Gait change in the elderly may be a strategy to maintain postural stability while walking. However, gait laterality is accompanied by back pain or an increased risk of a fall. This study aimed to examine group-related differences and gait laterality in elderly females with mild or severe unilateral knee pain. Seventy-five elderly females (66–87 years old) were included, which comprised the following groups: 47 with mild unilateral knee pain and 28 with severe unilateral knee pain. They completed a 12？m walk test with maximum effort. Stance time, swing time, and step length were selected as evaluation parameters. A two-way ANOVA (group leg) was used for analysis. No significant differences were found in interaction or in either main factor of the group and leg. In conclusion, elderly females do not show group-related differences or gait laterality regardless of the degree (mild or severe) of unilateral knee pain. 1. Introduction Walking is the most basic movement in daily life [1]. In old age, walking can be greatly affected by a marked decline in physical functions such as leg strength, balance, and leg joints. As a result, the frequency of activities of daily living (ADL) becomes markedly limited [2], quality of life (QOL) decreases [3], and the risk of fall increases [4]. It is therefore important to prevent a decrease of the aforementioned physical parameters in the elderly. Arthritis-associated knee joint pain affects locomotion in the elderly, particularly the female elderly. They have difficulty in walking or standing up [5, 6]. There are considerable individual differences in the degree of these conditions even among the elderly with knee joint pain. Tennant et al. [7] reported that approximately 8% of elderly individuals have severe knee pain requiring regular visits to a hospital or hospitalization. On the other hand, the elderly with mild knee pains who do not require regular visits are considered to be an auxiliary group of the severe knee pain group [8, 9]. This subset accounts for approximately 20% of the elderly [10–12]. Astephen et al. [13] and Sugiura and Demura [14] examined the effect of the degree of knee pain on gait and reported that the elderly with severe knee pain have inferior walking ability compared to those with mild knee pain. Walking is a symmetric and rhythmical exercise. The elderly with unilateral knee pain may have difficulty in exerting strength in the affected leg [5, 15], leading to gait laterality. Gait laterality in the elderly is a strategy to maintain stability during walking. However, it is accompanied by back
References
[1]
D. J. Pratt, “Some aspects of modern orthotics,” Physiological Measurement, vol. 15, no. 1, pp. 1–27, 1994.
[2]
J. Stessman, R. Hammerman-Rozenberg, A. Cohen, E. Ein-Mor, and J. M. Jacobs, “Physical activity, function, and longevity among the very old,” Archives of Internal Medicine, vol. 169, no. 16, pp. 1476–1483, 2009.
[3]
M. Suzuki, N. Ohyama, K. Yamada, and M. Kanamori, “The relationship between fear of falling, activities of daily living and quality of life among elderly individuals,” Nursing & Health Sciences, vol. 4, no. 4, pp. 155–161, 2002.
[4]
M. E. Tinetti, “Preventing falls in elderly persons,” The New England Journal of Medicine, vol. 348, no. 1, pp. 42–49, 2003.
[5]
H. Sugiura, S. Demura, and K. Takahashi, “Evaluating the effects of pain and disorders of the knee joint on knee extension strength and daily life activities in the female elderly,” Pain Studies and Treatment, vol. 1, no. 3, pp. 17–23, 2013.
[6]
H. Sugiura and S. Demura, “Effects of mild and severe knee joint pain on various activities of daily living in the female elderly,” Pain Research and Treatment, vol. 2013, Article ID 989508, 10 pages, 2013.
[7]
A. Tennant, J. Fear, A. Pickering, M. Hillman, A. Cutts, and M. A. Chamberlain, “Prevalence of knee problems in the population aged 55 years and over: identifying the need for knee arthroplasty,” British Medical Journal, vol. 310, no. 6990, pp. 1291–1293, 1995.
[8]
G. Peat, R. McCarney, and P. Croft, “Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care,” Annals of the Rheumatic Diseases, vol. 60, no. 2, pp. 91–97, 2001.
[9]
Z. Bejek, R. Paróczai, á. Illyés, and R. M. Kiss, “The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis,” Knee Surgery, Sports Traumatology, Arthroscopy, vol. 14, no. 7, pp. 612–622, 2006.
