Biomechanics of the paretic knee during overground gait in people with stroke: a systematic review

Abstract

Background

Biomechanics of the paretic knee during gait are well documented, yet these data have yet to be systematically summarised and analysed.

Objective

To analyse three-dimensional optic-based biomechanical data of the paretic knee post-stroke, compared to non-paretic or control participants’ knees, during overground gait.

Methods

Database searches were completed, with observational studies and baseline data from randomised controlled trials considered. Two reviewers independently screened studies, extracted data, and determined risk of bias using the Downs and Black Quality Index. Quantitative and descriptive analyses were undertaken, with level of evidence considered.

Results

31 studies were included, with 719 participants with stroke and 274 controls. Pooled data were heterogenous. Descriptive analyses demonstrated: reduced peak knee flexion at the paretic knee compared to non-paretic knee; reduced knee flexion during swing at the paretic knee compared to control knee; reduced sagittal range of motion at the paretic knee compared to non-paretic, and control knee; and reduced peak (internal) extension moments at the paretic knee compared to non-paretic knee. Most studies were at high risk of bias, demonstrating limited quality evidence in the current evidence base.

Conclusion

The paretic knee demonstrated reduced peak knee flexion, knee flexion during swing, range of motion, and knee extension moments compared to the non-paretic and/or control knee. Considerable heterogeneity prevented meta-analyses. The current evidence base reflects limited quality, with further research required to better explore biomechanical differences occurring in well documented post-stroke gait patterns.

Keywords:

• Stroke
• gait
• mobility
• biomechanics
• knee

Acknowledgement

We thank Associate Professor Gisela Sole, School of Physiotherapy, University of Otago, for her guidance in this paper; and her advice and support as the first author’s (CW) primary supervisor between November 2018 and February 2020. We thank Mrs Thelma Fisher, Physiotherapy Subject Librarian, University of Otago Library, for her advice and assistance with database selection and development of the search strategy for this review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributions by authors

The first author, Clifford Waller developed the current paper in conjunction with the listed authors. The listed authors have had an active role in the development and progression of the review. The guarantors of this review are the first author’s supervisors: Professor Leigh Hale, Dr Allyson Calder, Assoc. Professor Stephanie Woodley, and Dr Peter Lamb.

Additional information

Funding

This work was supported by Division of Health Sciences, University of Otago.

Notes on contributors

Clifford Paul Waller

Clifford Waller is a PhD student at the University of Otago. His research interests include neurorehabilitation.

Bahram Sangelaji

Bahram Sangelaji is a Tutor at the University of Otago. His research interests include neurorehabilitation, with a specific interest in multiple sclerosis and stroke rehabilitation.

Claire Hargest

Claire Hargest is a Professional Practice Fellow at the School of Physiotherapy, at the University of Otago. Her research and clinical interests focus on neurorehabilitation.

Stephanie J. Woodley

Stephanie Woodley is an Associate Professor in the Department of Anatomy, University of Otago. Her research encompasses musculoskeletal anatomy and physiotherapy, particularly relating to the pelvis, hip, and lower limb.

Peter Lamb

Peter Lamb is a Senior Lecturer of biomechanics at the University of Otago. His research interests include gait biomechanics, multi-limb coordination and the application of novel analyses to high-dimensional data representing human movement.

Suzanne Kuys

Suzanne Kuys is the National Head, School of Allied Health at Australian Catholic University. Her research interests include stroke rehabilitation, gait and balance rehabilitation, and physical activity in chronic disease populations.

Allyson Calder

Allyson Calder is a Lecturer at the School of Physiotherapy, University of Otago. Her research interests include physical activity for people with neurological conditions (particularly stroke and traumatic brain injury) and men living with disabilities.

Leigh A. Hale

Leigh Hale is the Dean of the School of Physiotherapy, University of Otago. Her research interest includes community-based rehabilitation and supported self-management, particularly in stroke survivors and people with long term disabilities.