Gait-Training Using Wearable Sensors

NCT ID: NCT04270565

Last Updated: 2022-05-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-05

Study Completion Date

2021-05-31

Brief Summary

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The overarching purpose of this project is to use sensor-derived patterns to guide running interventions during in-field training scenarios for runners with exercise-related lower leg pain. The investigators plan to use the RunScribe sensors to facilitate in-field gait-training to determine the effects of real-time gait-training interventions along with a home exercise program (intervention group) on biomechanical and patient-reported outcome measures of pain and function in runners with leg pain as opposed to receiving a home exercise program alone (control group).

Detailed Description

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The purpose of the study is to determine the effects of real-time gait-training interventions along with a home exercise program (intervention group) on biomechanical and patient-reported outcome measures of pain and function in runners with leg pain as opposed to receiving a home exercise program alone (control group). All participants will report to the Exercise and Sport Injury Laboratory for a 60-minute baseline clinical assessment performed by a blinded assessor to determine hip, knee, foot and ankle strength, range of motion, and alignment using valid and reliable measurement techniques. Participants will also perform a series of functional movement assessments while an assessor records frontal and sagittal camera views in order to determine lower extremity dynamic alignment. The functional assessments will include the star excursion balance test (SEBT), a lateral step-down, a single-leg squat to 45 degrees of knee flexion, and a treadmill gait assessment. The movement screens will be use to form criteria-based home exercise programs, such that a blinded assessor will evaluate the videos and categorize patients into varus, valgus, or neutral alignment groups. Participants will receive exercises tailored to these descriptions. Further, the static alignment measurements will be used to determine if lower extremity stretches are warranted.

Following the first baseline visit, participants will return to the lab for a second baseline visit to complete an indoor, instrumented gait analysis using a motion capture system. Participants will also become oriented to the RunScribe wearable sensors and associated phone application, and will perform a brief outdoor run at their preferred speed to calibrate the sensors. Participants will receive their home exercise prescription with supplemental videos to take home with them to ensure adequate understanding of the target exercise performance. Participants will then be randomly assigned to one of two groups: 1) sensor-based feedback with home exercises (intervention group), or 2) home exercises alone (control group). The randomization sequence will be created a priori with a random-number generator stratified by sex, and allocation will be placed in a sealed opaque envelope by the graduate student mentor to intentionally blind the study coordinator conducting the interventions.

Participants in the intervention group will receive a Garmin wristwatch to facilitate the gait-training feedback, and will be oriented to the procedures during 10 minutes of running on an indoor treadmill in the presence of the study coordinator to ensure adequate understanding and integration of the feedback. The RunScribe sensors will facilitate the feedback by providing real-time metrics on the Garmin watch face using a custom application. Contact time will be the central focus of the intervention; participants will receive a vibro-tactile alert to remain below the identified contact time cut-off based on preliminary data.

Regardless of group allocation, participants will be instructed to maintain a running log within the RunScribe phone application to track activity adherence, details of runs that are recorded by the sensors, and report pain 1-10 experienced before, during, and after runs. All participants will be asked to perform their interventions twice per week. Participants will be encouraged to maintain other normal activities in addition to the interventions.

During the intervention period, all participants will return to the lab once per week to determine if exercise progressions are warranted based using specific performance-based scoring criteria. These decisions will be made by an assessor blinded to group allocation. The intervention group participants will then check in with the unblinded study coordinator to receive instructions on gait-training feedback progressions. The intervention will follow a volume-based faded feedback design.

At the midpoint of the study, all participants will complete Visual Analog and Global Rating of Change scales to track self-reported recovery. At the end of the intervention period, all participants will be re-assessed by the same blinded assessor using the same baseline measures to determine changes in lower limb alignment, strength, flexibility, and functional movement patterns. The indoor gait assessment and calibration run performed at the second baseline visit will be repeated at this follow-up timepoint while all participants wear the RunScribe sensors. Participants will also repeat Visual Analog Pain and Global Rating of Change scales to assess self-reported recovery. The investigators will then be able to determine if contact time feedback delivered in the field effectively decreases contact time after feedback compared to baseline and compared to the control group, determine if contact time feedback delivered in the field carries over to other gait outcomes in the intervention group after gait-training compared to baseline and the control group, and assess if pain decreases and function increases after gait-training compared to baseline and to a greater extent than the control group.

