Knee OsteoarthritisNCT03900052
A Novel Walking Cane With Haptic Biofeedback Reduces Degenerative Loading in the Arthritic Knee
A study testing Haptic cane and typical cane in people with Knee Osteoarthritis, run by VA Puget Sound Health Care System.
Trial summary
The most commonly prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief for those with knee osteoarthritis. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading. Read more about this study
- Who is it for?
- Ages 35 to 80 yearsHealthy volunteers can take part
- Conditions the study is for
- Knee Osteoarthritis
- What is being tested?
- Haptic cane and typical cane
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 21 participants
- Where
- No sites listed yet
- Study dates
- 25 Jun 2015to 10 Jul 2017
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 35 to 80 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- • Radiographic evidence of tibiofemoral knee OA
- Between 35-80 years
- Stand and/or walk for at least 30 minutes without difficulty
- Have a VA medical record
Who cannot join
- • Knee joint replacement (<1 year)
- Lateral OA greater than medial OA
- Inadequate cognitive or language function to consent or participate
- BMI > 40
- pregnancy
About this study
Official title: The Effects of a Novel Walking Cane With Haptic Biofeedback on Degenerative Loading in the Arthritic Knee
The most commonly prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief for those with knee osteoarthritis. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading. The purpose of this study was twofold; 1) to determine the effectiveness of a novel walking haptic biofeedback cane to encourage proper cane loading compared with a conventional cane, and 2) to determine whether scale training or haptic feedback influences short term retention of cane loading. It is hypothesized that haptic biofeedback would increase cane loading (H1) and decrease knee loading (peak knee adduction moment (H2) and knee adduction angular impulse (H3)) when compared to naïve cane use.
Read the detailed description
- Up to 40 individuals who have experience using a walking cane and who self-report a clinical diagnosis of knee OA can participate in this study. Participants will be excluded if they had a knee replacement in the knee diagnosed with OA, had undergone knee surgery within the past year, could not perform cane walking continuously for 30 minutes, or exhibited other neurological and/or rheumatologic conditions that would impact gait.
- Participant biometrics, such as height, weight, and age will be collected in addition to information about OA and cane use history. Participants will complete the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, from which scores between 0 and 96 can be used to evaluate the impact of knee OA on the individual's quality of life.
- A haptic biofeedback cane was designed and manufactured to measure the user applied axial cane load, compare the load to the targeted 20% BW threshold, and then deliver a vibrotactile feedback in the cane handle when the loading was greater than threshold. The cane data acquisition was temporally synchronized to the motion analysis system and recorded axial cane loads at 100 Hz for later analysis. The haptic biofeedback cane consisted of a conventional bariatric walking cane (Patterson Medical Ltd) with a loadcell (Digi-Key100 LBS. Load Cell) placed inside a 3D printed modular cane foot. A microcontroller (Sparkfun™ Pro Micro), SD disk storage (Sparkfun™ OpenLog), eccentric rotating mass vibration motor (model 306-109, Precision Microdrives Limited), USB communications port, and battery completed the system.
- Each participant will attend a single laboratory data collection session for the acquisition of kinematic, kinetic, and biometric data. First, the participant will be asked to walk 20 m down a hallway with a conventional cane to establish a self-selected walking speed (SSWS). Participants will then change into motion capture conducive clothing and retro-reflective markers were placed using a modified Plug-In-Gait model with additional markers on the foot, thigh, and shank, via the Kadaba Model, for observation of the Kenn Adduction Moment (KAM) during level ground walking. Markers will also placed on the cane to track its motion.
- Participants will then be instructed to walk at their SSWS along an approximately 9-meter walkway containing five force-plates but will remain naïve as to the purpose of the plates throughout data collection, to avoid influencing gait. Data were collected under each of the following five conditions: 1) naïve, 2) scale training, 3) scale recall, 4) haptics training, and 5) haptics-only (Table 2). The order of the scale and haptics conditions was randomized at the beginning of data collection to avoid a learning bias. During all conditions the instrumented cane will be used, and axial loading recoded. However, haptic biofeedback from the cane will only be provided in the haptic conditions.
- For scale and haptic conditions, the participants will be instructed to hold the cane in the hand opposite their most affected knee. Before the recall and haptics-only conditions, a five-minute break will be given to test short-term instruction retention. For each condition, between five and eight successful steps will be collected. A successful walk trial is defined as at least one gait cycle with the affected limb's foot cleanly striking the force plate and the cane contacting the floor, not the force plate, during stance phase. Successful trials will also have to be within ± 10% of the subjects SSWS.
