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French HP, Abbott JH, Galvin R. Adjunctive therapies in addition to land-based exercise therapy for osteoarthritis of the hip or knee. Cochrane Database Syst Rev 2022; 10:CD011915. [PMID: 36250418 PMCID: PMC9574868 DOI: 10.1002/14651858.cd011915.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Land-based exercise therapy is recommended in clinical guidelines for hip or knee osteoarthritis. Adjunctive non-pharmacological therapies are commonly used alongside exercise in hip or knee osteoarthritis management, but cumulative evidence for adjuncts to land-based exercise therapy is lacking. OBJECTIVES To evaluate the benefits and harms of adjunctive therapies used in addition to land-based exercise therapy compared with placebo adjunctive therapy added to land-based exercise therapy, or land-based exercise therapy only for people with hip or knee osteoarthritis. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) and clinical trials registries up to 10 June 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of people with hip or knee osteoarthritis comparing adjunctive therapies alongside land-based exercise therapy (experimental group) versus placebo adjunctive therapies alongside land-based exercise therapy, or land-based exercise therapy (control groups). Exercise had to be identical in both groups. Major outcomes were pain, physical function, participant-reported global assessment, quality of life (QOL), radiographic joint structural changes, adverse events and withdrawals due to adverse events. We evaluated short-term (6 months), medium-term (6 to 12 months) and long-term (12 months onwards) effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of evidence for major outcomes using GRADE. MAIN RESULTS We included 62 trials (60 RCTs and 2 quasi-RCTs) totalling 6508 participants. One trial included people with hip osteoarthritis, one hip or knee osteoarthritis and 59 included people with knee osteoarthritis only. Thirty-six trials evaluated electrophysical agents, seven manual therapies, four acupuncture or dry needling, or taping, three psychological therapies, dietary interventions or whole body vibration, two spa or peloid therapy and one foot insoles. Twenty-one trials included a placebo adjunctive therapy. We presented the effects stratified by different adjunctive therapies along with the overall results. We judged most trials to be at risk of bias, including 55% at risk of selection bias, 74% at risk of performance bias and 79% at risk of detection bias. Adverse events were reported in eight (13%) trials. Comparing adjunctive therapies plus land-based exercise therapy against placebo therapies plus exercise up to six months (short-term), we found low-certainty evidence for reduced pain and function, which did not meet our prespecified threshold for a clinically important difference. Mean pain intensity was 5.4 in the placebo group on a 0 to 10 numerical pain rating scale (NPRS) (lower scores represent less pain), and 0.77 points lower (0.48 points better to 1.16 points better) in the adjunctive therapy and exercise therapy group; relative improvement 10% (6% to 15% better) (22 studies; 1428 participants). Mean physical function on the Western Ontario and McMaster (WOMAC) 0 to 68 physical function (lower scores represent better function) subscale was 32.5 points in the placebo group and reduced by 5.03 points (2.57 points better to 7.61 points better) in the adjunctive therapy and exercise therapy group; relative improvement 12% (6% better to 18% better) (20 studies; 1361 participants). Moderate-certainty evidence indicates that adjunctive therapies did not improve QOL (SF-36 0 to 100 scale, higher scores represent better QOL). Placebo group mean QOL was 81.8 points, and 0.75 points worse (4.80 points worse to 3.39 points better) in the placebo adjunctive therapy group; relative improvement 1% (7% worse to 5% better) (two trials; 82 participants). Low-certainty evidence (two trials; 340 participants) indicates adjunctive therapies plus exercise may not increase adverse events compared to placebo therapies plus exercise (31% versus 13%; risk ratio (RR) 2.41, 95% confidence interval (CI) 0.27 to 21.90). Participant-reported global assessment was not measured in any studies. Compared with land-based exercise therapy, low-certainty evidence indicates that adjunctive electrophysical agents alongside exercise produced short-term (0 to 6 months) pain reduction of 0.41 points (0.17 points better to 0.63 points better); mean pain in the exercise-only group was 3.8 points and 0.41 points better in the adjunctive therapy plus exercise group (0 to 10 NPRS); relative improvement 7% (3% better to 11% better) (45 studies; 3322 participants). Mean physical function (0 to 68 WOMAC subscale) was 18.2 points in the exercise group and 2.83 points better (1.62 points better to 4.04 points better) in the adjunctive therapy plus exercise group; relative improvement 9% (5% better to 13% better) (45 studies; 3323 participants). These results are not clinically important. Mean QOL in the exercise group was 56.1 points and 1.04 points worse in the adjunctive therapies plus exercise therapy group (1.04 points worse to 3.12 points better); relative improvement 2% (2% worse to 5% better) (11 studies; 1483 participants), indicating no benefit (low-certainty evidence). Moderate-certainty evidence indicates that adjunctive therapies plus exercise probably result in a slight increase in participant-reported global assessment (short-term), with success reported by 45% in the exercise therapy group and 17% more individuals receiving adjunctive therapies and exercise (RR 1.37, 95% CI 1.15 to 1.62) (5 studies; 840 participants). One study (156 participants) showed little difference in radiographic joint structural changes (0.25 mm less, 95% CI -0.32 to -0.18 mm); 12% relative improvement (6% better to 18% better). Low-certainty evidence (8 trials; 1542 participants) indicates that adjunctive therapies plus exercise may not increase adverse events compared with exercise only (8.6% versus 6.5%; RR 1.33, 95% CI 0.78 to 2.27). AUTHORS' CONCLUSIONS Moderate- to low-certainty evidence showed no difference in pain, physical function or QOL between adjunctive therapies and placebo adjunctive therapies, or in pain, physical function, QOL or joint structural changes, compared to exercise only. Participant-reported global assessment was not reported for placebo comparisons, but there is probably a slight clinical benefit for adjunctive therapies plus exercise compared with exercise, based on a small number of studies. This may be explained by additional constructs captured in global measures compared with specific measures. Although results indicate no increased adverse events for adjunctive therapies used with exercise, these were poorly reported. Most studies evaluated short-term effects, with limited medium- or long-term evaluation. Due to a preponderance of knee osteoarthritis trials, we urge caution in extrapolating the findings to populations with hip osteoarthritis.
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Affiliation(s)
- Helen P French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - J Haxby Abbott
- Orthopaedics: Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Li J, Li X, Deng M, Liang X, Wei H, Wu X. Features and predictive value of 6-min walk test outcomes in interstitial lung disease: an observation study using wearable monitors. BMJ Open 2022; 12:e055077. [PMID: 35705338 PMCID: PMC9204441 DOI: 10.1136/bmjopen-2021-055077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To describe 6-min walk test (6MWT) outcomes, and to investigate their correlations with cardiopulmonary and lung function among patients with interstitial lung disease (ILD) which was not limited to idiopathic pulmonary fibrosis. METHODS We collected patients' demographic data and obtained minute-by-minute 6MWT outcomes. Modified Borg scale was employed to assess patients' dyspnoea, whereas New York Heart Association (NYHA) classification and pulmonary function test were used to evaluate patients' cardiopulmonary functions. RESULTS Heart rate (HR) exhibited a continuous upward trend, while SpO2 exhibited an overall downward with a slight increase at the fifth minute. The SpO2 nadir for 70 patients (9.3%) was lower than 80%. Further, the SpO2 nadir for 78.27% of the participants appeared at the end of the fourth minute. The 6-min walk distance (6MWD) had the strongest correlation with NYHA classification (r=0.82, p<0.01). The ratio of 6MWD to predicted 6MWD was most correlated to forced expiratory volume in the first second (r=0.30, p<0.01) and forced vital capacity (r=0.30, p<0.01). SpO2 at 3 min had the strongest correlation to patients' diffusing capacity of the lungs for carbon monoxide (r=0.41, p<0.01). We found significant differences in 6MWD (F=2.44, p=0.033), SpO2 change (F=2.58, p=0.025), HR at 0 min (F=2.87, p=0.014), HR at end of 6 min (F=2.58, p=0.025) and HR zenith (F=2.64, p=0.022) between the subtypes of ILD. CONCLUSION This observation provided an important evidence regarding oxygen titration. It is better to maintain SpO2 above 88% for 4 min instead of 3 min. SpO2 at the third minute was the most valuable predictor of patients' lung function. 6MWD and SpO2 changes were more discriminative in subtypes.
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Affiliation(s)
- Jiaying Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xiaoyan Li
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China
| | - Miaozhen Deng
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China
| | - Xinyin Liang
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China
| | - Huiqun Wei
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China
| | - Xiaobing Wu
- Department of Internal Medicine, First Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong, China
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Davis IS, Hollander K, Lieberman DE, Ridge ST, Sacco ICN, Wearing SC. Stepping Back to Minimal Footwear: Applications Across the Lifespan. Exerc Sport Sci Rev 2021; 49:228-243. [PMID: 34091498 DOI: 10.1249/jes.0000000000000263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Minimal footwear has existed for tens of thousands of years and was originally designed to protect the sole of the foot. Over the past 50 yr, most footwear has become increasingly more cushioned and supportive. Here, we review evidence that minimal shoes are a better match to our feet, which may result in a lower risk of musculoskeletal injury.
