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Holden MA, Murphy M, Simkins J, Thomas MJ, Huckfield L, Quicke JG, Halliday N, Birrell FN, Borrelli B, Callaghan MJ, Dziedzic K, Felson D, Foster NE, Ingram C, Jinks C, Jowett S, Nicholls E, Peat G. KNEE BRACES FOR KNEE OSTEOARTHRITIS: A SCOPING REVIEW AND NARRARIVE SYNTHESIS OF INTERVENTIONS IN RANDOMISED CONTROLLED TRIALS. Osteoarthritis Cartilage 2024:S1063-4584(24)01365-7. [PMID: 39218202 DOI: 10.1016/j.joca.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To identify and synthesise the content of knee bracing interventions in randomised controlled trials (RCTs) of knee osteoarthritis (OA). DESIGN In this scoping review, three electronic databases (PubMed, Web of Science, Cochrane) were searched up to 10th June 2024. Nineteen previous systematic reviews of knee bracing for knee OA and four recent international clinical practice guidelines were also hand searched. Identified studies were screened for eligibility by two independent reviewers. Information on bracing interventions was extracted from included RCT reports, informed by Template for Intervention Description and Replication (TIDieR) guidelines. Data were synthesised narratively. RESULTS Thirty-one RCTs testing 47 different bracing interventions were included. Braces were broadly grouped as valgus/varus, patellofemoral, sleeve, neutral hinged, or control/placebo knee braces. Brace manufacturer and models varied, as did amount of recommended brace use. Only three interventions specifically targeted brace adherence. Information on brace providers, setting, number of treatment sessions, and intervention modification over time was poorly reported. Adherence to brace use was described for 32 (68%) interventions, most commonly via self-report. Several mechanisms of action for knee braces were proposed, broadly grouped as biomechanical, neuromuscular, and psychological. CONCLUSIONS Many different knee brace interventions have been tested for knee OA, with several proposed mechanisms of action, a lack of focus on adherence, and a lack of full reporting. These issues may be contributing to the heterogeneous findings and inconsistent guideline recommendations about the clinical effectiveness of knee bracing for knee OA to date.
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Affiliation(s)
- M A Holden
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Musculoskeletal Research, Keele University, Keele, Staffordshire, UK.
| | - M Murphy
- The Robert Jones Agnes Hunt Orthopaedic NHS Foundation Trust, Oswestry, Shropshire, UK.
| | - J Simkins
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Musculoskeletal Research, Keele University, Keele, Staffordshire, UK.
| | - M J Thomas
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Musculoskeletal Research, Keele University, Keele, Staffordshire, UK; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, UK.
| | - L Huckfield
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, UK.
| | - J G Quicke
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Brisbane, Queensland, Australia; School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK.
| | - N Halliday
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK.
| | - F N Birrell
- MRC-Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing, Newcastle University, UK.
| | - B Borrelli
- Henry M Goldman School of Dental Medicine, Boston University, Boston, Massachusetts, USA; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - M J Callaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Faculty of Health and Education, Manchester Metropolitan University Manchester, UK; Manchester University Hospitals NHS Foundation Trust, Manchester UK.
| | - K Dziedzic
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Musculoskeletal Research, Keele University, Keele, Staffordshire, UK.
| | - D Felson
- Research in OsteoArthritis Manchester (ROAM), Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester, UK; Boston University School of Medicine, Boston, Massachusetts, USA.
| | - N E Foster
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Brisbane, Queensland, Australia.
| | - C Ingram
- Research User Group, Keele University, Keele, Staffordshire, UK
| | - C Jinks
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Musculoskeletal Research, Keele University, Keele, Staffordshire, UK.
| | - S Jowett
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - E Nicholls
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Musculoskeletal Research, Keele University, Keele, Staffordshire, UK; Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK.
| | - G Peat
- School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK; Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, UK.
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Effectiveness of gait retraining interventions in individuals with hip or knee osteoarthritis: A systematic review and meta-analysis. Gait Posture 2022; 95:164-175. [PMID: 35500366 DOI: 10.1016/j.gaitpost.2022.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/31/2022] [Accepted: 04/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis is a chronic synovial joint disease leading to pain, stiffness, and gait dysfunction, resulting in a significant health and economic burden. Gait retraining strategies and tools are used to address biomechanical gait dysfunction and symptoms in individuals with osteoarthritis. However, there is limited evidence relating to their effectiveness. QUESTION Do gait retraining strategies and tools improve gait biomechanics and symptoms in individuals with hip or knee osteoarthritis compared to control or alternate intervention? METHODS Seven databases were searched using key words relating to osteoarthritis, gait retraining, and biomechanics. A best evidence synthesis was conducted on included studies. Where available, a meta-analysis was performed, and the standardised mean difference (SMD) and 95% confidence internals (CI) were reported. RESULTS Eighteen studies were included. One study investigated gait retraining in participants with hip osteoarthritis and demonstrated limited evidence for improving gait biomechanics. Seventeen studies on knee osteoarthritis were included in the best evidence synthesis with six included in the meta-analysis. Gait retraining strategies which incorporated a real-time biofeedback tool, appear to have strong evidence for effectively modifying walking biomechanics. Moderate evidence was identified to support kinesiology taping improving pain scores. The meta-analysis pooled effect demonstrated significant improvements for knee adduction moment [SMD, -1.10; 95% CI. -1.85, -0.35] and the Western Ontario and McMaster Osteoarthritis Index in favour of gait retraining than a control intervention [SMD, -0.86; 95% CI. -1.33, -0.39]. All other interventions demonstrated evidence that was conflicting, limited, or not in favour of gait retraining. CONCLUSION Gait retraining may be beneficial for improving biomechanics and symptoms in knee osteoarthritis, however due to the high heterogeneity and limited studies in the analysis, further research is required. Further high quality randomised controlled trials for knee and especially hip osteoarthritis investigating the effects of gait retraining on biomechanics and symptoms are required.