- Naïve condition
- Participants will be instructed to "walk across the lab and use the cane as is typical." During these trials the cane will record axial load but provided no biofeedback (i.e. the cane will act as a conventional cane).
- Scale conditions
- During scale training, participants will practice applying 20% BW to their canes while standing, using a beam scale set to the correct weight, until they feel comfortable recreating the technique. Participants then practice applying the 20% BW to their canes while walking, no external feedback regarding the load applied to the cane will be provided, however feedback on cane technique will be. Data will be collected during these walking trials. In the scale recall trials participants are to load the cane to 20% during walking without any feedback from a scale or the cane.
- Haptic conditions
- During haptic training, participants will be instructed to walk around the lab and load the cane during each step until they feel a vibration in the handle. The participants will then familiarize themselves with the biofeedback mechanism and practice loading the haptic cane while walking around the lab space. In the haptic-only trails participants will be instructed to load the cane during walking until they feel a vibration in the handle
- Three-dimensional kinematics will be collected using a camera 12 Vicon Nexus system (Vicon Motion Systems, Oxford, United Kingdom) with a sampling frequency of 120 Hz. Five force plates (AMTI) sampling at 1200 Hz were used for collection of ground reaction forces (GRFs) and identification of gait events during walking trials. Two time gates placed 2 meters apart will measure walking speed.
- The KAM will be calculated for the arthritic knee during stance phase of each processed step using the inverse kinematics packages in Visual 3D then normalized to body weight and height. KAMs will then be exported to MATLAB for further processing and analysis. Cane load will be normalized by weight and peak cane load per step will be determined in MATLAB. PKAM is calculated as highest KAM and KAAI is calculated as the area under the KAM curve.
- Conditions
- Knee Osteoarthritis
- Being tested
- Haptic cane, typical cane
- Keywords
- Knee Osteoarthritis, Knee adduction moment, Knee loading, Walking cane
- Medical subject headings
- Osteoarthritis, Knee
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Haptic caneDevice
- A haptic biofeedback cane was designed and manufactured to measure the user applied axial cane load, compare the load to the targeted 20% BW threshold, and then deliver a vibrotactile feedback in the cane handle when the loading was greater than threshold. The cane data acquisition was temporally synchronized to the motion analysis system and recorded axial cane loads at 100 Hz for later analysis. The haptic biofeedback cane consisted of a conventional bariatric walking cane (Patterson Medical Ltd) with a loadcell (Digi-Key100 LBS. Load Cell) placed inside a 3D printed modular cane foot. A microcontroller (Sparkfun™ Pro Micro), SD disk storage (Sparkfun™ OpenLog), eccentric rotating mass vibration motor (model 306-109, Precision Microdrives Limited), USB communications port, and battery completed the system.
typical caneDevice
Typical training cane loading training
| Study group | Role | What they receive |
|---|---|---|
| Naïve | No intervention | Conventional cane with no instruction given |
| Scale training | Active comparator | Conventional cane, scale training, and instruction on proper cane use Receives: Device: typical cane |
| Scale recall | Active comparator | Conventional cane with no further instruction or practice given Receives: Device: typical cane |
| Haptics training | Experimental | Haptic biofeedback cane with explanation and training. Receives: Device: Haptic cane |
| Haptics recall | Experimental | Haptic biofeedback cane with no further instruction or practice given. Receives: Device: Haptic cane |
What is being measured
The primary outcome is the main question the study is designed to answer.
Knee adduction moment (KAM) (percent body weight x height)
Calculated during stance phase of each step using inverse kinematics then normalized to body weight and height.
Measured: 5 minutes
Peak knee adduction moment (PKAM) (percent body weight x height)
calculated as highest KAM
Measured: 5 minutes
Knee adduction angular impulse (KAAI) (percent body weight x height x seconds)
calculated as the area under the KAM curve.
Measured: 5 minutes
Cane loading (percent body weight)
normalized by weight and peak cane load per step
Measured: 5 minutes
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Apr 2019
- Study start25 Jun 2015
- Primary completion10 Jul 2017
- Study completion10 Jul 2017
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Knee OsteoarthritisStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Device feasibility
- Allocation
- Randomised
- Intervention model
- Crossover
- Model description
- 1: Naïve - Conventional cane with no instruction given. 2A: Scale training - Conventional cane, scale training, and instruction on proper cane use. 2B: Scale recall - Conventional cane with no further instruction or practice given 3A: Haptics training - Haptic biofeedback cane with explanation and training. 3B: Haptics recall - Haptic biofeedback cane with no further instruction or practice given.