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Affiliation(s)
- Irene S Davis
- Spaulding National Running Center, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | | | - Daniel E Lieberman
- Department of Human Evolutionary Biology, Harvard University, Cambridge MA
| | - Sarah T Ridge
- Department of Exercise Sciences, Brigham Young University, Salt Lake City, Utah
| | - Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Ferreira V, Machado L, Vilaça A, Xará-Leite F, Roriz P. Effects of tailored lateral wedge insoles on medial knee osteoarthritis based on biomechanical analysis: 12-week randomized controlled trial. Clin Rehabil 2021; 35:1235-1246. [PMID: 33715477 DOI: 10.1177/0269215521997988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lateral wedge insoles adjusted by biomechanical analysis may improve the condition of patients with medial knee osteoarthritis. DESIGN This is a prospective, randomized, controlled, single-blind clinical trial. SETTING The study was conducted in a biomechanics laboratory. SUBJECTS A total of 38 patients with medial knee osteoarthritis were allocated to either an experimental group (lateral wedge insoles) or a control group (neutral insoles). INTERVENTIONS Experimental group (n = 20) received an adjusted lateral wedge insole of 2, 4, 6, 8, or 10 degrees, after previous biomechanical analysis. Control group (n = 18) received a neutral insole (0 degrees). All patients used the insoles for 12 weeks. MAIN MEASURES Visual analogue scale, Knee Injury and Osteoarthritis Outcome Score questionnaire, biomechanical parameters: first and second peak of the external knee adduction moment and knee adduction angular impulse, and physical performance tests: 30-second sit-to-stand test, the 40-m fast-paced walk test, and the 12-step stair-climb test. RESULTS After 12 weeks, between-group differences did not differ significantly for pain intensity (-12.5 mm, (95% CI -29.4-4.4)), biomechanical parameters (p = 0.05), Knee Injury and Osteoarthritis Outcome Score, and physical performance tests, except on the Knee Injury and Osteoarthritis Outcome Score subscale other symptoms (p = 0.002; 13.8 points, (95% CI 5.6-22.0)). CONCLUSION Tailored wedge insoles were no more effective at improving biomechanical or clinically meaningful outcomes than neutral insoles, except on symptoms. More participants from the experimental group reported they felt some improvement. However, these effects were minimal and without clinical significance.
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Affiliation(s)
- Vitor Ferreira
- School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
| | - Leandro Machado
- CIF2D, LABIOMEP, Faculdade de Desporto da Universidade do Porto, Porto, Portugal
| | - Adélio Vilaça
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Francisco Xará-Leite
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Paulo Roriz
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, LABIOMEP (Porto Biomechanics Laboratory), 4475-690 Maia, Portugal
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Khosravi M, Babaee T, Daryabor A, Jalali M. Effect of knee braces and insoles on clinical outcomes of individuals with medial knee osteoarthritis: A systematic review and meta-analysis. Assist Technol 2021; 34:501-517. [PMID: 33507124 DOI: 10.1080/10400435.2021.1880495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Knee osteoarthritis is a disabling disease, causing pain and reduced function.Orthoses are used to manage this problem, including knee braces and lateral wedge insoles. However, there is still controversy on which type of intervention is more effective. This systematic review and meta-analysis aimed toevaluate the effect of knee braces and lateral wedge insoles and compare their clinical outcomes onindividuals with medial knee osteoarthritis. We conducted the search strategy based on the population, intervention, comparison, andoutcome (PICO) method. We searched with PubMed, EMBASE, Web of Science, and Scopus databases for the related studies. The articles quality assessment was done based on the modified Downs and Black checklist. Totally, we chose 32 controlled trials, including 1.849 participants, for the final evaluation. Almosttwo-thirds of the studies had a moderate quality. The overall outcome suggested that both interventionshad improved pain and function. The difference between both interventions on pain reduction was not significant (standardized mean difference = 0.12, 95% confidence interval = 0.34 to 0.1) based on meta-analysis. Both knee brace and lateral wedge insole can improve pain and function in people with knee osteoarthritis. Using either separately or both of them together are effective.
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Affiliation(s)
- Mobina Khosravi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aliyeh Daryabor
- Department of Physiotherapy, Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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6
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Jarl G, Hellstrand Tang U, Nordén E, Johannesson A, Rusaw DF. Nordic clinical guidelines for orthotic treatment of osteoarthritis of the knee: A systematic review using the AGREE II instrument. Prosthet Orthot Int 2019; 43:556-563. [PMID: 31256710 DOI: 10.1177/0309364619857854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND High-quality clinical practice guidelines are necessary for effective use of resources both at an individual patient- and national-level. Nordic clinical practice guidelines recommendations for orthotic treatment of knee osteoarthritis vary and little is known about their quality. OBJECTIVES The aim of the study was to critically evaluate the quality of clinical practice guidelines in orthotic management of knee osteoarthritis in the Nordic countries. STUDY DESIGN Systematic review. METHODS Four national clinical practice guidelines for treatment of knee osteoarthritis were assessed for methodological rigour and transparency by four independent assessors using the AGREE II instrument. Summary domain scores and inter-rater agreement (Kendall's W) were calculated. RESULTS Domain scores indicate that many guidelines have not sufficiently addressed stakeholder involvement (average score: 55%), applicability (20%) and editorial independence (33%) in the development process. Inter-rater agreement for assessors indicated 'good' agreement for clinical practice guidelines from Finland, Norway and Sweden (W = 0.653, p < 0.001; W = 0.512, p = 0.003 and W = 0.532, p = 0.002, respectively) and 'strong' agreement for the clinical practice guideline from Denmark (W = 0.800, p < 0.001). CONCLUSION Quality of clinical practice guidelines for orthotic treatment of knee osteoarthritis in the Nordic region is variable. Future guideline development should focus on improving methodology by involving relevant stakeholders (e.g. certified prosthetist/orthotists (CPOs)), specifying conflicts of interest and providing guidance for implementation. CLINICAL RELEVANCE The current review suggests that, for the Nordic region, there are areas of improvement which can be addressed, which ensure clinical practice guidelines are developed under stringent conditions and based on sound methods. These improvements would ensure knee osteoarthritis patients are receiving orthotic interventions based on appropriate guidance from published guidelines.
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Affiliation(s)
- Gustav Jarl
- Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ulla Hellstrand Tang
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erika Nordén
- Ottobock, Medical Care Sweden, Stockholm, Sweden
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Solomonow-Avnon D, Herman A, Giwnewer U, Rozen N, Elbaz A, Mor A, Wolf A. Trunk kinematic, kinetic, and neuro-muscular response to foot center of pressure translation along the medio-lateral foot axis during gait. J Biomech 2019; 86:141-148. [PMID: 30777339 DOI: 10.1016/j.jbiomech.2019.01.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/20/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
Footwear devices that shift foot center of pressure (COP), thereby impacting lower-limb biomechanics to produce clinical benefit, have been studied regarding degenerative diseases of knee and hip joints, exhibiting evidence of clinical success. Ability to purposefully affect trunk biomechanics has not been investigated for this type of footwear. Fifteen healthy young male subjects underwent gait and electromyography analysis using a biomechanical device that shifts COP via moveable convex elements attached to the shoe sole. Analyses were performed in three COP configurations for pairwise comparison: (1) neutral (control) (2) laterally deviated, and (3) medially deviated. Sagittal and frontal-plane pelvis and spine kinematics, external oblique activity, and frontal and transverse-plane lumbar moments were affected by medio-lateral COP shift. Transverse-plane trunk kinematics, activity of the lumbar longissimus, latissimus dorsi, rectus abdominus, and quadratus lumborum, and sagittal-plane lumbar moment, were not significantly impacted. Two linear mixed effects models assessed predictive impact of (I) COP location, and (II) trunk kinematics and neuromuscular activity, on the significant lumbar moment parameters. The COP was a significant predictor of all modeled frontal and transverse-plane lumbar moment parameters, while pelvic and spine rotation, and lumbar longissimus activity were significant predictors of one frontal-plane lumbar moment parameter. Model results suggest that, although trunk biomechanics and muscle activity were altered by COP shift, COP offset influences lumbar kinetics directly, or via lower-limb changes not assessed in this study, but not by means of alteration of trunk kinematics or muscle activity. Further study may reveal implications in treatment of low back pain.
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Affiliation(s)
- Deborah Solomonow-Avnon
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel.
| | - Amir Herman
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, Israel, Affiliated with: Ben-Gurion University, Beer-Sheva, Israel
| | - Uriel Giwnewer
- Department of Orthopedic Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Nimrod Rozen
- Department of Orthopedic Surgery, Ha'Emek Medical Center, Afula, Israel
| | - Avi Elbaz
- APOS Research Group, Herzliya, Israel
| | - Amit Mor
- APOS Research Group, Herzliya, Israel
| | - Alon Wolf
- Biorobotics and Biomechanics Lab (BRML), Faculty of Mechanical Engineering, Technion - Israel Institute of Technology, Haifa 32000, Israel
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Healy A, Farmer S, Pandyan A, Chockalingam N. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PLoS One 2018; 13:e0192094. [PMID: 29538382 PMCID: PMC5851539 DOI: 10.1371/journal.pone.0192094] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.