Conditions

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Shin Splint Running-related Injury

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

There will be two groups:

1. real-time gait-training interventions along with a home exercise program (intervention group)
2. only home exercise program (control group).
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Caregivers Outcome Assessors
The investigator assessing laboratory-based outcome measures will be blinded to group allocation. Additionally, the investigator designing the home exercise program and making progression decisions will be blinded to group allocation.

Study Groups

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Intervention Group

The intervention group will receive real-time gait-training interventions along with a home exercise program. Participants in this group will be given a pair of sensors to wear on their shoes to wear during runs throughout the study period, and wear a Garmin watch to get information from the sensors to the watch for feedback. They will also do home exercises during the study, and to come into the laboratory weekly for about 30 minutes per visit to progress the home exercises and get instructions on feedback for the next week.

Group Type EXPERIMENTAL

In-Field Gait-Training

Intervention Type BEHAVIORAL

The intervention will deliver a series of vibrations on the participants' wrists through the Garmin when the sensors indicate that their contact time in milliseconds exceeds a threshold. The runners will be asked to reduce the amount of time their foot is in contact with the ground by picking their feet up more quickly. Participants will also receive a series of exercises based on noted impairments at baseline. The feedback during running will be completed twice per week for four weeks.

Home Exercise

Intervention Type BEHAVIORAL

Participants will receive a series of exercises based on noted impairments at baseline. Exercises will be completed twice per week for four weeks.

Control Group

The control group will receive only a home exercise program. Participants in this group will be given a pair of sensors to wear on their shoes to wear during runs throughout the study period, and do home exercises during the study. Participants will be asked to come into the laboratory weekly for about 30 minutes per visit to progress the home exercises.

Group Type ACTIVE_COMPARATOR

Home Exercise

Intervention Type BEHAVIORAL

Participants will receive a series of exercises based on noted impairments at baseline. Exercises will be completed twice per week for four weeks.

Interventions

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In-Field Gait-Training

The intervention will deliver a series of vibrations on the participants' wrists through the Garmin when the sensors indicate that their contact time in milliseconds exceeds a threshold. The runners will be asked to reduce the amount of time their foot is in contact with the ground by picking their feet up more quickly. Participants will also receive a series of exercises based on noted impairments at baseline. The feedback during running will be completed twice per week for four weeks.

Intervention Type BEHAVIORAL

Home Exercise

Participants will receive a series of exercises based on noted impairments at baseline. Exercises will be completed twice per week for four weeks.

Intervention Type BEHAVIORAL

Other Intervention Names

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RunScribe Garmin

Eligibility Criteria

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Inclusion Criteria

* Ages 18-45 years
* Male or female
* Involved in running training at least two times per week over the past three months
* Current weekly mileage of at least 6 miles
* Currently experiencing pain during or after running in the anterior or medial aspect of the leg (between the knee and the ankle) of at least one week in duration, with maximum pain levels between 3/10 and 8/10 on the Visual Analogue Scale
* All subjects must be willing to use their own smart phone device (iPhone or Android) to download the RunScribe application for study procedures.

Exclusion Criteria

* Primary complaint is of pain over the Achilles tendon, popliteal fossa, or lateral or superficial posterior compartment of the lower leg
* Medical diagnosis of compartment syndrome, tibial or fibular stress fracture, or tibial or fibular fracture within the past 3 months
* Current running-related injuries within 3 months at the foot, ankle, knee, thigh, hip, or lower back
* Any history of lower extremity or lower back surgery
* Subjects with known pregnancy
* Subject with any type of neuropathy (numbness/tingling) in lower extremity
* Subject with clinical diagnosis of Parkinson's disease
Minimum Eligible Age

18 Years

Maximum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Virginia

OTHER

Sponsor Role lead

Responsible Party

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Jay Hertel, PhD, ATC

Joe H. Gieck Professor of Sports Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jay Hertel, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia

Locations

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Memorial Gymnasium - Exercise and Sport Injury Laboratory

Charlottesville, Virginia, United States

Site Status

Countries

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United States

References

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Willy RW. Innovations and pitfalls in the use of wearable devices in the prevention and rehabilitation of running related injuries. Phys Ther Sport. 2018 Jan;29:26-33. doi: 10.1016/j.ptsp.2017.10.003. Epub 2017 Oct 6.

