Gait-Training Using Wearable Sensors

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).

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.

There will be two groups: real-time gait-training interventions along with a home exercise program (intervention group) only home exercise program (control group).

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.

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.

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.

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.

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

the amount of time (in milliseconds) the foot is in contact with the ground as measured using the RunScribe sensors

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

the amount of time (in milliseconds) the foot is in contact with the ground as measured using the RunScribe sensors

the amount of time (in milliseconds) the foot is in contact with the ground as measured using the RunScribe sensors

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

Hip frontal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Normalized gluteus medius muscle activity root mean square electromyography measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Normalized tibialis anterior muscle activity root mean square electromyography measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

the speed in which the foot turns over, or pronates, (in degrees/sec) during running as measured using the RunScribe sensors

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

the extent of lower extremity loading (in g's) during running as measured using the RunScribe sensors

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

the area on the foot that participants land on (on a 1-16 scale, with 1 indicating rear foot strike and 16 indicating a forefoot strike) during running as measured using the RunScribe sensors

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

Change in Exercise-Induced Leg Pain Questionnaire - British Version Outcomes Across the Intervention Period

Normalized peroneus longus muscle activity root mean square electromyography measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Normalized medial gastrocnemius muscle activity root mean square electromyography measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

the area on the foot that participants land on (on a 1-16 scale, with 1 indicating rear foot strike and 16 indicating a forefoot strike) during running as measured using the RunScribe sensors

the extent of lower extremity loading (in g's) during running as measured using the RunScribe sensors

the speed in which the foot turns over, or pronates, (in degrees/sec) during running as measured using the RunScribe sensors

the area on the foot that participants land on (on a 1-16 scale, with 1 indicating rear foot strike and 16 indicating a forefoot strike) during running as measured using the RunScribe sensors

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

the extent of lower extremity loading (in g's) during running as measured using the RunScribe sensors

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

the speed in which the foot turns over, or pronates, (in degrees/sec) during running as measured using the RunScribe sensors

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

Hip sagittal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Hip sagittal plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Hip transverse plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Hip transverse plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Hip frontal plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Knee frontal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Knee frontal plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Knee sagittal plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Ankle sagittal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Ankle sagittal plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Knee sagittal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Trunk frontal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Trunk sagittal plane motion (in degrees) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Trunk frontal plane joint moment (in Nm/kg)measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

Trunk sagittal plane joint moment (in Nm/kg) measured during the indoor motion capture gait analysis on a treadmill

This outcome change will be measured from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

This outcome change will be assessed from the end of the intervention (4 weeks) to follow-up at 6 weeks for both groups.

single-leg squat to 45 degrees of knee flexion functional performance scores (valgus, varus, or neutral scoring)

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

star excursion balance test performance scores (reach distances as a % of leg length for 8 reach directions)

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

This outcome change will be assessed from baseline to the end of the intervention (4 weeks) for both groups.

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

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