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Affiliation(s)
- Aoife Healy
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Sybil Farmer
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Anand Pandyan
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
- School of Health & Rehabilitation, Keele University, Keele, United Kingdom
| | - Nachiappan Chockalingam
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
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9
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Paterson KL, Kasza J, Bennell KL, Wrigley TV, Metcalf BR, Campbell PK, Hunter DJ, Hinman RS. Moderators and mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis: an exploratory analysis of the SHARK randomised controlled trial. Osteoarthritis Cartilage 2018; 26:227-235. [PMID: 29128507 DOI: 10.1016/j.joca.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/17/2017] [Accepted: 11/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate moderators and biomechanical mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis (OA). METHODS Exploratory analysis from 164 participants in a clinical trial comparing unloading (ASICS GEL-Melbourne OA) to conventional walking shoes. The primary outcome was 6-month change in knee pain (11-point numerical rating scale (NRS)). Moderators included baseline peak knee adduction moment (KAM), radiographic severity (Kellgren & Lawrence (KL) scale), body mass, foot posture, neuropathic pain and diffuse knee pain. Mediators included change in peak KAM and KAM impulse. RESULTS Radiographic severity was the only moderator to interact with footwear group (P = 0.02). Participants with KL = 2 experienced greater pain reductions with conventional compared to unloading shoes (mean difference in change in pain -1.64 units, 95% CI -3.07, -0.21), while unloading shoes tended to result in greater pain reductions than conventional shoes in KL = 3 (0.98, 95% CI -0.44, 2.39) and KL = 4 (0.64, 95% CI -0.64, 1.93). No variable showed any significant mediating effect in the entire cohort. However, there was some evidence that unloading shoes may reduce pain through reductions in peak KAM (indirect effect -0.31, 95% CIs -0.65, 0.03; P = 0.07) in people with KL ≥ 3, compared to conventional shoes. CONCLUSION Unloading shoes conferred additional symptomatic benefits over conventional shoes in people with moderate to severe knee OA. There was some evidence effects may be mediated by a reduction in peak KAM. However, we were underpowered for subgroup analyses. These patients may represent a subgroup to which biomechanical interventions designed to reduce the KAM may be more effectively targeted.
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Affiliation(s)
- K L Paterson
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia.
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - T V Wrigley
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - B R Metcalf
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - P K Campbell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - D J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Rheumatology Department, Royal North Shore Hospital Australia, Sydney, Australia
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
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10
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Zhang Z, Wang L, Hu K, Liu Y. Characteristics of Plantar Loads During Walking in Patients with Knee Osteoarthritis. Med Sci Monit 2017; 23:5714-5719. [PMID: 29194431 PMCID: PMC5721590 DOI: 10.12659/msm.905136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a common disease that can change the load on lower limbs during walking. Plantar loads in patients with KOA may provide a basis for clinical decisions regarding footwear and foot orthoses. This study aimed to compare plantar loads in females with and without KOA during gait. MATERIAL AND METHODS Plantar pressure during walking was recorded in 23 females with KOA and 23 females without KOA. Maximum force (MF), contact area (CA), and peak pressure (PP) were measured at 7 different regions underneath the foot, named heel (M1), midfoot (M2), first metatarsophalangeal joint (MPJ) (M3), second MPJ (M4), third to fifth MPJ (M5), hallux (M6), and lesser toes (M7). RESULTS PPs for M2 and (M3) in females with KOA were higher than those in females without KOA. High PPs were also found in females with KOA for M2, M3, and M4. CONCLUSIONS Increased plantar loading in females with KOA may lead to foot pronation and gait changes during walking. Plantar loading may be offered to patients with KOA when considering footwear and foot orthoses.
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Affiliation(s)
- Zhiwang Zhang
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
| | - Lin Wang
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
| | - Kaijun Hu
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
| | - Yu Liu
- Key Laboratory of Exercise and Health Science of the Ministry of Education, Shanghai University of Sport, Shanghai, China (mainland)
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Kluge F, Krinner S, Lochmann M, Eskofier BM. Speed dependent effects of laterally wedged insoles on gait biomechanics in healthy subjects. Gait Posture 2017; 55:145-149. [PMID: 28445855 DOI: 10.1016/j.gaitpost.2017.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 03/29/2017] [Accepted: 04/07/2017] [Indexed: 02/02/2023]
Abstract
Laterally wedged insoles have been shown to be effective for the reduction of the knee adduction moment and other biomechanical variables that are associated with the pathogenesis of knee osteoarthritis. However, inconclusive results such as adverse effects in individual subjects or even no group-wise wedge effects have been presented in different studies and it has been suggested to identify variables that potentially confound the wedge effect. The main objective of this study was the investigation of interaction effects of lateral wedges with walking speed, as different self-selected speeds have mainly been used in previous studies. Twenty-two healthy subjects completed gait analysis trials on an instrumented treadmill. They walked in different speed conditions (0.9, 1.1, 1.3, 1.5m/s) with a neutral and a laterally wedged insole. Kinematics were acquired using infrared cinematography with reflective markers attached to the lower body. From the stance phase we extracted biomechanical parameters that are associated with knee joint loading and osteoarthritis severity. No interaction effect of lateral wedges and speed was observed for most biomechanical parameters except for the ankle eversion range of motion. The main effects of wedges were reductions of the external knee adduction moment and of the knee adduction angular impulse. All biomechanical variables changed with increasing speed. Only the lateral offset of the center of pressure did not respond to wedge or to speed changes. Our results suggest that different self-selected speeds do not confound the effect of laterally wedged insoles.
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Affiliation(s)
- Felix Kluge
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Martensstrasse 3, 91058 Erlangen, Germany; Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058 Erlangen, Germany.
| | - Sebastian Krinner
- Department of Trauma Surgery, University Hospital Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany.
| | - Matthias Lochmann
- Institute of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Gebbertstraße 123B, 91058 Erlangen, Germany.
| | - Bjoern M Eskofier
- Digital Sports Group, Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Martensstrasse 3, 91058 Erlangen, Germany.
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Cherian JJ, Jauregui JJ, Leichliter AK, Elmallah RK, Bhave A, Mont MA. The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee. Bone Joint J 2016; 98-B:89-94. [PMID: 26733650 DOI: 10.1302/0301-620x.98b1.36353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee. The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee. This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up.
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Affiliation(s)
- J J Cherian
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - J J Jauregui
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - A K Leichliter
- Philadelphia College of Osteopathic Medicine, 4170 City Ave, Philadelphia, PA 19131, USA
| | - R K Elmallah
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - A Bhave
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
| | - M A Mont
- Sinai Hospital of Baltimore, 2401 W. Belvedere Ave, Baltimore, Maryland, 21215, USA
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Resende RA, Kirkwood RN, Deluzio KJ, Hassan EA, Fonseca ST. Ipsilateral and contralateral foot pronation affect lower limb and trunk biomechanics of individuals with knee osteoarthritis during gait. Clin Biomech (Bristol, Avon) 2016; 34:30-7. [PMID: 27060435 DOI: 10.1016/j.clinbiomech.2016.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/11/2016] [Accepted: 03/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral wedges have been suggested for the treatment of individuals with knee osteoarthritis, but it may have undesirable effects on the biomechanics of gait through increased foot pronation. This study investigated the effects of increased unilateral foot pronation on the biomechanics of individuals with knee osteoarthritis during gait. METHODS Biomechanical data of twenty individuals with knee osteoarthritis were collected while they walked in three conditions: i) flat sandals; ii) wedged sandal on the knee osteoarthritis limb and flat sandal on the healthy limb; and iii) flat sandal on the osteoarthritis and wedged sandal on the healthy limb. Knee pain and comfort were evaluated. Principal Component Analysis followed by ANOVA was implemented to identify differences between conditions. FINDINGS The wedged sandal on the osteoarthritis limb increased rearfoot eversion (P<0.001; ES=0.79); increased shank rotation range of motion (P<0.001; ES=0.70); reduced knee internal rotation moment (P<0.001; ES=0.83); reduced hip internal rotation moment (P=0.001; ES=0.66); increased ipsilateral trunk lean (P=0.031; ES=0.47); and increased trunk rotation range of motion (P=0.001; ES=0.69). Walking with the wedged sandal on the healthy limb increased hip (P=0.003; ES=0.61) and knee (P=0.002; ES=0.63) adduction moments. Individuals reported greater comfort walking with the flat sandals (P=0.004; ES=0.55). INTERPRETATION Increased unilateral foot pronation of the knee osteoarthritis and healthy limbs causes lower limb and trunk mechanical changes that may overload the knee and the lower back, such as increased knee adduction moment, shank rotation and trunk lateral lean. Foot motion of both lower limbs should be evaluated and care must be taken when suggesting lateral wedges for individuals with knee osteoarthritis.
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Affiliation(s)
- Renan A Resende
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Avenida Antônio Carlos 6627 Campus Pampulha, Pampulha, 31270-901 Belo Horizonte, MG, Brazil.
| | - Renata N Kirkwood
- Wilfrid Laurier University, 75 University Avenue W, Waterloo, ON N2L 3C5, Canada.
| | - Kevin J Deluzio
- Queen's University, McLaughlin Hall, Faculty of Engineering and Applied Science, Department of Mechanical and Materials Engineering, Kingston, Ontario, Canada.
| | - Elizabeth A Hassan
- Queen's University, McLaughlin Hall, Faculty of Engineering and Applied Science, Department of Mechanical and Materials Engineering, Kingston, Ontario, Canada.
| | - Sérgio T Fonseca
- Universidade Federal de Minas Gerais, School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy, Avenida Antônio Carlos 6627 Campus Pampulha, Pampulha, 31270-901 Belo Horizonte, MG, Brazil.
