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      Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial

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          Abstract

          Objectives

          To assess the effects of a 4-week randomised controlled trial comparing an outdoor gait-training programme to reduce contact time in conjunction with home exercises (contact time gait-training feedback with home exercises (FBHE)) to home exercises (HEs) alone for runners with exercise-related lower leg pain on sensor-derived biomechanics and patient-reported outcomes.

          Design

          Randomised controlled trial.

          Setting

          Laboratory and field-based study.

          Participants

          20 runners with exercise-related lower leg pain were randomly allocated into FBHE (4 male (M), 6 female (F), 23±4 years, 22.0±4.3 kg/m 2) or HE groups (3 M, 7 F, 25±5 years, 23.6±3.9 kg/m 2).

          Interventions

          Both groups completed eight sessions of HEs over 4 weeks. The FBHE group received vibrotactile feedback through wearable sensors to reduce contact time during outdoor running.

          Primary and secondary outcome measures

          Patient-reported outcome measures (PROMs) and outdoor gait assessments were conducted for both groups at baseline and 4 weeks. PROMs were repeated at 6 weeks, and feedback retention was assessed at 6 weeks for the FBHE group. Repeated measures analyses of variance were used to assess the influence of group and timepoint on primary outcomes.

          Results

          The FBHE group reported increased function and recovery on PROMs beyond the HE group at 6 weeks (p<0.001). There was a significant group by time interaction for Global Rating of Change (p=0.004) and contact time (p=0.002); the FBHE group reported greater subjective improvement and reduced contact time at 4 and 6 weeks compared with the HE group and compared with baseline. The FBHE group had increased cadence (mean difference: 7 steps/min, p=0.01) at 4 weeks during outdoor running compared with baseline.

          Conclusion

          FBHE was more effective than HE alone for runners with exercise-related lower leg pain, manifested with improved PROMs, reduced contact time and increased cadence.

          Trial registration number

          NCT04270565.

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          Most cited references45

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          The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network.

          J M Binkley, P Stratford, S A Lott … (1999)
          The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS). The LEFS was administered to 107 patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks. The SF-36 (acute version) was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability. Pearson correlations and one-way analyses of variance were used to examine construct validity. Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF-36 scores. Test-retest reliability of the LEFS scores was excellent (R = .94 [95% lower limit confidence interval (CI) = .89]). Correlations between the LEFS and the SF-36 physical function subscale and physical component score were r=.80 (95% lower limit CI = .73) and r = .64 (95% lower limit CI = .54), respectively. There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF-36 physical function score. The potential error associated with a score on the LEFS at a given point in time is +/-5.3 scale points (90% CI), the minimal detectable change is 9 scale points (90% CI), and the minimal clinically important difference is 9 scale points (90% CI). The LEFS is reliable, and construct validity was supported by comparison with the SF-36. The sensitivity to change of the LEFS was superior to that of the SF-36 in this population. The LEFS is efficient to administer and score and is applicable for research purposes and clinical decision making for individual patients.
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            Reliability of the visual analog scale for measurement of acute pain.

            Mary W. Silver, P Bijur, E. Gallagher (2001)
            Reliable and valid measures of pain are needed to advance research initiatives on appropriate and effective use of analgesia in the emergency department (ED). The reliability of visual analog scale (VAS) scores has not been demonstrated in the acute setting where pain fluctuation might be greater than for chronic pain. The objective of the study was to assess the reliability of the VAS for measurement of acute pain. This was a prospective convenience sample of adults with acute pain presenting to two EDs. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (95% CIs) and a Bland-Altman analysis were used to assess reliability of paired VAS measurements obtained 1 minute apart every 30 minutes over two hours. The summary ICC for all paired VAS scores was 0.97 [95% CI = 0.96 to 0.98]. The Bland-Altman analysis showed that 50% of the paired measurements were within 2 mm of one another, 90% were within 9 mm, and 95% were within 16 mm. The paired measurements were more reproducible at the extremes of pain intensity than at moderate levels of pain. Reliability of the VAS for acute pain measurement as assessed by the ICC appears to be high. Ninety percent of the pain ratings were reproducible within 9 mm. These data suggest that the VAS is sufficiently reliable to be used to assess acute pain.
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              Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review.