Reference Type BACKGROUND
PMID: 29172095 (View on PubMed)

Koldenhoven RM, Hertel J. Validation of a Wearable Sensor for Measuring Running Biomechanics. Digit Biomark. 2018 Aug 2;2(2):74-78. doi: 10.1159/000491645. eCollection 2018 May-Aug.

Reference Type BACKGROUND
PMID: 32095758 (View on PubMed)

Hollis CR, Koldenhoven RM, Resch JE, Hertel J. Running biomechanics as measured by wearable sensors: effects of speed and surface. Sports Biomech. 2021 Aug;20(5):521-531. doi: 10.1080/14763141.2019.1579366. Epub 2019 Mar 7.

Reference Type BACKGROUND
PMID: 30843475 (View on PubMed)

DeJong AF, Hertel J. Gait-training devices in the treatment of lower extremity injuries in sports medicine: current status and future prospects. Expert Rev Med Devices. 2018 Dec;15(12):891-909. doi: 10.1080/17434440.2018.1551130. Epub 2018 Dec 10.

Reference Type BACKGROUND
PMID: 30466335 (View on PubMed)

Willems TM, Witvrouw E, De Cock A, De Clercq D. Gait-related risk factors for exercise-related lower-leg pain during shod running. Med Sci Sports Exerc. 2007 Feb;39(2):330-9. doi: 10.1249/01.mss.0000247001.94470.21.

Reference Type BACKGROUND
PMID: 17277598 (View on PubMed)

Reinking MF, Hayes AM. Intrinsic factors associated with exercise-related leg pain in collegiate cross-country runners. Clin J Sport Med. 2006 Jan;16(1):10-4. doi: 10.1097/01.jsm.0000188041.04760.d2.

Reference Type BACKGROUND
PMID: 16377969 (View on PubMed)

Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001 Dec;8(12):1153-7. doi: 10.1111/j.1553-2712.2001.tb01132.x.

Reference Type BACKGROUND
PMID: 11733293 (View on PubMed)

Korakakis V, Malliaropoulos N, Baliotis K, Papadopoulou S, Padhiar N, Nauck T, Lohrer H. Cross-cultural Adaptation and Validation of the Exercise-Induced Leg Pain Questionnaire for English- and Greek-Speaking Individuals. J Orthop Sports Phys Ther. 2015 Jun;45(6):485-96. doi: 10.2519/jospt.2015.5428. Epub 2015 Apr 30.

Reference Type BACKGROUND
PMID: 25927499 (View on PubMed)

Abbott JH, Wright AA. Global Rating of Change (GROC): the minimally important change at which patients choose to stop seeking treatment. N Z J Physiother. 2010;38(2):66-66.

Reference Type BACKGROUND

Nelson EO, Ryan M, AufderHeide E, Heiderscheit B. Development of the University of Wisconsin Running Injury and Recovery Index. J Orthop Sports Phys Ther. 2019 Oct;49(10):751-760. doi: 10.2519/jospt.2019.8868. Epub 2019 Aug 3.

Reference Type BACKGROUND
PMID: 31378123 (View on PubMed)

DeJong Lempke AF, Stephens SL, Fish PN, Thompson XD, Hart JM, Hryvniak DJ, Rodu JS, Hertel J. Sensor-based gait training to reduce contact time for runners with exercise-related lower leg pain: a randomised controlled trial. BMJ Open Sport Exerc Med. 2022 Nov 3;8(4):e001293. doi: 10.1136/bmjsem-2021-001293. eCollection 2022.

Reference Type DERIVED
PMID: 36353183 (View on PubMed)

Other Identifiers

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22107

Identifier Type: -

Identifier Source: org_study_id

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