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Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication

King, Stephanie L.; Vanicek, Natalie; O'Brien, Thomas D.

Authors

Thomas D. O'Brien



Abstract

Objective
To determine the lower limb joint kinetic strategies during stair descent in claudicants with peripheral arterial disease (PAD-IC).

Design
Cross-sectional observation study.

Setting
University laboratory.

Participants
A total of 22 participants; 10 healthy controls and 12 patients diagnosed with PAD-IC.

Main outcome measures
Between-group comparisons of ground reaction force (GRF) and, hip, knee and ankle kinetics during steady-state stair descent.

Results
The claudicating-limb group demonstrated reduced vertical and posterior GRF compared to healthy controls (ES = −1.46 [−2.32,−0.69] and ES = −1.08 [−0.42,−0.26]) as well as demonstrating an greater contribution to support moment from the ankle and trends towards a smaller hip contribution (42 ± 14% vs 28 ± 7%, P = .005 and Hip 16 ± 8% vs 21 ± 11%, P = .056, respectively). A unique sub-group was identified within the PAD-IC cohort demonstrating different hip moment strategies during weight acceptance: a novel hip extensor group (PAD-IC HExt) and stereotypical hip flexor group (PAD-IC HFlex). Compared to both healthy controls and the PAD-IC HFlex groups, the PAD-IC HExt group demonstrated increased hip extensor moment (ES = 3.05 [1.67,4.42] and ES = 3.62 [1.89,5.35]) and reduced knee extensor moment (ES = −2.00 [−3.15,−0.85] and ES = −1.36 [−2.60,−0.11] respectively) during weight acceptance.

Conclusions
A novel hip extensor strategy was identified in a sub-group of claudicants which acts to reduce the demand on the knee extensors, but not the plantarflexors. Weakness in the knee extensors may prevent redistribution of the task demand, typically seen in older adults in stair descent, away from the functionally limited plantarflexor muscle group. Further investigation into multi-level joint strength and the relationship to functional tasks is warranted to inform targeted intervention programmes.

Journal Article Type Article
Publication Date 2018-05
Journal Gait & Posture
Print ISSN 0966-6362
Electronic ISSN 1879-2219
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 62
Pages 359-365
APA6 Citation King, S. L., Vanicek, N., & O'Brien, T. D. (2018). Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication. Gait and Posture, 62, 359-365. https://doi.org/10.1016/j.gaitpost.2018.03.035
DOI https://doi.org/10.1016/j.gaitpost.2018.03.035
Keywords Biophysics; Rehabilitation; Orthopedics and Sports Medicine
Publisher URL https://www.sciencedirect.com/science/article/pii/S0966636218302583?via%3Dihub
Copyright Statement © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Additional Information This article is maintained by: Elsevier; Article Title: Joint moment strategies during stair descent in patients with peripheral arterial disease and intermittent claudication; Journal Title: Gait & Posture; CrossRef DOI link to publisher maintained version: http://dx.doi.org/10.1016/j.gaitpost.2018.03.035; Content Type: article; Copyright: © 2018 Elsevier B.V. All rights reserved.

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Copyright Statement
© 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/



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