Efeitos das estratégias de retreinamento de marcha em desfechos clínicos e biomecânicos em indivíduos com osteoartrite de joelhos: uma revisão sistemática com metanálise e recomendações GRADE

Abstract

The knee osteoarthritis induces pain and disability globally. The high prevalence of the disease coupled with its repercussions prompts the investigation of strategies that offer relief of symptoms and slow down the disease progression. Considering these aspects, the present study has two objectives: 1) to systematically review the literature regarding neuromuscular gait retraining strategies applied to individuals with knee osteoarthritis and their effects on biomechanical and clinical outcomes; 2) to present the protocol of a clinical trial that aims to compare the effect of gait retraining associated with knee and hip muscle strengthening on pain, self-reported function, muscle torque, and spatiotemporal and kinematic parameters of gait in individuals with knee osteoarthritis. In the systematic review with meta-analysis, different retraining strategies such as retrograde gait, toe-out gait, and free approaches were identified. The meta-analysis revealed a statistically significant difference with high-quality evidence favoring gait retraining for pain (MD = -1.22; 95% CI: [-1.48; -0.96]; I2 = 14%; P = 0.32) and function (DMP = -0.82; 95% CI: [-1.24; -0.41]; I2 = 22%; P = 0.28). A statistically significant difference was also observed favoring gait retraining for the first knee adductor moment (MD = -0.20; 95% CI: [-0.38; -0.02]; I2 = 84%; P < 0.01). Comparisons indicated similarity between groups for the second knee adductor moment (MD = −0.16; 95% CI: [−0.47; 0.16]; I² = 79%; P = 0.03) and the knee flexion moment (MD = 0.07; 95% CI: [-0.07; 0.20]; I2 = 76%; P = 0.02). The second article, being a clinical trial protocol, does not yet have results demonstrating the benefits of one strategy over another or similarity between control and intervention groups. However, it is known at this point that the protocol provides a detailed description of all procedures to be performed, enabling method replication in different populations. Finally, it is relevant to emphasize that both works fill gaps concerning the care process for individuals with knee osteoarthritis. It is noteworthy that they complement each other, as the definition of parameters used in gait retraining and described in the protocol partly stems from the findings of the systematic review.