The relation of altered pain processing to impact loading and response to a gait retraining treatment in knee osteoarthritis

疼痛处理改变与膝骨关节炎步态再训练治疗的影响负荷和反应的关系

• 批准号: 9616902
• 负责人: Joshua Jon Stefanik
• 金额: $ 16.56万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-13 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9616902
• 关键词: relation; altered; pain; processing; impact

PROJECT SUMMARY/ABSTRACT Knee osteoarthritis (OA) is a major public health problem, causing substantial pain and functional limitations, yet few effective therapies are available to improve pain and function. Non-invasive treatments are needed to improve quality of life and decrease the need for total knee arthroplasty. Abnormal mechanical loading is a well-recognized cause of knee OA and many rehabilitation treatments aim to improve abnormal loading. Impact loading is one such factor that can be intervened upon to potentially improve pain and function. While gait retraining strategies have been shown to improve the knee adduction moment, it is unknown if gait retraining can change impact loading and improve knee pain in older individuals with knee OA. Individuals with painful knee OA also demonstrate a heightened response to normally non-painful stimuli (i.e., sensitization) and impaired descending inhibition of pain, both of which contribute to greater pain severity. It is unknown, however, whether these alterations in the sensory nervous system also affect the motor efferent nervous system, with resulting adverse effects on motor function. Furthermore, the presence of altered pain processing may modify the effect of traditional rehabilitation strategies. Such insights would provide opportunities for tailoring individual rehabilitation strategies. The specific aims of the proposed work are: 1) To evaluate the relation of altered pain processing, independent of knee pain severity, to impact loading (e.g., peak impact force and loading rate from the ground reaction force) during walking, 2) To determine whether a gait retraining program decreases impact loading and knee pain in individuals with knee OA, and 3) To determine whether altered pain processing modifies the effect of gait retraining on impact loading. For specific aim 1, we will leverage data from the NIH funded Multicenter Osteoarthritis Study (MOST), a cohort study of ~3000 individuals with or at risk of knee OA, in which measures of pain sensitization and ground reaction forces (GRFs) during gait have been assessed. Measures of impact loading will be determined from GRFs. For specific aim 2 and 3, subjects will be recruited locally and undergo biomechanical and pain assessments at baseline and follow-up. Subjects will be a randomized to either a control walking intervention or a walking program with gait retraining. The retraining will involve verbal feedback to soften footfalls and real-time visual feedback to decrease tibial acceleration (a correlate of knee loading) using an accelerometer while walking on a treadmill. Primary and secondary outcomes include measures of impact loading and knee pain, respectively. The proposed research is highly significant in that it will directly affect the clinical management of individuals with knee OA. This proposal will provide Dr. Stefanik new training and mentorship in the neurobiology of pain, biomechanics and motion analysis methodology, gait retraining and conducting a clinical intervention study, which builds upon his previous research experience in clinical epidemiology. This training will be integral in assisting Dr. Stefanik to meet his long-term career goal of developing novel and effective rehabilitation interventions for individuals with knee OA.

项目总结/摘要 膝关节骨关节炎（OA）是一个主要的公共卫生问题，导致严重的疼痛和功能限制， 然而，很少有有效的疗法可用于改善疼痛和功能。需要非侵入性治疗， 提高生活质量，减少全膝关节置换术的需求。异常机械负荷是一种 膝关节骨性关节炎的公认原因和许多康复治疗旨在改善异常负荷。 冲击负荷是一个这样的因素，可以干预，以潜在地改善疼痛和功能。而 步态再训练策略已被证明可以改善膝关节内收力矩，但尚不清楚步态是否 再训练可以改变膝关节OA老年患者的冲击负荷并改善膝关节疼痛。人士 疼痛的膝关节OA还表现出对正常非疼痛刺激的高反应（即，致敏） 以及疼痛的下行抑制受损，这两者都导致更严重的疼痛。目前尚不清楚， 然而，感觉神经系统的这些改变是否也影响运动传出神经系统， 系统，对运动功能产生不利影响。此外，疼痛处理过程的改变 可能会改变传统康复策略的效果。这种洞察力将为以下方面提供机会： 制定个人康复策略。建议工作的具体目标是：1）评估 与膝关节疼痛严重程度无关的改变的疼痛处理与冲击负荷的关系（例如，峰值冲击 力和负荷率从地面反作用力）在步行过程中，2）为了确定是否步态再训练 程序减少膝关节OA患者的冲击负荷和膝关节疼痛，以及3）为了确定是否 改变的疼痛处理改变了步态再训练对冲击负荷的影响。具体目标1： 利用NIH资助的多中心骨关节炎研究（MOST）的数据，该研究是一项约3000人的队列研究， 患有膝关节骨性关节炎或有膝关节骨性关节炎风险的个体，其中疼痛敏感性和地面反作用力的测量 （GRF）在步态中进行了评估。冲击载荷的测量将根据GRF确定。为 具体目标2和3，受试者将在当地招募，并在 基线和随访。受试者将随机接受对照步行干预或步行干预。 步态再训练计划再培训将包括口头反馈，以软化脚步和实时视觉 在行走时使用加速度计反馈以降低胫骨加速度（与膝关节负荷相关） 跑步机主要和次要结局分别包括冲击负荷和膝关节疼痛的测量。 这项研究具有重要的意义，因为它将直接影响个人的临床管理 膝关节OA这项提议将为Stefanik博士提供疼痛神经生物学方面的新培训和指导， 生物力学和运动分析方法，步态再训练和进行临床干预研究， 这是基于他以前在临床流行病学方面的研究经验。这一培训将是不可或缺的， 协助Stefanik博士实现其开发新颖有效康复的长期职业目标 对膝关节OA患者进行干预。