- Masking
- None (open label)
- Enrolment
- 21 participants (actual)
Sponsor and investigators
- Lead sponsor
- VA Puget Sound Health Care System
- Sponsor type
- US federal agency
- Responsible party
- Principal investigator, Patrick Aubin, VA Puget Sound Health Care System
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03900052
- Sponsor's protocol ID
- RX001926
- Status last verified
- Apr 2019
- First submitted
- 18 Mar 2019
- Last updated
- 4 Apr 2019
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Apr 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effects of a Novel Walking Cane With Haptic Biofeedback on Degenerative Loading in the Arthritic Knee
- ClinicalTrials.gov ID
- NCT03900052
- Acronym / sponsor ID
- RX001926
- Conditions
- Knee Osteoarthritis
- Keywords
- Knee Osteoarthritis, Knee adduction moment, Knee loading, Walking cane
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 21 participants (actual)
- Lead sponsor
- VA Puget Sound Health Care SystemUS federal agency
- Study start
- 25 Jun 2015 (actual)
- Primary completion
- 10 Jul 2017 (actual)
- Study completion
- 10 Jul 2017 (actual)
- First posted
- 2 Apr 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The most commonly prescribed mobility aid, the walking cane, is often underloaded and therefore fails to reduce knee joint loading and provide symptomatic relief for those with knee osteoarthritis. For this study, a novel walking cane with haptic biofeedback was designed to improve cane loading. The purpose of this study was twofold; 1) to determine the effectiveness of a novel walking haptic biofeedback cane to encourage proper cane loading compared with a conventional cane, and 2) to determine whether scale training or haptic feedback influences short term retention of cane loading. It is hypothesized that haptic biofeedback would increase cane loading (H1) and decrease knee loading (peak knee adduction moment (H2) and knee adduction angular impulse (H3)) when compared to naïve cane use.
Detailed description
- Up to 40 individuals who have experience using a walking cane and who self-report a clinical diagnosis of knee OA can participate in this study. Participants will be excluded if they had a knee replacement in the knee diagnosed with OA, had undergone knee surgery within the past year, could not perform cane walking continuously for 30 minutes, or exhibited other neurological and/or rheumatologic conditions that would impact gait.
- Participant biometrics, such as height, weight, and age will be collected in addition to information about OA and cane use history. Participants will complete the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, from which scores between 0 and 96 can be used to evaluate the impact of knee OA on the individual's quality of life.
- A haptic biofeedback cane was designed and manufactured to measure the user applied axial cane load, compare the load to the targeted 20% BW threshold, and then deliver a vibrotactile feedback in the cane handle when the loading was greater than threshold. The cane data acquisition was temporally synchronized to the motion analysis system and recorded axial cane loads at 100 Hz for later analysis. The haptic biofeedback cane consisted of a conventional bariatric walking cane (Patterson Medical Ltd) with a loadcell (Digi-Key100 LBS. Load Cell) placed inside a 3D printed modular cane foot. A microcontroller (Sparkfun™ Pro Micro), SD disk storage (Sparkfun™ OpenLog), eccentric rotating mass vibration motor (model 306-109, Precision Microdrives Limited), USB communications port, and battery completed the system.
- Each participant will attend a single laboratory data collection session for the acquisition of kinematic, kinetic, and biometric data. First, the participant will be asked to walk 20 m down a hallway with a conventional cane to establish a self-selected walking speed (SSWS). Participants will then change into motion capture conducive clothing and retro-reflective markers were placed using a modified Plug-In-Gait model with additional markers on the foot, thigh, and shank, via the Kadaba Model, for observation of the Kenn Adduction Moment (KAM) during level ground walking. Markers will also placed on the cane to track its motion.
- Participants will then be instructed to walk at their SSWS along an approximately 9-meter walkway containing five force-plates but will remain naïve as to the purpose of the plates throughout data collection, to avoid influencing gait. Data were collected under each of the following five conditions: 1) naïve, 2) scale training, 3) scale recall, 4) haptics training, and 5) haptics-only (Table 2). The order of the scale and haptics conditions was randomized at the beginning of data collection to avoid a learning bias. During all conditions the instrumented cane will be used, and axial loading recoded. However, haptic biofeedback from the cane will only be provided in the haptic conditions.
- For scale and haptic conditions, the participants will be instructed to hold the cane in the hand opposite their most affected knee. Before the recall and haptics-only conditions, a five-minute break will be given to test short-term instruction retention. For each condition, between five and eight successful steps will be collected. A successful walk trial is defined as at least one gait cycle with the affected limb's foot cleanly striking the force plate and the cane contacting the floor, not the force plate, during stance phase. Successful trials will also have to be within ± 10% of the subjects SSWS.
