Personalized Medicine: Knee OA Rehabilitation
Muscle strengthening exercises have been shown to improve pain and function
in adults with mild-to-moderate knee osteoarthritis, but individual response rates can vary greatly. Predicting individuals who respond and those who do not is important in developing a more efficient and effective model of care for knee osteoarthritis. Therefore, Dr. Reed Ferber’s lab at the University of Calgary developed a scientific method to address this problem. By combining 3-dimensional (3D) walking gait data(the system used at Parkway) with self-reported measures of pain and function, they were able to predict how a knee OA patient will respond to physiotherapy treatment with greater than 85% accuracy. Predicting which patients will and will not respond to therapeutic intervention, along with the ability to create customized and individual programs, is an optimal model of care and a significant step forward in personalized and precision medicine.
Patients were sub-grouped as
(1) Non-Responders
(2) Low-Responders (20%-50% improvement in pain and function)
(3) High-Responders (>80% improvement in pain and function)
High-Responders
At baseline, the “High-Responders” exhibited greater pain, lower function, and significantly altered hip mechanics and knee loading response. However, after the 6-week hip-focused protocol, they demonstrate greater than 80% improvement in pain and function.
LowResponders
This group exhibit atypical distal limb mechanics and benefit more from a foot-ankle-knee focused protocol.
Non-Responders
This group exhibit low levels of baseline pain, are very high functioning, and exhibit very typical gait mechanics. Therefore, this group don’t require specific therapy but rather benefit from activity modification and education about disease management.
This knee OA group was also followed for 3-years and the follow-up data showed that High-Responders became more similar to healthy non-OA controls, while other subgroups regressed away from controls in the classification suggesting periodic “exercise tune-ups” are necessary to maintain their low level of pain and high functioning.
In summary, this research has been implemented to offer knee OA patients an objective method, which uses both clinical and gait data, to make evidence-based decisions regarding optimal treatment. For more information contact Parkway Physiotherapy + Performance Centre.