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Arnold JB. Lateral wedge insoles for people with medial knee osteoarthritis: one size fits all, some or none? Osteoarthritis Cartilage 2016; 24:193-5. [PMID: 26432985 DOI: 10.1016/j.joca.2015.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/08/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Affiliation(s)
- J B Arnold
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia.
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Chapman GJ, Parkes MJ, Forsythe L, Felson DT, Jones RK. Ankle motion influences the external knee adduction moment and may predict who will respond to lateral wedge insoles?: an ancillary analysis from the SILK trial. Osteoarthritis Cartilage 2015; 23:1316-22. [PMID: 25749010 PMCID: PMC4523688 DOI: 10.1016/j.joca.2015.02.164] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 02/16/2015] [Accepted: 02/23/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Lateral wedge insoles are a potential simple treatment for medial knee osteoarthritis (OA) patients by reducing the external knee adduction moment (EKAM). However in some patients, an increase in their EKAM is seen. Understanding the role of the ankle joint complex in the response to lateral wedge insoles is critical in understanding and potentially identifying why some patients respond differently to lateral wedge insoles. METHOD Participants with medial tibiofemoral OA underwent gait analysis whilst walking in a control shoe and a lateral wedge insole. We evaluated if dynamic ankle joint complex coronal plane biomechanical measures could explain and identify those participants that increased (biomechanical non-responder) or decreased (biomechanical responder) EKAM under lateral wedge conditions compared to the control shoe. RESULTS Of the 70 participants studied (43 male), 33% increased their EKAM and 67% decreased their EKAM. Overall, lateral wedge insoles shifted the centre of foot pressure laterally, increased eversion of the ankle/subtalar joint complex (STJ) and the eversion moment compared to the control condition. Ankle angle at peak EKAM and peak eversion ankle/STJ complex angle in the control condition predicted if individuals were likely to decrease EKAM under lateral wedge conditions. CONCLUSIONS Coronal plane ankle/STJ complex biomechanical measures play a key role in reducing EKAM when wearing lateral wedge insoles. These findings may assist in the identification of those individuals that could benefit more from wearing lateral wedge insoles.
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Affiliation(s)
- G J Chapman
- School of Health Sciences, University of Salford, Salford, UK.
| | - M J Parkes
- Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, University of, Manchester, Manchester, UK.
| | - L Forsythe
- Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, University of, Manchester, Manchester, UK.
| | - D T Felson
- Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, University of, Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit (BRU), Manchester Academic Health Sciences Centre, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA.
| | - R K Jones
- School of Health Sciences, University of Salford, Salford, UK; Arthritis Research UK Epidemiology Unit, Centre for Musculoskeletal Research, University of, Manchester, Manchester, UK.
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Hsu WC, Jhong YC, Chen HL, Lin YJ, Chen LF, Hsieh LF. Immediate and long-term efficacy of laterally-wedged insoles on persons with bilateral medial knee osteoarthritis during walking. Biomed Eng Online 2015; 14:43. [PMID: 25971308 PMCID: PMC4431374 DOI: 10.1186/s12938-015-0040-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/21/2015] [Indexed: 12/03/2022] Open
Abstract
Background The current study aimed to investigate the immediate and long-term effects of laterally-wedged (LW) insoles on the knee loadings, the knee abductor moment (KAM) in particular, and the compensatory changes at other lower limb joints in patients with bilateral medial knee osteoarthritis during level walking with and without LW insoles. Methods Older adults with bilateral medial knee OA (age 66 ± 5.3 years; height 156 ± 4.9 cm; mass 60 ± 5.1 kg; leg length 83.72 ± 3.64 cm) were studied using computerized gait analysis initially (Baseline) and 6 weeks after using LW insoles (Follow-up) during barefoot walking and walking with LW insoles (7° of lateral inclination, with medial arch support). The three-dimensional angles and internal moments at the lower limb joints, as well as the ground reaction forces, were obtained using a motion analysis system and two forceplates. Key features of all the variables were compared using paired t tests for immediate effects (barefoot vs. LW) and for long-term effects (Baseline vs. Follow-up). The symptomatic severity (WOMAC Index) was also evaluated (Baseline vs. Follow-up). Results The KAM with LW insoles at Baseline was significantly reduced when compared to the barefoot condition (p < 0.05), suggesting that the LW insoles were effective in reducing unfavorable loadings at the knee immediately upon wearing the insoles. After 6 weeks of wearing LW insoles (Follow-up), no significant changes were found in most of the biomechanical variables, including KAM (p > 0.05), when compared to Baseline with LW insoles. However, a specific gait adaptation with reduced knee loading was revealed when walking without LW insoles, i.e., for the barefoot condition (p < 0.05). Conclusions After long-term use of LW insoles, the pain and physical function were improved with decreased peak KAM. A specific gait adaptation with reduced KAM was also found when walking without LW insoles. These results indicate a positive long-term effect in persons with bilateral medial knee OA, both as an orthosis to assist walking, and as a treatment intervention to facilitate gait adaptations in favor of reduced KAM.
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Affiliation(s)
- Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan. .,National Defense Medical Center, Taipei, Taiwan.
| | - You-Cai Jhong
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
| | - Hao-Ling Chen
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan.
| | - Yi-Jia Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
| | - Li-Fei Chen
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. .,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JAN, Bierma‐Zeinstra SMA. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev 2015; 2015:CD004020. [PMID: 25773267 PMCID: PMC7173742 DOI: 10.1002/14651858.cd004020.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Individuals with osteoarthritis (OA) of the knee can be treated with a knee brace or a foot/ankle orthosis. The main purpose of these aids is to reduce pain, improve physical function and, possibly, slow disease progression. This is the second update of the original review published in Issue 1, 2005, and first updated in 2007. OBJECTIVES To assess the benefits and harms of braces and foot/ankle orthoses in the treatment of patients with OA of the knee. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE (current contents, HealthSTAR) up to March 2014. We screened reference lists of identified trials and clinical trial registers for ongoing studies. SELECTION CRITERIA Randomised and controlled clinical trials investigating all types of braces and foot/ankle orthoses for OA of the knee compared with an active control or no treatment. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials and extracted data. We assessed risk of bias using the 'Risk of bias' tool of The Cochrane Collaboration. We analysed the quality of the results by performing an overall grading of evidence by outcome using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. As a result of heterogeneity of studies, pooling of outcome data was possible for only three insole studies. MAIN RESULTS We included 13 studies (n = 1356): four studies in the first version, three studies in the first update and six additional studies (n = 529 participants) in the second update. We included studies that reported results when study participants with early to severe knee OA (Kellgren & Lawrence grade I-IV) were treated with a knee brace (valgus knee brace, neutral brace or neoprene sleeve) or an orthosis (laterally or medially wedged insole, neutral insole, variable or constant stiffness shoe) or were given no treatment. The main comparisons included (1) brace versus no treatment; (2) foot/ankle orthosis versus no treatment or other treatment; and (3) brace versus foot/ankle orthosis. Seven studies had low risk, two studies had high risk and four studies had unclear risk of selection bias. Five studies had low risk, three studies had high risk and five studies had unclear risk of detection bias. Ten studies had high risk and three studies had low risk of performance bias. Nine studies had low risk and four studies had high risk of reporting bias.Four studies compared brace versus no treatment, but only one provided useful data for meta-analysis at 12-month follow-up. One study (n = 117, low-quality evidence) showed lack of evidence of an effect on visual analogue scale (VAS) pain scores (absolute percent change 0%, mean difference (MD) 0.0, 95% confidence interval (CI) -0.84 to 0.84), function scores (absolute percent change 1%, MD 1.0, 95% CI -2.98 to 4.98) and health-related quality of life scores (absolute percent change 4%, MD -0.04, 95% CI -0.12 to 0.04) after 12 months. Many participants stopped their initial treatment because of lack of effect (24 of 60 participants in the brace group and 14 of 57 participants in the no treatment group; absolute percent change 15%, risk ratio (RR) 1.63, 95% CI 0.94 to 2.82). The other studies reported some improvement in pain, function and health-related quality of life (P value ≤ 0.001). Stiffness and treatment failure (need for surgery) were not reported in the included studies.For the comparison of laterally wedged insole versus no insole, one study (n = 40, low-quality evidence) showed a lower VAS pain score in the laterally wedged insole group (absolute percent change 16%, MD -1.60, 95% CI -2.31 to -0.89) after nine months. Function, stiffness, health-related quality of life, treatment failure and adverse events were not reported in the included study.For the comparison of laterally wedged versus neutral insole after pooling of three studies (n = 358, moderate-quality evidence), little evidence was found of an effect on numerical rating scale (NRS) pain scores (absolute percent change 1.0%, MD 0.1, 95% CI -0.45 to 0.65), Western Ontario-McMaster Osteoarthritis Scale (WOMAC) stiffness scores (absolute percent change 0.1%, MD 0.07, 95% CI -4.96 to 5.1) and WOMAC function scores (absolute percent change 0.9%, MD 0.94, 95% CI - 2.98 to 4.87) after 12 months. Evidence of an effect on health-related quality of life scores (absolute percent change 1.0%, MD 0.01, 95% CI -0.05 to 0.03) was lacking in one study (n = 179, moderate-quality evidence). Treatment failure and adverse events were not studied for this comparison in the included studies.Data for the comparison of laterally wedged insole versus valgus knee brace could not be pooled. After six months' follow-up, no statistically significant difference was noted in VAS pain scores (absolute percent change -2.0%, MD -0.2, 95% CI -1.15 to 0.75) and WOMAC function scores (absolute percent change 0.1%, MD 0.1, 95% CI -7.26 to 0.75) in one study (n = 91, low-quality evidence); however both groups showed improvement. Stiffness, health-related quality of life, treatment failure and adverse events were not reported in the included studies for this comparison. AUTHORS' CONCLUSIONS Evidence was inconclusive for the benefits of bracing for pain, stiffness, function and quality of life in the treatment of patients with medial compartment knee OA. On the basis of one laterally wedged insole versus no treatment study, we conclude that evidence of an effect on pain in patients with varus knee OA is lacking. Moderate-quality evidence shows lack of an effect on improvement in pain, stiffness and function between patients treated with a laterally wedged insole and those treated with a neutral insole. Low-quality evidence shows lack of an effect on improvement in pain, stiffness and function between patients treated with a valgus knee brace and those treated with a laterally wedged insole. The optimal choice for an orthosis remains unclear, and long-term implications are lacking.
