after the gait training program was introduced to patients at post-op 1 month. Conclusion: OGA provides valuable information of gait deviation. Thus, integration of the OGA finding into conventional physical examination, a comprehensive and holistic treatment plan including gait training can be delivered to patient to improve their treatment outcome.
