The Lower Body Positive Pressure Treadmill for Knee Osteoarthritis Rehabilitation
July 22nd, 2019
Here, based on a clinician’s point-of-view, we propose a two-model lower body positive pressure (LBPP) protocol (walking and squatting models) in addition to a clinical, functional assessment methodology, including details for further encouragement of the development of non-drug surgical intervention strategies in knee osteoarthritis patients. However, we only present the effect of LBPP training in improvement of pain and knee function in one patient through three-dimensional gait analysis. The exact, long-term eff
Pain and the resulting gait are the main problems of patients with knee osteoarthritis. Here, we propose The Lower Body Positive Pressure Treadmill Intervention Protocol, which includes both clinical assessment and treatment models for the rehabilitation of lower extremity motor functions in knee osteoarthritis. The LBPP treadmill protocol allows people to achieve exercises with relatively low heart rate, blood pressure and oxygen consumption, so it is safer and more effective than full-weight exercises for knee OA patients with cardiopulmonary disease.
Visual demonstration of this method is critical for safe operation of the LBPP training system and understanding of our protocol. Demonstrating the procedure will be Dr.Junjie Liang, Dr.Qiang Lin, PT Hongxin Chen, and Dr.Shijuan Lang from my lab. Begin the clinical assessment by asking the patient to describe their pain intensity from zero to 10 where zero is no pain and 10 is the worst pain.
Then conduct the active/passive knee joint range of motion assessment using a handheld two arm goniometer. Then conduct the Western Ontario and McMaster Universities Osteoarthritis Index or WOMAC by asking the patient to mark the corresponding position of pain or limited function on a straight line for five pain-related items, two stiffness items, and 17 functional items. Zero indicates no pain or no function limitation.
10 indicates severe pain or extreme limited function. Following the WOMAC, conduct two optional assessments:the Knee Injury and Osteoarthritis Outcome Score or KOOS, and/or the European Five Dimensional Health Scale, EQ-5D, to assess pain symptoms and quality of life. Then for the 10-meter walk test ask the patient to perform three consecutive 10-meter walk test trials at a self-selected pace for safety and comfort.
Ask the patient to walk without assistance for 10 meters and measure the time taken for the middle six meters. Next, to conduct The Timed Up and Go test ask the patient to perform three consecutive trials at a self-selected pace. Stand up, walk three meters, turn, walk back and sit down.
Lastly, perform a 3D gait analysis. To do this, position 22 spherical markers on the patient's anatomical landmarks based on the Davis Protocol. Then position six surface EMG electrodes on the bilateral rectus femoris, semitendinosus and long head biceps femoris of the patient.
Ask the patient to hold an orthostatic position for at least three to five seconds with the feet aligned in order to avoid having one foot in the more anterior or posterior position with respect to the other. Instruct the patient to walk with a self-selected speed along the fiver-meter walkway five times. Finally, remove all the spherical markers and EMG electrodes from the patient and save all the collected data for later processing.
Begin by introducing the lower body positive pressure or LBPP treadmill training process and related precautions to the patient. Next, check the patient's blood pressure and heart rate. Determine the size of the air seal shorts according to the waist circumference of the patient and ask the patient to put on the shorts.
Turn on the treadmill by operating the switch located on the front cover of the system and run the self-testing of the antigravity treadmill. Lower the cockpit. And have the patient step into the fabric enclosure of the antigravity treadmill.
Lift the cockpit to the appropriate height according to the LBPP training model such that the cockpit height is at the anterior superior iliac spine with a walking model, and slightly below the femur's great trochanter for the squatting model. Once the cockpit is in place, zip the patient into the antigravity treadmill. Use the safety lanyard supplied with the machine to secure the clip onto the patient's clothing, which is essential for emergency stopping during the training process.
Then instruct the patient to stand still on the surface of the treadmill belt to allow the system to hold and weigh the patient's a full body weight without any support from any part of the system, and then press the start button to perform an antigravity treadmill system calculation for accurate unweighting. Lastly, adjust the positions of three cameras supplied with the machine to obtain the synchronized video feedback during the training process to help the patient correct abnormal movement patterns. For the training session, start the warm-up with the following settings:five minutes with the speed zero to two miles per hour, BW 65%incline 0%Increase speed by 4 miles per hour and body weight support in 7%increments per minute.
Then perform the walking model session with the following settings:15 minutes with the speed at two miles per hour, BW at 65%and incline at 0%Perform the cool down session with the following settings:five minutes with the speed at two to zero miles per hour, BW 65 to 100%incline at 0%Decrease speed by 4 miles per hour, and body weight support in 7%decrements per minute. End up with the squatting model session with the following settings:five minutes with the speed at zero miles per hour, BW 50%incline 0%AROM zero to 50 degrees or the maximum tolerable joint range of motion within 50 degrees, 30 seconds of squatting followed by a 30-second rest period. Finally after two weeks of the LBPP training session, reevaluate the patient using the standardized tests and 3D gait analysis.