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Affiliation(s)
- Tijs Duivenvoorden
- Erasmus University Medical CenterDepartment of OrthopaedicsRotterdamNetherlands
| | - Reinoud W Brouwer
- Martini HospitalDepartment of Orthopaedic SurgeryPO Box 30033GroningenNetherlands9700 RM
| | - Tom M van Raaij
- Martini HospitalDepartment of Orthopaedic SurgeryPO Box 30033GroningenNetherlands9700 RM
| | - Arianne P Verhagen
- Erasmus Medical CenterDepartment of General PracticePO Box 2040RotterdamNetherlands3000 CA
| | - Jan AN Verhaar
- Erasmus University Medical CenterDepartment of OrthopaedicsRotterdamNetherlands
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McWilliams DF, Muthuri S, Muir KR, Maciewicz RA, Zhang W, Doherty M. Self-reported adult footwear and the risks of lower limb osteoarthritis: the GOAL case control study. BMC Musculoskelet Disord 2014; 15:308. [PMID: 25240981 PMCID: PMC4190490 DOI: 10.1186/1471-2474-15-308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 09/17/2014] [Indexed: 11/13/2022] Open
Abstract
Background Biomechanical factors may play a role in osteoarthritis (OA) development and progression. Previous biomechanical studies have indicated that types of footwear may modulate forces across the knee joint, and high heeled womens’ shoes in particular are hypothesised to be detrimental to lower limb joint health. This analysis of data from a case control study investigated persistent users of different adult footwear for risks of knee and hip OA. Our underlying hypotheses were that high heeled, narrow heeled, and hard soled shoe types were putative risk factors for lower limb OA. Methods Data on footwear were initially obtained from participants during the Genetics of Osteoarthritis and Lifestyle (GOAL) hospital-based, case control study using standardised interview-delivered questionnaires. An additional questionnaire was later sent to GOAL study participants to verify findings and to further investigate specific shoe use per decade of life. Persistent users of footwear types (high or narrow heel; sole thickness or hardness) were identified from early adulthood. Participants were grouped into single sex knee OA, hip OA or control groups. Adjusted odds ratios (aOR) and 95% confidence interval (CI) were calculated. Results Univariate analysis of persistent users of women’s high heeled and narrow heeled shoes during early adulthood showed negative associations with knee OA and hip OA. After logistic regression, persistent narrow heel users were associated with less risk of OA (knee OA aOR 0.59, 95% CI 0.35 – 1.00 and hip aOR: 0.50, 95% CI 0.30 – 0.85), and other analyses were not statistically significant. Further analysis suggested that women with hip OA may have stopped wearing high and narrow heeled footwear to attenuate hip pain in early adulthood. Consistent associations between shoe soles and OA were not found. Conclusions In general, persistent users of high and narrow heeled shoes during early adulthood had a negative association with knee or hip OA. This does not necessarily imply a causal relationship, as changing footwear during early adulthood to modulate index joint pain may provide a possible explanation. Despite the findings of previous biomechanical studies of high heels, we did not find a positive association between women’s shoes and lower limb osteoarthritis. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-308) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel F McWilliams
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
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Sole CC, Milosavljevic S, Sole G, Sullivan SJ. Patterns of mediolateral asymmetry in worn footwear. FOOTWEAR SCIENCE 2014. [DOI: 10.1080/19424280.2014.913694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Riskowski JL, Dufour AB, Hagedorn TJ, Hillstrom HJ, Casey VA, Hannan MT. Associations of foot posture and function to lower extremity pain: results from a population-based foot study. Arthritis Care Res (Hoboken) 2014; 65:1804-12. [PMID: 24591410 DOI: 10.1002/acr.22049] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/16/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. METHODS Participants were members of the Framingham Foot Study. Lower extremity joint pain was determined by the response to the National Health and Nutrition Examination Survey-type question, "On most days do you have pain, aching or stiffness in your (hips, knees, ankles, or feet)?" The Modified Arch Index classified participants as having planus, rectus (referent), or cavus foot posture. The Center of Pressure Excursion Index classified participants as having overpronated, normal (referent), or oversupinated foot function. Crude and adjusted (age, sex, and body mass index) logistic regression determined associations of foot posture and function to lower extremity pain. RESULTS Participants with planus structure had higher odds of knee (odds ratio [OR] 1.57, 95% confidence interval [95% CI] 1.24-1.99) or ankle (OR 1.47, 95% CI 1.05-2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (OR 7.56, 95% CI 1.99-28.8) and pain at 1 lower extremity site (OR 1.37, 95% CI 1.04-1.80). Associations between foot function and lower extremity joint pain were not statistically significant except for a reduced risk of hip pain in those with an oversupinated foot function (OR 0.69, 95% CI 0.51-0.93). CONCLUSION These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies.
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Menz HB, Levinger P, Tan JM, Auhl M, Roddy E, Munteanu SE. Rocker-sole footwear versus prefabricated foot orthoses for the treatment of pain associated with first metatarsophalangeal joint osteoarthritis: study protocol for a randomised trial. BMC Musculoskelet Disord 2014; 15:86. [PMID: 24629181 PMCID: PMC3995518 DOI: 10.1186/1471-2474-15-86] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 02/26/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Osteoarthritis affecting the first metatarsophalangeal joint of the foot is a common condition which results in pain, stiffness and impaired ambulation. Footwear modifications and foot orthoses are widely used in clinical practice to treat this condition, but their effectiveness has not been rigorously evaluated. This article describes the design of a randomised trial comparing the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with first metatarsophalangeal joint osteoarthritis. METHODS Eighty people with first metatarsophalangeal joint osteoarthritis will be randomly allocated to receive either a pair of rocker-sole shoes (MBT® Matwa, Masai Barefoot Technology, Switzerland) or a pair of individualised, prefabricated foot orthoses (Vasyli Customs, Vasyli Medical™, Queensland, Australia). At baseline, the biomechanical effects of the interventions will be examined using a wireless wearable sensor motion analysis system (LEGSys™, BioSensics, Boston, MA, USA) and an in-shoe plantar pressure system (Pedar®, Novel GmbH, Munich, Germany). The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire (FHSQ), measured at baseline and 4, 8 and 12 weeks. Secondary outcome measures will include the function, footwear and general foot health subscales of the FHSQ, severity of pain and stiffness at the first metatarsophalangeal joint (measured using 100 mm visual analog scales), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 questionnaire), use of rescue medication and co-interventions to relieve pain, the frequency and type of self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention to treat principle. DISCUSSION This study is the first randomised trial to compare the effectiveness of rocker-sole footwear and individualised prefabricated foot orthoses in reducing pain associated with osteoarthritis of the first metatarsophalangeal joint, and only the third randomised trial ever conducted for this condition. The study has been pragmatically designed to ensure that the findings can be implemented into clinical practice if the interventions are found to be effective, and the baseline biomechanical analysis will provide useful insights into their mechanism of action. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613001245785.
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Affiliation(s)
- Hylton B Menz
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
| | - Pazit Levinger
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne 8001, Victoria, Australia
| | - Jade M Tan
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
| | - Maria Auhl
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire ST5 5BG, UK
| | - Shannon E Munteanu
- Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
- Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora 3086, Victoria, Australia
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Andreoni G, Mazzola M, Perego P, Standoli CE, Manzoni S, Piccini L, Molteni F. Wearable monitoring devices for assistive technology: case studies in post-polio syndrome. SENSORS 2014; 14:2012-27. [PMID: 24469354 PMCID: PMC3958267 DOI: 10.3390/s140202012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/16/2022]
Abstract
The correct choice and customization of an orthosis are crucial to obtain the best comfort and efficiency. This study explored the feasibility of a multivariate quantitative assessment of the functional efficiency of lower limb orthosis through a novel wearable system. Gait basographic parameters and energetic indexes were analysed during a Six-Minute Walking Test (6-MWT) through a cost-effective, non-invasive polygraph device, with a multichannel wireless transmission, that carried out electro-cardiograph (ECG); impedance-cardiograph (ICG); and lower-limb accelerations detection. Four subjects affected by Post-Polio Syndrome (PPS) were recruited. The wearable device and the semi-automatic post-processing software provided a novel set of objective data to assess the overall efficiency of the patient-orthosis system. Despite the small number of examined subjects, the results obtained with this new approach encourage the application of the method thus enlarging the dataset to validate this promising protocol and measuring system in supporting clinical decisions and out of a laboratory environment.