[10]
T. E. McAlindon, S. Snow, C. Cooper, and P. A. Dieppe, “Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint,” Annals of the Rheumatic Diseases, vol. 51, no. 7, pp. 844–849, 1992.
[11]
S. C. O'Reilly, K. R. Muir, and M. Doherty, “Screening for pain in knee osteoarthritis: which question?” Annals of the Rheumatic Diseases, vol. 55, no. 12, pp. 931–933, 1996.
[12]
M. Urwin, D. Symmons, T. Allison et al., “Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation,” Annals of the Rheumatic Diseases, vol. 57, no. 11, pp. 649–655, 1998.
[13]
J. L. Astephen, K. J. Deluzio, G. E. Caldwell, and M. J. Dunbar, “Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity,” Journal of Orthopaedic Research, vol. 26, no. 3, pp. 332–341, 2008.
[14]
H. Sugiura and S. Demura, “The effects of knee joint pain and disorders on knee extension strength and walking ability in the female elderly,” Advances in Physical Education, vol. 2, no. 4, pp. 139–143, 2012.
[15]
H. Sugiura and S. Demura, “Effect of subjective knee-joint pain on the laterality of knee extension strength and gait in elderly women,” Archives of Gerontology and Geriatrics, vol. 54, no. 2, pp. 366–369, 2012.
[16]
H. Kim, T. Suzuki, H. Yoshida et al., “Are gait parameters related to knee pain, urinary incontinence and a history of falls in community-dwelling elderly women?” Japanese Journal of Geriatrics, vol. 50, no. 4, pp. 528–535, 2013.
[17]
E. B. Titianova and I. M. Tarkka, “Asymmetry in walking performance and postural sway in patients with chronic unilateral cerebral infarction,” Journal of Rehabilitation Research and Development, vol. 32, no. 3, pp. 236–244, 1995.
[18]
H. Sadeghi, P. Allard, F. Prince, and H. Labelle, “Symmetry and limb dominance in able-bodied gait: a review,” Gait & Posture, vol. 12, no. 1, pp. 34–45, 2000.
[19]
H. Hashimoto, T. Hanyu, C. B. Sledge, and E. A. Lingard, “Validation of a Japanese patient-derived outcome scale for assessing total knee arthroplasty: comparison with Western Ontario and McMaster Universities osteoarthritis index (WOMAC),” Journal of Orthopaedic Science, vol. 8, no. 3, pp. 288–293, 2003.
[20]
N. Bellamy, W. W. Buchanan, C. H. Goldsmith, J. Campbell, and L. W. Stitt, “Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee,” Journal of Rheumatology, vol. 15, no. 12, pp. 1833–1840, 1988.
[21]
Y. Oida and N. Nakamura, Exercise Learning Support Manual for the Knee Joint Ache Prevention and Reduction, Sunlife Plan, Tokyo, Japan, 2008.
[22]
K. Shigeshima, T. Fujiwara, Y. Ogoma, M. Ohkura, and H. Nakaya, “Symmetry of step length and temporal variability in gait of people without impairment,” Journal of Japan Academy of Health Sciences, vol. 12, no. 1, pp. 25–30, 2009.
[23]
P. A. Dieppe and L. S. Lohmander, “Pathogenesis and management of pain in osteoarthritis,” The Lancet, vol. 365, no. 9463, pp. 965–973, 2005.
[24]
M. P. Murray, E. H. Duthie Jr., S. R. Gambert, S. B. Sepic, and L. A. Mollinger, “Age-related differences in knee muscle strength in normal women,” Journals of Gerontology, vol. 40, no. 3, pp. 275–280, 1985.
[25]
H. Maruyama, The Gait, The Society of Physical Therapy Science, Tokyo, Japan, 2003.
[26]
S. Demura, S. Yamaji, and S. Sato, “Gait and fall characteristics of the elderly,” Journal of Joint Surgery, vol. 30, no. 2, pp. 100–107, 2011.
[27]
G. Kirsten, Gait Analysis by Observation, Igaku-Shoin, Tokyo, Japan, 2009.
