Effect of Retrowalking Exercise as Adjunctive Therapy on Functional Disability in Patients with Knee Osteoarthritis: A Randomized Controlled Trial
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Published:
Jul 24, 2026
Keywords:
Exercise Training, Adjunctive Therapy, Retrowalking, Disability Evaluation, Osteoarthritis of Knee
Main Article Content
Abstract
Background: Osteoarthritis (OA) is a degenerative joint disease and one of the major health problems caused functional disability that inhibits the performance of daily activities. Previous studies reported the beneficial effect of retrowalking in patients with knee osteoarthritis. The current study aims to find the effectiveness of retrowalking exercise as an adjunct to conventional therapy on functional disability in patients with knee osteoarthritis.
Methods: A randomized control trial design was conducted at outpatient Medical Rehabilitation Department in December 2018 to March 2019. Thirty-eight patients with knee OA participated in this study, which were randomly into 2 groups: experimental and control groups. The subjects from both groups received conventional therapy and only the experimental group received retrowalking exercise, 3x/week for 4 weeks. WOMAC Index was used to measure functional disabilitybefore and after intervention. Data were analysed using SPSS version 20.
Results: Per-protocol analysis showed a statistically significant change in the WOMAC index score in patients who received retrowalking exercises compared to the control group (p= 0.027) after 4 weeks of intervention. Only the pain subscale of the WOMAC index showed a statistically significant difference between the experimental and control groups (p= 0.043).
Conclusions: The 4 weeks retrowalking exercise as an adjunctive therapy in patients with knee osteoarthritis is more effective to reduce functional disability compared to conventional therapy alone.
Keywords: Exercise Training, Adjunctive Therapy, Retrowalking, Disability Evaluation, Osteoarthritis of Knee
Methods: A randomized control trial design was conducted at outpatient Medical Rehabilitation Department in December 2018 to March 2019. Thirty-eight patients with knee OA participated in this study, which were randomly into 2 groups: experimental and control groups. The subjects from both groups received conventional therapy and only the experimental group received retrowalking exercise, 3x/week for 4 weeks. WOMAC Index was used to measure functional disabilitybefore and after intervention. Data were analysed using SPSS version 20.
Results: Per-protocol analysis showed a statistically significant change in the WOMAC index score in patients who received retrowalking exercises compared to the control group (p= 0.027) after 4 weeks of intervention. Only the pain subscale of the WOMAC index showed a statistically significant difference between the experimental and control groups (p= 0.043).
Conclusions: The 4 weeks retrowalking exercise as an adjunctive therapy in patients with knee osteoarthritis is more effective to reduce functional disability compared to conventional therapy alone.
Keywords: Exercise Training, Adjunctive Therapy, Retrowalking, Disability Evaluation, Osteoarthritis of Knee
Article Details
How to Cite
Nelfidayani, Tamin, T. Z., I Nyoman Murdana, & Dewi Friska. (2026). Effect of Retrowalking Exercise as Adjunctive Therapy on Functional Disability in Patients with Knee Osteoarthritis: A Randomized Controlled Trial. Indonesian Journal of Physical Medicine and Rehabilitation, 15(1), 9 - 17. https://doi.org/10.36803/indojpmr.v15i1.490
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Original Article
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References
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9. Flynn TW, Soutas-Little RW. Patellofemoral joint compressive forces in forward and backward running. J Orthop Sports Phys Ther. 1995 May;21(5):277–82.
10. Flynn TW, Soutas-Little RW. Mechanical power and muscle action during forward and backward running. J Orthop Sports Phys Ther. 1993 Feb;17(2):108–12.
11. Anadkat H, Soman A, Kumar D. Effectiveness of retro walking treadmill training on pain and disability in knee osteoarthritis: A randomized controlled trail. 2015 Jan 1;6:B43–50.
12. Azlin MN, Lyn KS. Effects of passive joint mobilization on patients with knee osteoarthritis. Sains Malaysiana. 2011 Dec 1;40:1461–5.
13. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–49.
14. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502.
15. DELORME TL, WATKINS AL. Technics of progressive resistance exercise. Arch Phys Med Rehabil. 1948 May;29(5):263–73.
16. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–40.
17. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008 Jan;58(1):26–35.
18. Riset Kesehatan dasar (RISKESDAS) 2018. Hasil Utama Riskesdas 2018. Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia. 2018.
19. Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014 Feb;28(1):5–15.
20. Messier SP, Legault C, Mihalko S, Miller GD, Loeser RF, DeVita P, et al. The Intensive Diet and Exercise for Arthritis (IDEA) trial: design and rationale. BMC Musculoskelet Disord. 2009 Jul;10:93.
21. Alghadir AH, Anwer S, Sarkar B, Paul AK, Anwar D. Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord. 2019 Apr;20(1):159.
22. Fitzgerald GK, Fritz JM, Childs JD, Brennan GP, Talisa V, Gil AB, et al. Exercise, manual therapy, and use of booster sessions in physical therapy for knee osteoarthritis: a multi-center, factorial randomized clinical trial. Osteoarthr Cartil. 2016 Aug;24(8):1340–9.
23. van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, et al. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil. 2014 Oct;95(10):1962–8.
24. Grasso R, Bianchi L, Lacquaniti F. Motor patterns for human gait: backward versus forward locomotion. J Neurophysiol. 1998 Oct;80(4):1868–85.
25. DeVita P, Stribling J. Lower extremity joint kinetics and energetics during backward running. Med Sci Sports Exerc. 1991 May;23(5):602–10.
