# Personalized Gait Training with Feedback to Reduce Knee Pain from Osteoarthritis

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

This study is a randomized controlled trial to investigate a novel treatment for patients with painful
knee osteoarthritis. The study will recruit patients who have osteoarthritis isolated to the medial
compartment of the knee. Half of the patients will participate in a gait retraining program to alter their
foot placement during walking; the other half will be assigned to a self-directed walking group. Gait
retraining will be subject-specific and will depend on a key feature of each subject's baseline gait,
namely which peak (early or late) in the bi-modal knee adduction moment (KAM) profile is larger. The
retraining will involve changing the foot progression angle, which is the angle the foot makes relative
to the forward direction. The intervention will involve either increasing internal foot rotation (toe-in) or
increasing external foot rotation (toe-out). Previously, toe-in has been shown to reduce only the first
peak, whereas toe-out has been shown to reduce only the second peak. Because of the personalized
intervention, we expect all retrained subjects will be able to reduce the (larger) peak KAM and to
reduce knee pain. Based on previous studies, we expect that approximately 80% of subjects in the
gait retraining group will need to increase toe-in, and 20% of subjects will need to increase toe-out.
 Gait retraining will be done using a vibration feedback device taped to the lower leg as each
subject walks on a treadmill. Body segment kinematics will be captured and ground reaction forces
will be measured. During each step, subjects will receive vibration feedback informing them how
they should change their foot progression angle during the next step. Real-time feedback facilitates
training since an individual knows immediately whether their foot placement was correct or not, and
they are informed via the feedback signal whether or not to change their foot angle during the next
step. The gait retraining consists of once a week sessions for six weeks. The training uses a fading
feedback approach, where the percentage of each weekly session during which feedback is used is
decreased from week to week until no feedback is used by the last training session. At that point the
new gait pattern is internalized and that new pattern then represents the new “natural” gait pattern
for each individual. Throughout the six-week training period subjects will be encouraged to practice
their new gait for at least ten minutes per day. After the six-week training, subjects will continue to
use their new gait. Subjects will undergo gait lab checks at weeks 21, 31 and 41 and monitoring of
foot progression angle under free-living conditions using “smart” shoes during weeks 8, 31 and 52
to assess retention, with refresher training if necessary. Their last assessment will be at 52 weeks.
 Participants in the control group will receive an educational pamphlet developed by the Arthritis
Foundation that describes the benefits of regular walking for those with arthri...

## Key facts

- **NIH application ID:** 10292413
- **Project number:** 5I01RX001811-05
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Julie Ann Kolesar
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2016-10-01 → 2021-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10292413

## Citation

> US National Institutes of Health, RePORTER application 10292413, Personalized Gait Training with Feedback to Reduce Knee Pain from Osteoarthritis (5I01RX001811-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10292413. Licensed CC0.

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