              Phillip A Gribble, Jay Hertel, Phil Plisky (2016)
              A dynamic postural-control task that has gained notoriety in the clinical and research settings is the Star Excursion Balance Test (SEBT). Researchers have suggested that, with appropriate instruction and practice by the individual and normalization of the reaching distances, the SEBT can be used to provide objective measures to differentiate deficits and improvements in dynamic postural-control related to lower extremity injury and induced fatigue, and it has the potential to predict lower extremity injury. However, no one has reviewed this body of literature to determine the usefulness of the SEBT in clinical applications. To provide a narrative review of the SEBT and its implementation and the known contributions to task performance and to systematically review the associated literature to address the SEBT's usefulness as a clinical tool for the quantification of dynamic postural-control deficits from lower extremity impairment. Databases used to locate peer-reviewed articles published from 1980 and 2010 included Derwent Innovations Index, BIOSIS Previews, Journal Citation Reports, and MEDLINE. The criteria for article selection were (1) The study was original research. (2) The study was written in English. (3) The SEBT was used as a measurement tool. Specific data extracted from the articles included the ability of the SEBT to differentiate pathologic conditions of the lower extremity, the effects of external influences and interventions, and outcomes from exercise intervention and to predict lower extremity injury. More than a decade of research findings has established a comprehensive portfolio of validity for the SEBT, and it should be considered a highly representative, noninstrumented dynamic balance test for physically active individuals. The SEBT has been shown to be a reliable measure and has validity as a dynamic test to predict risk of lower extremity injury, to identify dynamic balance deficits in patients with a variety of lower extremity conditions, and to be responsive to training programs in both healthy people and people with injuries to the lower extremity. Clinicians and researchers should be confident in employing the SEBT as a lower extremity functional test.
              Article 0 comments Cited 200 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Sport Exerc Med
                Journal ID (iso-abbrev): BMJ Open Sport Exerc Med
                Journal ID (hwp): bmjosem
                Journal ID (publisher-id): bmjosem
                Title: BMJ Open Sport — Exercise Medicine
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2055-7647
                Publication date Collection: 2022
                Publication date (Electronic): 3 November 2022
                Volume: 8
                Issue: 4
                Electronic Location Identifier: e001293
                Affiliations
                [1 ]departmentKinesiology , University of Michigan , Ann Arbor, Michigan, USA
                [2 ]departmentKinesiology , University of Virginia , Charlottesville, Virginia, USA
                [3 ]departmentKidney Center , Fresenius Medical Care , Knoxville, Tennessee, USA
                [4 ]departmentOrthopaedics , The University of North Carolina at Chapel Hill , Chapel Hill, North Carolina, USA
                [5 ]departmentPhysical Medicine & Rehabilitation , University of Virginia Medical Center , Charlottesville, Virginia, USA
                [6 ]departmentStatistics , University of Virginia , Charlottesville, Virginia, USA
                Author notes
                [Correspondence to ] Dr Alexandra F DeJong Lempke; alempke@ 123456umich.edu
                Author information
                http://orcid.org/0000-0002-5702-9184
                Article
                Publisher ID: bmjsem-2021-001293
                DOI: 10.1136/bmjsem-2021-001293
                PMC ID: 9639130
                SO-VID: 4b74eb07-cc0d-4425-b4f9-d673ff983447
                Copyright © © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 11 October 2022
                Funding
                Funded by: Mid-Atlantic Athletic Trainer’s Association;
                Award ID: Not Applicable
                Funded by: National Athletic Trainers' Association;
                Award ID: 1920DGP01
                Funded by: University of Virginia School of Education and Human Development;
                Award ID: Not Applicable
                Categories
                Subject: Original Research
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: running,accelerometer,sports medicine,lower limb quadrant related to injuries
                Data availability:
                Keywords: running, accelerometer, sports medicine, lower limb quadrant related to injuries

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