The Effect of Intrinsic Focus on Gait Cycle and the Possible Confounding Effect of Noise in Patients With Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Patients with knee osteoarthritis may develop an antalgic gait over time due to pain in the
      knee, characterized by a decrease in the stance phase and stride length on the painful side.
      Gait asymmetry, which may lead to different musculoskeletal problems in the future, is
      observed in the patients. Gait symmetry can be achieved with gait retraining, and effective
      focus is required during training.

      In the literature, there are many studies of the positive effects of white noise on focusing,
      but there are also studies that report that it reduces focusing.

      Today, exercise training is usually performed in rehabilitation units or on treadmills. As
      there are important differences between walking on a treadmill and walking outdoors in terms
      of noise, uneven ground and visual stimuli, the place where walking training is performed
      does not reflect the outdoor environment.

      It was aimed to investigate the effect of internal focusing on gait cycle and the effect of
      white noise and environmental sound on internal focusing in patients with knee osteoarthritis
    

Detailed description: 
      A total of 40 patients between the ages of 50 and 75 years, who were admitted to the
      outpatient clinic of Gazi University Faculty of Medicine, Department of Physical Medicine and
      Rehabilitation or hospitalized in the ward and diagnosed with knee osteoarthritis according
      to ACR knee osteoarthritis criteria and had a Kellgren Lawrence staging of at least 2, were
      included.

      The demographic data of the patients who were evaluated with the Hearing Handicap Inventory
      for the Elderly Screening Version (HHIE-S) and had adequate hearing level were recorded,
      bilateral true leg lengths were measured and detailed knee examinations were performed.
      Lequesne Knee Osteoarthritis Severity Index, Western Ontario and McMaster Universities
      Osteoarthritis Index (WOMAC), Lower Extremity Functional Scale (LEFS), 30 Second Sit to Stand
      Test and Timed Up and Go Test were applied to the patients who met the inclusion and
      exclusion criteria.

      Patients walked at a speed of 0.40-0.45 m/s on a treadmill (Biodex Gait Trainer) where gait
      parameters were collected. Each patient walked at a constant speed for three minutes each in
      the baseline (without any instruction or sound), intrinsic focus (focusing on ensuring equal
      step lengths and step durations on both sides and symmetry between both steps), white noise
      (intrinsic focus accompanied by white noise) and environmental sound (intrinsic focus
      accompanied by environmental sound) conditions. After walking in each condition, gait
      parameters ( average step cycle, average step length, percentage of step length variability,
      percentage of left/right side stepping time and ambulation index) were recorded. The User
      Experience Questionnaire Short Form was adapted for our study to assess patients' experiences
      during intrinsically focused walking in white noise and environmental sound conditions.
      Patients were asked to rate their walking periods in white noise and environmental sound
      conditions in terms of inhibiting-supportive, inefficient-efficient, complex-simple,
      confusing-clear, boring-exciting, uninteresting-interesting, traditional-unique, and
      familiar-unusual characteristics.
    

Intervention name(s): Baseline; Intrinsic focus; White noise; environmental sound
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Walking without any instruction or sound; Walking focusing on ensuring equal step lengths and step durations on both sides and symmetry between both steps; Intrinsic focus accompanied by white noise; Intrinsic focus accompanied by environmental sound
Intervention model: Single Group Assignment
Intervention model description: Between the ages of 50 and 75 years, who were admitted to the outpatient clinic of Gazi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation or hospitalized in the ward and diagnosed with knee osteoarthritis according to ACR knee osteoarthritis criteria and had a Kellgren Lawrence staging of at least 2, were included.
Masking: None (Open Label)
Primary purpose: Other
Keywords: knee osteoarthritis; white noise; intrinsic focusing; environmental sound