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Affiliation(s)
- Giuseppe Andreoni
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | - Marco Mazzola
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | - Paolo Perego
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | | | - Simone Manzoni
- Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy.
| | - Luca Piccini
- SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy.
| | - Franco Molteni
- Villa Beretta" Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy.
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Skou ST, Hojgaard L, Simonsen OH. Customized foot insoles have a positive effect on pain, function, and quality of life in patients with medial knee osteoarthritis. J Am Podiatr Med Assoc 2013; 103:50-5. [PMID: 23328853 DOI: 10.7547/1030050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a prevalent degenerative disease in older adults. Treatment strategies, including insoles, focus on reducing pain and physical disability. In medial KOA, insoles have been studied extensively with conflicting results, possibly due to heterogeneity in outcome measures and the intervention. We sought to investigate the effect of custom-made laterally wedged insoles on pain, function, and quality of life in patients with medial KOA. METHODS Fifty-one consecutive patients with medial KOA were prescribed custom-made insoles with arch support and a 5.0° to 8.7° lateral wedge. At follow-up, 42 of the 51 participants (22 men; mean age, 63 years; mean Kellgren-Lawrence, 3.4) participated. Retrospectively, participants were asked to rate the pain intensity in their affected knee before and after the intervention measured on a visual analog scale after 30 min of physical activity (primary outcome), at rest, at night, and after 50 m of walking. Additionally, they completed the Oxford Knee Score and the EQ-5D. The paired-samples t test was applied in the statistics. RESULTS The visual analog scale score after 30 min of physical activity was significantly reduced after the intervention (mean, 3.3 cm; 95% confidence interval, 2.1-4.5 cm; P < .001). The same significant changes were found in all of the secondary outcomes. CONCLUSIONS There was a significant reduction in pain and improvements in function and quality of life with custom-made laterally wedged insoles with arch support in older adults with mild-to-severe medial KOA. The customization of laterally wedged insoles may be essential for the effect in medial KOA.
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Affiliation(s)
- Søren Thorgaard Skou
- Orthopaedic Surgery Research Unit, Aalborg Hospital-Aarhus University Hospital, Aalborg, Denmark
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Abstract
SYNOPSIS Altered knee joint biomechanics and excessive joint loading have long been considered as important contributors to the development and progression of knee osteoarthritis. Therefore, a better understanding of how various treatment options influence the loading environment of the knee joint could have practical implications for devising more effective physical therapy management strategies. The aim of this clinical commentary was to review the pertinent biomechanical evidence supporting the use of treatment options intended to provide protection against excessive joint loading while offering symptomatic relief and functional improvements for better long-term management of patients with knee osteoarthritis. The biomechanical and clinical evidence regarding the effectiveness of knee joint offloading strategies, including contralateral cane use, laterally wedged shoe insoles, variable-stiffness shoes, valgus knee bracing, and gait-modification strategies, within the context of effective disease management is discussed. In addition, the potential role of therapeutic exercise and neuromuscular training to improve the mechanical environment of the knee joint is considered. Management strategies for treatment of joint instability and patellofemoral compartment disease are also mentioned. Based on the evidence presented as part of this clinical commentary, it is argued that special considerations for the role of knee joint biomechanics and excessive joint loading are necessary in designing effective short- and long-term management strategies for treatment of patients with knee osteoarthritis. LEVEL OF EVIDENCE Therapy, level 5.
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Parkes MJ, Maricar N, Lunt M, LaValley MP, Jones RK, Segal NA, Takahashi-Narita K, Felson DT. Lateral wedge insoles as a conservative treatment for pain in patients with medial knee osteoarthritis: a meta-analysis. JAMA 2013; 310:722-30. [PMID: 23989797 PMCID: PMC4458141 DOI: 10.1001/jama.2013.243229] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE There is no consensus regarding the efficacy of lateral wedge insoles as a treatment for pain in medial knee osteoarthritis. OBJECTIVE To evaluate whether lateral wedge insoles reduce pain in patients with medial knee osteoarthritis compared with an appropriate control. DATA SOURCES Databases searched include the Cochrane Central Register of Controlled Trials, EMBASE, AMED, MEDLINE, CINAHL Plus, ScienceDirect, SCOPUS, Web of Science, and BIOSIS from inception to May 2013, with no limits on study date or language. The metaRegister of Controlled Trials and the NHS Evidence website were also searched. STUDY SELECTION Included were randomized trials comparing shoe-based treatments (lateral heel wedge insoles or shoes with variable stiffness soles) aimed at reducing medial knee load, with a neutral or no wedge control condition in patients with painful medial knee osteoarthritis. Studies must have included patient-reported pain as an outcome. DATA EXTRACTION AND SYNTHESIS Trial data were extracted independently by 2 researchers using a standardized form. Risk of bias was assessed using the Cochrane Risk of Bias tool by 2 observers. Eligible studies were pooled using a random-effects approach. MAIN OUTCOME AND MEASURES Change in self-reported knee pain at follow-up. RESULTS Twelve trials met inclusion criteria with a total of 885 participants of whom 502 received lateral wedge treatment. The pooled standardized mean difference (SMD) suggested a favorable association with lateral wedges compared with control (SMD, -0.47; 95% CI, -0.80 to -0.14); however, substantial heterogeneity was present (I2 = 82.7%). This effect size represents an effect of -2.12 points on the 20-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale. Larger trials with a lower risk of bias suggested a null association. Meta-regression analyses showed that higher effect sizes (unstandardized β, 1.07 [95% CI, 0.28 to 1.87] for trials using a no treatment control) were seen in trials using a no wedge treatment control group (n = 4 trials; SMD, -1.20 [95% CI, -2.09 to -0.30]) and lower effect sizes (unstandardized β, 0.26 [95% CI, 0.002 to 0.52] for each bias category deemed low risk) when the study method was deemed at low risk of bias. Among trials in which the control treatment was a neutral insole (n = 7), lateral wedges showed no association (SMD, -0.03 [95% CI, -0.18 to 0.12] on WOMAC; this represents an effect of -0.12 points), and results showed little heterogeneity (I2 = 7.1%). CONCLUSIONS AND RELEVANCE Although meta-analytic pooling of all studies showed a statistically significant association between use of lateral wedges and lower pain in medial knee osteoarthritis, restriction of studies to those using a neutral insole comparator did not show a significant or clinically important association. These findings do not support the use of lateral wedges for this indication.
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Affiliation(s)
- Matthew J Parkes
- Arthritis Research UK Epidemiology Unit, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, England.
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Greitemann B, Maronna U. [Technical orthopedics. Importance in an increasingly operatively oriented faculty]. DER ORTHOPADE 2013; 42:842-53. [PMID: 23955523 DOI: 10.1007/s00132-013-2096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The foundation of the German Society for Orthopedics in 1901 was due to a separation from the faculty of surgery because a surgical approach alone did not adequately deal with the symptoms. Orthopedists were initially considered as a fringe group. The conservative treatment approach was initially at the forefront and operative measures were a side line. The main aim was the rehabilitation of patients into a normal life as best as possible. In the conservative area treatment with orthopedic technical aids and appliances rapidly came to play an important role and a great multitude of technical appliances were developed with sometimes very different possible applications. Despite the clearly improved operative treatment approaches in orthopedics and trauma surgery, technical orthopedics still plays a substantial role even today. Healing and supportive aids and appliances are of decisive importance for the treatment of a multitude of diseases and handicaps. They stabilize and improve operative treatment results and often result in new approaches. This depends on cooperation between technicians, therapists and physicians in a team, even in the scientific field. Evidence-based studies on the effectiveness of technical aids are currently still uncommon but recently some clear evidence for effectiveness could be shown. Scientifically this is a very varied field of work. The demographic development presents new requirements which must be dealt with. Technical solutions are often very promising especially in this field. Technical orthopedics remains an important component of the specialty of orthopedics and trauma surgery and with an increasing tendency due to more recent research and development.