26. Wadhawa D, Hande D. Effects of Retrowalking on Osteoarthritis of Knee in Geriatric Population. IOSR J Sport Phys Educ. 2016 Apr 16;3:37–43.
27. Lee M, Kim J, Son J, Kim Y. Kinematic and kinetic analysis during forward and backward walking. Gait Posture. 2013 Sep;38(4):674–8.
28. Zhang M, Liu A, Jiang L, Pang J, Guo H, Chen B, et al. The biomechanical effects of backward walking on the knee: A new method for releasing the joint loading. Osteoarthr Cartil [Internet]. 2015 Apr 1;23:A121–2. Available from: https://doi.org/10.1016/j.joca.2015.02.845
2. Hamerman D. Clinical implications of osteoarthritis and ageing. Ann Rheum Dis. 1995 Feb;54(2):82–5.
3. McConnell S, Kolopack P, Davis AM. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum. 2001 Oct;45(5):453–61.
4. Centers for Disease Control and Prevention (CDC). Racial/ethnic differences in the prevalence and impact of doctor-diagnosed arthritis--United States, 2002. MMWR Morb Mortal Wkly Rep. 2005;54(5):119â€23.
5. Jönsson T, Ekvall Hansson E, Thorstensson CA, Eek F, Bergman P, Dahlberg LE. The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group. BMC Musculoskelet Disord. 2018 Jun;19(1):198.
6. Hurley M, Dickson K, Hallett R, Grant R, Hauari H, Walsh N, et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed methods review. Cochrane database Syst Rev. 2018 Apr;4(4):CD010842.
7. Chen L-Y, Su F-C, Chiang P-Y. Kinematic and EMG analysis of backward walking on treadmill. In: Annual International Conference of the IEEE Engineering in Medicine and Biology - Proceedings [Internet]. 2000. p. 825–7. Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-0034445044&partnerID=40&md5=cdc1999d8687a43d187babd51d0c6a19
8. Cipriani DJ, Armstrong CW, Gaul S. Backward walking at three levels of treadmill inclination: an electromyographic and kinematic analysis. J Orthop Sports Phys Ther. 1995 Sep;22(3):95–102.
9. Flynn TW, Soutas-Little RW. Patellofemoral joint compressive forces in forward and backward running. J Orthop Sports Phys Ther. 1995 May;21(5):277–82.
10. Flynn TW, Soutas-Little RW. Mechanical power and muscle action during forward and backward running. J Orthop Sports Phys Ther. 1993 Feb;17(2):108–12.
11. Anadkat H, Soman A, Kumar D. Effectiveness of retro walking treadmill training on pain and disability in knee osteoarthritis: A randomized controlled trail. 2015 Jan 1;6:B43–50.
12. Azlin MN, Lyn KS. Effects of passive joint mobilization on patients with knee osteoarthritis. Sains Malaysiana. 2011 Dec 1;40:1461–5.
13. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039–49.
14. KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502.
15. DELORME TL, WATKINS AL. Technics of progressive resistance exercise. Arch Phys Med Rehabil. 1948 May;29(5):263–73.
16. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–40.
17. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008 Jan;58(1):26–35.
18. Riset Kesehatan dasar (RISKESDAS) 2018. Hasil Utama Riskesdas 2018. Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia. 2018.
19. Johnson VL, Hunter DJ. The epidemiology of osteoarthritis. Best Pract Res Clin Rheumatol. 2014 Feb;28(1):5–15.
20. Messier SP, Legault C, Mihalko S, Miller GD, Loeser RF, DeVita P, et al. The Intensive Diet and Exercise for Arthritis (IDEA) trial: design and rationale. BMC Musculoskelet Disord. 2009 Jul;10:93.
21. Alghadir AH, Anwer S, Sarkar B, Paul AK, Anwar D. Effect of 6-week retro or forward walking program on pain, functional disability, quadriceps muscle strength, and performance in individuals with knee osteoarthritis: a randomized controlled trial (retro-walking trial). BMC Musculoskelet Disord. 2019 Apr;20(1):159.
22. Fitzgerald GK, Fritz JM, Childs JD, Brennan GP, Talisa V, Gil AB, et al. Exercise, manual therapy, and use of booster sessions in physical therapy for knee osteoarthritis: a multi-center, factorial randomized clinical trial. Osteoarthr Cartil. 2016 Aug;24(8):1340–9.
23. van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, et al. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil. 2014 Oct;95(10):1962–8.
24. Grasso R, Bianchi L, Lacquaniti F. Motor patterns for human gait: backward versus forward locomotion. J Neurophysiol. 1998 Oct;80(4):1868–85.
25. DeVita P, Stribling J. Lower extremity joint kinetics and energetics during backward running. Med Sci Sports Exerc. 1991 May;23(5):602–10.
26. Wadhawa D, Hande D. Effects of Retrowalking on Osteoarthritis of Knee in Geriatric Population. IOSR J Sport Phys Educ. 2016 Apr 16;3:37–43.
27. Lee M, Kim J, Son J, Kim Y. Kinematic and kinetic analysis during forward and backward walking. Gait Posture. 2013 Sep;38(4):674–8.
28. Zhang M, Liu A, Jiang L, Pang J, Guo H, Chen B, et al. The biomechanical effects of backward walking on the knee: A new method for releasing the joint loading. Osteoarthr Cartil [Internet]. 2015 Apr 1;23:A121–2. Available from: https://doi.org/10.1016/j.joca.2015.02.845