These results indicate that the 10-minute walk test decreased from 4.1 seconds at pre-training to 3.3 seconds at post-training. The TUG test decreased from 9.1 seconds at pre-training to 8.2 seconds at post-training. After two weeks of LBPP training, patients showed an improvement in total WOMAC scores, pain subscales, stiffness subscales, and function subscales.
The total VAS pain scores did not change after two weeks of treatment. The right swing phase increased. And left swing phase decreased from pre-training to post-training.
The right side length decreased, but the left side stride length increased from pre-training to post-training. Further, the mean velocity and cadence increased from pre-to post-training, but the step width decreased. Our LBPP training session consists of the walking and squatting modules.
The walking module focuses on improving walking function and the squatting module focuses on enhancement of the tight muscles'joints. If the patient can not tolerate the squatting training module, only perform the walking module.
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Overview
This study proposes a Lower Body Positive Pressure (LBPP) treadmill intervention protocol for knee osteoarthritis rehabilitation. The protocol includes clinical assessments and treatment models aimed at improving lower extremity motor functions.
Key Study Components
Area of Science
- Neuroscience
- Rehabilitation
- Orthopedics
Background
- Knee osteoarthritis leads to pain and impaired gait.
- LBPP allows for safer exercise with lower cardiovascular strain.
- Visual demonstrations are essential for proper protocol implementation.
- Clinical assessments are crucial for understanding patient pain levels.
Purpose of Study
- To develop a non-drug surgical intervention strategy for knee OA.
- To assess the effectiveness of LBPP in improving pain and function.
- To provide a framework for future studies on LBPP.
Methods Used
- Clinical assessment of pain intensity on a scale of 0 to 10.
- LBPP treadmill intervention with walking and squatting models.
- Three-dimensional gait analysis for evaluating outcomes.
- Demonstration by trained professionals for safety and efficacy.
Main Results
- LBPP training showed improvement in pain and knee function in one patient.
- Further studies are needed to explore long-term effects.
- LBPP is safer for patients with cardiopulmonary issues.
- Visual demonstrations enhance understanding and implementation.
Conclusions
- LBPP may be a viable non-drug intervention for knee OA.
- Clinical assessments are integral to the rehabilitation process.
- Future research should focus on broader patient populations.
Frequently Asked Questions
Executive Industry Relevance
Lower Body Positive Pressure (LBPP) treadmill protocols offer a non-pharmacological, non-surgical intervention for knee osteoarthritis, addressing the need for safer rehabilitation in patients with comorbidities. Quantitative gait analysis and standardized clinical assessments provide objective endpoints for evaluating functional improvement and pain reduction. This approach supports early-stage mechanistic de-risking and informs translational strategies for musculoskeletal therapeutic development.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables objective measurement of functional endpoints through 3D gait analysis and validated pain scales.
- Supports mechanistic de-risking by isolating the effects of LBPP on joint function and pain.
- Facilitates hypothesis testing for non-drug interventions in disease-relevant patient populations.
Screening & Assay Development
- Standardizes clinical and functional assessments for reproducible data collection across cohorts.
- Provides quantitative outputs (e.g., WOMAC, KOOS, gait metrics) for comparative analysis.
- Establishes a platform for evaluating adjunctive therapies or device-based interventions.
Translational & Preclinical Research
- Aligns functional readouts with patient-centric endpoints relevant to clinical translation.
- Enables continuity from discovery-stage mechanistic studies to preclinical validation of rehabilitation strategies.
- Supports risk-adjusted advancement decisions based on objective improvement in mobility and pain.
Pipeline & Workflow Integration
The LBPP treadmill protocol integrates into the rehabilitation discovery continuum, bridging early mechanistic validation with translational research and preclinical assessment of functional outcomes.
- Discovery Biology: Provides a controlled system for testing therapeutic hypotheses in knee osteoarthritis rehabilitation.
- Screening: Delivers reproducible, quantitative clinical and functional metrics for cross-condition comparison.
- Analytics: Enables statistical analysis of dependent variables such as gait velocity, stride length, and pain scores.
- Translational Research: Connects device-based interventions to patient-relevant functional improvements.
- Enterprise Reuse: Offers a standardized protocol adaptable to broader musculoskeletal and rehabilitation research portfolios.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in non-drug intervention efficacy and functional target validation.
- Operational Value: Enhances standardization, reproducibility, and scalability of rehabilitation protocols.
- Strategic Value: Informs go/no-go decisions for device-based or adjunctive therapy development.
- Portfolio Impact: Supports risk-adjusted prioritization of rehabilitation strategies in musculoskeletal R&D pipelines.
Implementation Considerations
- Requires clinical expertise in functional assessment and device operation.
- Needs access to LBPP treadmill systems and 3D gait analysis infrastructure.
- Demands cross-team standardization of assessment protocols and data collection.
- Adaptable to various patient populations with musculoskeletal conditions.
- Limited by current evidence base to short-term, single-patient outcomes; broader validation needed.