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Affiliation(s)
- B Greitemann
- Reha-Klinikum Bad Rothenfelde, Klinik Münsterland, Auf der Stöwwe 11, 49214, Bad Rothenfelde, Deutschland,
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Kean CO, Bennell KL, Wrigley TV, Hinman RS. Modified walking shoes for knee osteoarthritis: Mechanisms for reductions in the knee adduction moment. J Biomech 2013; 46:2060-6. [DOI: 10.1016/j.jbiomech.2013.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/17/2013] [Accepted: 05/21/2013] [Indexed: 10/26/2022]
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The biomechanical effects of a new design of lateral wedge insole on the knee and ankle during walking. Hum Mov Sci 2013; 32:596-604. [PMID: 24054897 DOI: 10.1016/j.humov.2012.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 12/21/2012] [Accepted: 12/27/2012] [Indexed: 11/22/2022]
Abstract
Lateral wedged insoles are a common treatment in individuals with medial tibiofemoral osteoarthritis of the knee joint. One concern has been the potential for increased foot and ankle pain due to increased eversion. The purpose of this study was to assess the biomechanical effectiveness of a typical lateral wedged insole and a combined insole with a lateral wedge and off-the-shelf anti-pronatory device in shoes while walking. A cross-over randomized design was used where each insole was worn by fifteen healthy subjects while three-dimensional motion data were collected in three different conditions: (1) control condition (with standard shoes), (2) with an insole with a lateral wedge and additional off-the-shelf anti-pronatory support (supporting), and (3) with an insole with a lateral wedge with no additional support (unsupported) in the standard shoes. The unsupported insole significantly increased the amount of ankle/subtalar joint complex eversion than the other experimental conditions, with the supporting insole reducing the ankle/subtalar joint complex eversion, and was found to be more comfortable. Both the supporting and unsupported lateral wedged insoles significantly reduced knee loading (external knee adduction moment reduction 8.5% and 9.1%, respectively), the knee adduction angular impulse. This new design of lateral wedge may offer increased adherence in future osteoarthritis population studies while offering reductions in joint loading.
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Snyder-Mackler L. Lateral wedge insoles worn for 12 months provided no symptomatic or structural benefit for people with medial knee osteoarthritis. J Physiother 2013; 57:195. [PMID: 21843837 DOI: 10.1016/s1836-9553(11)70043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Barrios JA, Butler RJ, Crenshaw JR, Royer TD, Davis IS. Mechanical effectiveness of lateral foot wedging in medial knee osteoarthritis after 1 year of wear. J Orthop Res 2013; 31:659-64. [PMID: 23097326 PMCID: PMC4026192 DOI: 10.1002/jor.22252] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 09/25/2012] [Indexed: 02/04/2023]
Abstract
The use of lateral foot wedging in the management of medial knee osteoarthritis is under scrutiny. Interestingly, there have been minimal efforts to evaluate biomechanical effectiveness with long-term use. Therefore, we aimed to evaluate dynamic knee loading (assessed using the knee adduction moment) and other secondary gait parameters in patients with medial knee osteoarthritis wearing lateral foot wedging at a baseline visit and after 1 year of wear. Three-dimensional gait data were captured in an intervention group of 19 patients with symptomatic medial knee osteoarthritis wearing their prescribed laterally wedged foot orthoses at 0 and 12 months. Wedge amounts were prescribed based on symptom response to a step-down test. A control group of 19 patients wearing prescribed neutral orthoses were also captured at 0 and 12 months. The gait of the intervention group wearing neutral orthoses was additionally captured. Walking speed and shoes were controlled. Analyses of variance were conducted to examine for group-by-time (between the groups in their prescribed orthoses) and condition-by-time (within the intervention group) interactions, main effects, and simple effects. We observed increased knee adduction moments and frontal plane motion over time in the control group but not the intervention group. Further, within the intervention group, the mechanical effectiveness of the lateral wedging did not decrease. In patients with medial knee osteoarthritis, the effects of lateral foot wedging on pathomechanics associated with medial knee osteoarthritis were favorable and sustained over time.
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Affiliation(s)
| | - Robert J. Butler
- Doctor of Physical Therapy Division DUMC 104002 Durham, NC 27705 919-681-7225
| | - Jeremy R. Crenshaw
- 200 1 St. SW Charlton North L-110F Mayo Clinic Rochester, MN 55905 507-266-3401
| | - Todd D. Royer
- 144 Rust Ice Arena 541 South College Avenue University of Delaware Newark, DE 19716 302-831-4351
| | - Irene S. Davis
- 1575 Cambridge St Harvard Medical School Cambridge, MA 02138 617-234-7921
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A systematic review investigating the efficacy of laterally wedged insoles for medial knee osteoarthritis. Rheumatol Int 2013; 33:2529-38. [DOI: 10.1007/s00296-013-2760-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 04/16/2013] [Indexed: 11/26/2022]
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Hinman RS, Bardin L, Simic M, Bennell KL. Medial arch supports do not significantly alter the knee adduction moment in people with knee osteoarthritis. Osteoarthritis Cartilage 2013; 21:28-34. [PMID: 23103749 DOI: 10.1016/j.joca.2012.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 10/07/2012] [Accepted: 10/14/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to evaluate the immediate effects of medial arch supports on indices of medial knee joint load (the peak external knee adduction moment (KAM) and knee adduction angular (KAA) impulse) and knee pain during walking in people with medial knee osteoarthritis (OA). DESIGN Twenty-one people with medial compartment OA underwent gait analysis in standardised athletic shoes wearing (1) no medial arch supports and (2) prefabricated medial arch supports, in random order. Outcomes were the first and second peaks in the external KAM, the KAA impulse and severity of knee pain during testing. Outcomes were compared across conditions using paired t tests (gait data) and Wilcoxon Signed Ranks test (pain data). RESULTS There were no significant changes in either first or second peak KAM, or in the KAA impulse, with the addition of medial arch supports (all P > 0.05). Considerable individual variation in response to the arch supports was observed across participants. There was no immediate change in knee pain during walking when medial arch supports were worn (P = 0.56). CONCLUSIONS This study showed no mean change in any of the measured indices of medial knee load with medial arch supports. No immediate changes in knee pain were evident.
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Affiliation(s)
- R S Hinman
- Centre for Health, Exercise and Sports Medicine, Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Malvankar S, Khan WS, Mahapatra A, Dowd GS. How Effective are Lateral Wedge Orthotics in Treating Medial Compartment Osteoarthritis of the Knee? A Systematic Review of the Recent Literature. Open Orthop J 2012; 6:544-7. [PMID: 23248725 PMCID: PMC3522189 DOI: 10.2174/1874325001206010544] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 08/28/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022] Open
Abstract
Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee but recent reviews suggest that lateral wedges do not affect disease progression. We performed a systematic review to analyse the recent literature and define how effective, if at all, lateral wedges are in the management of medial compartment osteoarthritis of the knee. The inclusion criteria were defined as any study published within the last decade, using a sample size of at least twenty patients, and investigating the effect of insoles or wedges on either unilateral or bilateral knee varus osteoarthritis. The standardised keyword term 'lateral*wedge*OR insole*OR orthotic* OR medial compartment OR varus OR osteoarthri* OR knee*' was used. We identified 10 studies that fitted our inclusion criteria. Although there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee, there is some evidence to suggest that they do have some symptomatic effect. Patients with early osteoarthritis and higher BMI may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI. The literature is unclear as to what the optimal duration for the use of lateral wedges is, but does support the prolonged use of the wedges as the benefits at one month are maintained at one year. Future studies should be randomised controlled trials with a large sample size with long follow-up, and use objective clinical, biomechanical and radiological outcome measures.
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Affiliation(s)
- Seema Malvankar
- University College London Medical School, Gower Street, London, WC1E 6BT, UK
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Moyer RF, Birmingham TB, Dombroski CE, Walsh RF, Leitch KM, Jenkyn TR, Giffin JR. Combined effects of a valgus knee brace and lateral wedge foot orthotic on the external knee adduction moment in patients with varus gonarthrosis. Arch Phys Med Rehabil 2012; 94:103-12. [PMID: 22995151 DOI: 10.1016/j.apmr.2012.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 09/04/2012] [Accepted: 09/09/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To test the hypothesis that a custom-fit valgus knee brace and custom-made lateral wedge foot orthotic will have greatest effects on decreasing the external knee adduction moment during gait when used concurrently. DESIGN Proof-of-concept, single test session, crossover trial. SETTING Biomechanics laboratory within a tertiary care center. PARTICIPANTS Patients (n=16) with varus alignment and knee osteoarthritis (OA) primarily affecting the medial compartment of the tibiofemoral joint (varus gonarthrosis). INTERVENTIONS Custom-fit valgus knee brace and custom-made full-length lateral wedge foot orthotic. Amounts of valgus angulation and wedge height were tailored to each patient to ensure comfort. MAIN OUTCOME MEASURES The external knee adduction moment (% body weight [BW]*height [Ht]), frontal plane lever arm (cm), and ground reaction force (N/kg), determined from 3-dimensional gait analysis completed under 4 randomized conditions: (1) control (no knee brace, no foot orthotic), (2) knee brace, (3) foot orthotic, and (4) knee brace and foot orthotic. RESULTS The reduction in knee adduction moment was greatest when concurrently using the knee brace and foot orthotic (effect sizes ranged from 0.3 to 0.4). The mean decrease in first peak knee adduction moment compared with control was .36% BW*Ht (95% confidence interval [CI], -.66 to -.07). This was accompanied by a mean decrease in frontal plane lever arm of .59cm (95% CI, -.94 to -.25). CONCLUSIONS These findings suggest that using a custom-fit knee brace and custom-made foot orthotic concurrently can produce a greater overall reduction in the knee adduction moment, through combined effects in decreasing the frontal plane lever arm.