- Naïve condition
- Participants will be instructed to "walk across the lab and use the cane as is typical." During these trials the cane will record axial load but provided no biofeedback (i.e. the cane will act as a conventional cane).
- Scale conditions
- During scale training, participants will practice applying 20% BW to their canes while standing, using a beam scale set to the correct weight, until they feel comfortable recreating the technique. Participants then practice applying the 20% BW to their canes while walking, no external feedback regarding the load applied to the cane will be provided, however feedback on cane technique will be. Data will be collected during these walking trials. In the scale recall trials participants are to load the cane to 20% during walking without any feedback from a scale or the cane.
- Haptic conditions
- During haptic training, participants will be instructed to walk around the lab and load the cane during each step until they feel a vibration in the handle. The participants will then familiarize themselves with the biofeedback mechanism and practice loading the haptic cane while walking around the lab space. In the haptic-only trails participants will be instructed to load the cane during walking until they feel a vibration in the handle
- Three-dimensional kinematics will be collected using a camera 12 Vicon Nexus system (Vicon Motion Systems, Oxford, United Kingdom) with a sampling frequency of 120 Hz. Five force plates (AMTI) sampling at 1200 Hz were used for collection of ground reaction forces (GRFs) and identification of gait events during walking trials. Two time gates placed 2 meters apart will measure walking speed.
- The KAM will be calculated for the arthritic knee during stance phase of each processed step using the inverse kinematics packages in Visual 3D then normalized to body weight and height. KAMs will then be exported to MATLAB for further processing and analysis. Cane load will be normalized by weight and peak cane load per step will be determined in MATLAB. PKAM is calculated as highest KAM and KAAI is calculated as the area under the KAM curve.
Study design
- Primary purpose
- Device feasibility
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- None (open label)
- Number of arms
- 5
- Model description
- 1: Naïve - Conventional cane with no instruction given. 2A: Scale training - Conventional cane, scale training, and instruction on proper cane use. 2B: Scale recall - Conventional cane with no further instruction or practice given 3A: Haptics training - Haptic biofeedback cane with explanation and training. 3B: Haptics recall - Haptic biofeedback cane with no further instruction or practice given.
| Arm | Type | Receives |
|---|---|---|
| Naïve | No intervention | –Conventional cane with no instruction given |
| Scale training | Active comparator | Device: typical caneConventional cane, scale training, and instruction on proper cane use |
| Scale recall | Active comparator | Device: typical caneConventional cane with no further instruction or practice given |
| Haptics training | Experimental | Device: Haptic caneHaptic biofeedback cane with explanation and training. |
| Haptics recall | Experimental | Device: Haptic caneHaptic biofeedback cane with no further instruction or practice given. |
Who may qualify
- Ages
- 35 to 80 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- • Radiographic evidence of tibiofemoral knee OA
Key exclusion criteria (5 listed)
- • Knee joint replacement (<1 year)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Haptic cane• A haptic biofeedback cane was designed and manufactured to measure the user applied axial cane load, compare the load to the targeted 20% BW threshold, and then deliver a vibrotactile feedback in the cane handle when the loading was greater than threshold. The cane data acquisition was temporally synchronized to the motion analysis system and recorded axial cane loads at 100 Hz for later analysis. The haptic biofeedback cane consisted of a conventional bariatric walking cane (Patterson Medical Ltd) with a loadcell (Digi-Key100 LBS. Load Cell) placed inside a 3D printed modular cane foot. A microcontroller (Sparkfun™ Pro Micro), SD disk storage (Sparkfun™ OpenLog), eccentric rotating mass vibration motor (model 306-109, Precision Microdrives Limited), USB communications port, and battery completed the system. | Device | Haptics recall, Haptics training |
| typical caneTypical training cane loading training | Device | Scale recall, Scale training |
Primary outcome
Knee adduction moment (KAM) (percent body weight x height)
Time frame: 5 minutes
Calculated during stance phase of each step using inverse kinematics then normalized to body weight and height.
Peak knee adduction moment (PKAM) (percent body weight x height)
Time frame: 5 minutes
calculated as highest KAM
Knee adduction angular impulse (KAAI) (percent body weight x height x seconds)
Time frame: 5 minutes
calculated as the area under the KAM curve.
Cane loading (percent body weight)
Time frame: 5 minutes
normalized by weight and peak cane load per step
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Apr 2019.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
A study testing Haptic cane and typical cane in people with Knee Osteoarthritis, run by VA Puget Sound Health Care System.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 4 Apr 2019. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Knee adduction moment (KAM) (percent body weight x height) (time frame: 5 minutes). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Apr 2019.