This month we are taking a closer look at PhD researcher Yi Wan and her work exploring biofeedback gait retraining methods to help the knee osteoarthritis population to manage their knees by reducing knee loading and knee joint pain. 

“As the way people walk during daily activities can have a significant impact on the loading distribution at the knee joint, training knee osteoarthritis patients or a high-risk population to walk in a modified gait pattern that can maximally reduce knee loading could be of great help in slowing the disease progression and knee joint degeneration. Therefore, my original plan was to evaluate the effectiveness of a long-term gait retraining programme combined with different types of real-time biofeedback in people with knee osteoarthritis, and to identify the most effective method in reducing knee loading and joint pain.”

“I used a 12 camera Qualisys motion capture system and an instrumented treadmill to measure the knee loading and gait patterns as well as to provide real-time biofeedback. Personalised gait targets and their real-time knee loading/gait patterns (biofeedback) were projected on the screen for participants while they were training the modified gait by matching the targets. The results of knee loading, knee joint pain and functional ability improvement were compared between two different types of biofeedback groups and a control group, to identify the effectiveness of the method in each outcome domain.”

We asked Yi what have she has achieved so far and what are her next steps?
“I have completed the data collection for this randomised controlled trial in knee osteoarthritis, which is a 6-week gait retraining programme with three groups (knee loading feedback group, gait pattern feedback group and control group). The preliminary results are quite exciting as the people in both intervention feedback groups have shown significant improvement in knee joint pain reduction and functional ability improvement over the 6-week training. Most of the participants also expressed that this programme has made a huge change in their life, that they can now do things (such as climbing up to the loft) that they couldn’t do before. 
However, the main challenge for this programme is that it requires a professional and expensive lab setting and equipment, which is not accessible to the general public. Therefore, my next step is to explore possible ways to take this gait retraining idea outside of the lab with a portable device such as wearable sensors, to make it applicable to hospitals, physio clinics and home-based training. If you are familiar with or interested in developing such a portable gait retraining device, please feel free to contact me for collaboration.”

Yi has worked with the team at CAMERA on this project and recently helped to run two CAMERA Biomechanics workshops for physios, personal trainers and people in sports related careers. “It was a nice experience to introduce my research to people outside of academia, and to bridge the gap between academia and industry. It is good to raise the attention of the potential benefits of applying the technique from current research and collaborating with research, to enhance the treatment effect and training outcome in clinics.”

If you want to find out more about Yi’s research, it has been presented at two conferences. This was a cross-sectional study investigating the immediate effect of foot orientation modifications on knee loading during different daily activities (over ground walking, stair ambulation and sit-to-stand) in both knee osteoarthritis and healthy populations. It laid the foundation for future longitudinal study regarding how to design the gait modification during training sessions in knee osteoarthritis population. More papers are currently under review and in preparation.

1) Wan, Y, Wade, L, McGuigan, P & Bilzon, J 2022, ‘The effect of foot orientation modifications on knee joint biomechanics during different activities’, Congress of European Society of Biomechanics, Porto, Portugal, 26/06/22 – 29/06/22.

2) Wan, Y, McGuigan, P, Bilzon, J & Wade, L 2023, ‘Altering foot orientation changes knee loading in people with and without knee osteoarthritis during three daily activities ‘, Congress of the International Society of Biomechanics (ISB), Fukuoka, Japan, 30/07/23 – 3/08/23 pp. 340.