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Affiliation(s)
- Rebecca F Moyer
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
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Fukuchi C, Worobets J, Wannop JW, Stefanyshyn D. A small integrated lateral wedge does not alter knee joint moments during walking. FOOTWEAR SCIENCE 2012. [DOI: 10.1080/19424280.2012.683044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Segal NA. Bracing and Orthoses: A Review of Efficacy and Mechanical Effects for Tibiofemoral Osteoarthritis. PM R 2012; 4:S89-96. [DOI: 10.1016/j.pmrj.2012.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 11/16/2022]
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Woolacott NF, Corbett MS, Rice SJC. The use and reporting of WOMAC in the assessment of the benefit of physical therapies for the pain of osteoarthritis of the knee: findings from a systematic review of clinical trials. Rheumatology (Oxford) 2012; 51:1440-6. [DOI: 10.1093/rheumatology/kes043] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hinman RS, Bowles KA, Metcalf BB, Wrigley TV, Bennell KL. Lateral wedge insoles for medial knee osteoarthritis: effects on lower limb frontal plane biomechanics. Clin Biomech (Bristol, Avon) 2012; 27:27-33. [PMID: 21862189 DOI: 10.1016/j.clinbiomech.2011.07.010] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 04/03/2011] [Accepted: 07/19/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lateral wedges reduce the peak knee adduction moment and are advocated for knee osteoarthritis. However some patients demonstrate adverse biomechanical effects with treatment. Clinical management is hampered by lack of knowledge about their mechanism of effect. We evaluated effects of lateral wedges on frontal plane biomechanics, in order to elucidate mechanisms of effect. METHODS Seventy three participants with knee osteoarthritis underwent gait analysis with and without 5° lateral wedges. Frontal plane parameters at the foot, knee and hip were evaluated, including peak knee adduction moment, knee adduction angular impulse, center of pressure displacement, ground reaction force, and knee-ground reaction force lever arm. FINDINGS Lateral wedges reduced peak knee adduction moment and knee adduction angular impulse (-5.8% and -6.3% respectively, both P<0.001). Although reductions in peak moment were correlated with more lateral center of pressure (r=0.25, P<0.05), less varus malalignment (r values 0.25-0.38, P<0.05), reduced knee-ground reaction force lever arm (r=0.69, P<0.01), less hip adduction (r=0.24, P<0.05) and a more vertical frontal plane ground reaction force vector (r=0.67, P<0.001), only reduction in knee-ground reaction force lever arm was significantly predictive in regression analyses (B=0.056, adjusted R(2)=0.461, P<0.001). INTERPRETATION Lateral wedges significantly reduce peak knee adduction moment and knee adduction angular impulse. It seems a reduced knee-ground reaction force lever arm with lateral wedges is the central mechanism explaining their load-reducing effects. In order to understand why some patients do not respond to treatment, future evaluation of patient characteristics that mediate wedge effects on this lever arm is required.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Physiotherapy, School of Health Sciences, The University of Melbourne, Victoria, Australia.
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Abdallah AA, Radwan AY. Biomechanical changes accompanying unilateral and bilateral use of laterally wedged insoles with medial arch supports in patients with medial knee osteoarthritis. Clin Biomech (Bristol, Avon) 2011; 26:783-9. [PMID: 21497965 DOI: 10.1016/j.clinbiomech.2011.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 03/24/2011] [Accepted: 03/28/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laterally wedged insoles have controversial effect in treating medial compartment knee osteoarthritis. This study examined the effects of unilateral and bilateral use of insoles having medial arch supports and of different inclinations on the frontal plane external hip, knee, subtalar moments and pelvic alignment. METHODS Kinetic and kinematic gait parameters were collected from 21 patients with primary medial knee osteoarthritis. The insoles' inclinations were 0, 6 and 11°, where each of the 6° and 11° was used once unilaterally and another bilaterally while the 0° was used bilaterally as a control. FINDINGS The Multivariate Analysis of Variance revealed significant increase in the external subtalar eversion moment using either of the 6° or 11° laterally wedged vs the 0° non-wedged insole conditions (P=0.003). Moreover, there were significant increases in the external eversion moment using the 11° vs the 6° insole conditions (P<0.05). However, there were no significant differences for the remaining tested variables (P>0.05). The bivariate correlations revealed significant negative correlations between the subtalar eversion and knee adduction moments (r=-0.409, P=0.000) and the subtalar eversion and hip adduction moments (r=-0.226, P=0.049), and positive correlation between the hip and knee adduction moments (r=0.268, P=0.019). INTERPRETATION The non-significant reduction in the external knee adduction moment may question the efficacy of using wedged insoles having medial arch supports in treating patients with medial knee osteoarthritis. Additionally, using such insoles did not produce appreciable mechanical effects on remote articulations as the hip and pelvis.
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Riskowski J, Dufour AB, Hannan MT. Arthritis, foot pain and shoe wear: current musculoskeletal research on feet. Curr Opin Rheumatol 2011; 23:148-55. [PMID: 21150623 DOI: 10.1097/bor.0b013e3283422cf5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Both arthritis and foot pain are major public health problems. Approximately 24% of adults have foot ailments, and the prevalence increases with age. Foot pain, particularly related to shoes, footwear and rheumatic disorders, may be an important modifiable factor. Surprisingly, this topic has received little attention in the rheumatology community. RECENT FINDINGS Despite the major focus of structure and alignment in arthritis, remarkably little work has focused on the foot and nonsurgical foot interventions that might affect lower extremity joint alignment, structure and pain in rheumatic diseases. Emerging research suggests that there may be a significant role for foot orthotics and footwear in the treatment of rheumatoid arthritis and osteoarthritis of the hip, knee and foot. This review highlights the current understanding on the topic of foot orthotics and footwear in adults with rheumatic diseases. SUMMARY Biomechanical evidence indicates that foot orthotics and specialized footwear may change muscle activation and gait patterns to reduce joint loading. Emerging evidence suggests that orthotics, specific shoe types and footwear interventions may provide an effective nonsurgical intervention in rheumatic diseases. Yet good data are sparse, and it is premature to recommend guidelines. As there are a limited number of studies that underpin the foot's role in arthritis cause and progression, clinical trials and prospective studies are of utmost importance to unravel the links between foot pain, foot conditions and interventions that lessen the impact of rheumatic diseases.
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Affiliation(s)
- Jody Riskowski
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA 02131-1097, USA
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Bennell KL, Bowles KA, Payne C, Cicuttini F, Williamson E, Forbes A, Hanna F, Davies-Tuck M, Harris A, Hinman RS. Lateral wedge insoles for medial knee osteoarthritis: 12 month randomised controlled trial. BMJ 2011; 342:d2912. [PMID: 21593096 PMCID: PMC3100910 DOI: 10.1136/bmj.d2912] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the effect of lateral wedge insoles compared with flat control insoles on improving symptoms and slowing structural disease progression in medial knee osteoarthritis. DESIGN Randomised controlled trial. SETTING Community in Melbourne, Australia. PARTICIPANTS 200 people aged 50 or more with clinical and radiographic diagnosis of mild to moderately severe medial knee osteoarthritis. INTERVENTIONS Full length 5 degree lateral wedged insoles or flat control insoles worn inside the shoes daily for 12 months. MAIN OUTCOME MEASURES Primary symptomatic outcome was change in overall knee pain (past week) measured on an 11 point numerical rating scale. Primary structural outcome was change in volume of medial tibial cartilage from magnetic resonance imaging scans. Secondary clinical outcomes included changes in measures of pain, function, stiffness, and health related quality of life. Secondary structural outcomes included progression of medial cartilage defects and bone marrow lesions. RESULTS Between group differences did not differ significantly for the primary outcomes of change in overall pain (-0.3 points, 95% confidence intervals -1.0 to 0.3) and change in medial tibial cartilage volume (-0.4 mm(3), 95% confidence interval -15.4 to 14.6), and confidence intervals did not include minimal clinically important differences. None of the changes in secondary outcomes showed differences between groups. CONCLUSION Lateral wedge insoles worn for 12 months provided no symptomatic or structural benefits compared with flat control insoles. Trial registration Australian New Zealand Clinical Trials Registry ACTR12605000503628 and ClinicalTrials.gov NCT00415259.
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Parkville, 3010 VIC, Australia.
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Hinman RS, Bowles KA, Bennell KL. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear? BMC Musculoskelet Disord 2009; 10:146. [PMID: 19939281 PMCID: PMC2791095 DOI: 10.1186/1471-2474-10-146] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 11/25/2009] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to determine whether the effect of laterally wedged insoles on the adduction moment in knee osteoarthritis (OA) declined after one month of wear, and whether higher reported use of insoles was associated with a reduced effect on the adduction moment at one month. Methods Twenty people with medial compartment OA underwent gait analysis in their own shoes wearing i) no insoles and; ii) insoles wedged laterally 5° in random order. Testing occurred at baseline and after one month of use of the insoles. Participants recorded daily use of insoles in a log-book. Outcomes were the first and second peak external knee adduction moment and the adduction angular impulse, compared across conditions and time with repeated measures general linear models. Correlations were obtained between total insole use and change in gait parameters with used insoles at one month, and change scores were compared between high and low users of insoles using general linear models. Results There was a significant main effect for condition, whereby insoles significantly reduced the adduction moment (all p < 0.001). However there was no significant main effect for time, nor was an interaction effect evident. No significant associations were observed between total insole use and change in gait parameters with used insoles at one month, nor was there a difference in effectiveness of insoles between high and low users of the insoles at this time. Conclusion Effects of laterally wedged insoles on the adduction moment do not appear to decline after one month of continuous use, suggesting that significant wedge degradation does not occur over the short-term.
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Affiliation(s)
- Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, The University of Melbourne, Victoria, Australia.
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