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Huang XM, Yuan FZ, Chen YR, Huang Y, Yang ZX, Lin L, Yu JK. Physical therapy and orthopaedic equipment-induced reduction in the biomechanical risk factors related to knee osteoarthritis: a systematic review and Bayesian network meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e051608. [PMID: 35140149 PMCID: PMC8830256 DOI: 10.1136/bmjopen-2021-051608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 01/14/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Are physical therapy or orthopaedic equipment efficacious in reducing the biomechanical risk factors in people with tibiofemoral osteoarthritis (OA)? Is there a better therapeutic intervention than others to improve these outcomes? DESIGN Systematic review with network meta-analysis (NMA) of randomised trials. DATA SOURCES PubMed, Web of Science, Cochrane Library, Embase and MEDLINE were searched through January 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trials exploring the benefits of using physical therapy or orthopaedic equipment in reducing the biomechanical risk factors which included knee adduction moment (KAM) and knee adduction angular impulse (KAAI) in individuals with tibiofemoral OA. DATA EXTRACTION AND SYNTHESIS Two authors extracted data independently and assessed risk of bias. We conducted an NMA to compare multiple interventions, including both direct and indirect evidences. Heterogeneity was assessed (sensitivity analysis) and quantified (I2 statistic). Grading of Recommendations Assessment, Development and Evaluation assessed the certainty of the evidence. RESULTS Eighteen randomised controlled trials, including 944 participants, met the inclusion criteria, of which 14 trials could be included in the NMA. Based on the collective probability of being the overall best therapy for reducing the first peak KAM, lateral wedge insoles (LWI) plus knee brace was closely followed by gait retraining, and knee brace only. Although no significant difference was observed among the eight interventions, variable-stiffness shoes and neuromuscular exercise exhibited an increase in the first peak KAM compared with the control condition group. And based on the collective probability of being the overall best therapy for reducing KAAI, gait retraining was followed by LWI only, and lower limb exercise. CONCLUSION The results of our study support the use of LWI plus knee brace for reducing the first peak KAM. Gait retraining did not rank highest but it influenced both KAM and KAAI and therefore it was the most recommended therapy for reducing the biomechanical risk factors.
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Affiliation(s)
- Xi-Meng Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Fu-Zhen Yuan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - You-Rong Chen
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ying Huang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Xi Yang
- Department of Orthopedic, Peking University Third Hospital, Beijing, China
| | - Lin Lin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jia-Kuo Yu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
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Pereira LC, Runhaar J, Favre J, Jolles BM, Bierma-Zeinstra S. Association between changes in the knee adduction moment and changes in knee pain and function in response to non-surgical biomechanical interventions for medial knee osteoarthritis: a systematic review. Eur J Phys Rehabil Med 2021; 57:948-958. [PMID: 34468109 DOI: 10.23736/s1973-9087.21.06828-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is lack of understanding of the relationship between knee adduction moment (KAM) reductions and improvements in pain or function in patients with knee osteoarthritis (KOA). Moreover, there is no systematic review describing the longitudinal relationship between KAM changes and subsequent changes in pain and/or physical function. We aimed (1) to investigate the relationship between changes in KAM induced by non-surgical biomechanical interventions and consecutive changes in pain and/or physical function in patients with medial KOA and (2) to compare this relationship for different interventions. We considered eligible all RCTs using biomechanical interventions aimed to reduce KAM in KOA patients, that measured pain/function. We used Cohen's d effect size to quantify outcome measurements. 14 papers reporting 11 studies were identified. Braces were tested in 6 studies, insoles in 5 studies, shoes in 3 studies and gait retraining in 2 studies. Methodological differences were large among studies. Large effect sizes (≥0.8) changes in pain/function were observed with interventions having at least a small KAM effect size (≥0.2), suggesting an association between KAM and pain/function changes. A linear trend was observed between inter-intervention KAM and VAS pain effect sizes, based on 4 studies. No firm conclusions could be drawn for the different intervention types. There was a trend toward larger KAM reductions leading to larger improvements in pain/function in non-surgical biomechanical interventions. Additional high-quality RCT with consistent methodology are needed to fully characterize the association between KAM and pain/function changes.
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Affiliation(s)
- Luis C Pereira
- Departement of Musculoskeletal Medicine (DAL), Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland -
| | - Jos Runhaar
- Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julien Favre
- Departement of Musculoskeletal Medicine (DAL), Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland
| | - Brigitte M Jolles
- Departement of Musculoskeletal Medicine (DAL), Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Switzerland.,Institute of Microengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Falahatgar M, Jalali M, Babaee T, Safaeepour Z, Torkaman A, Baniasad M. Comparing Two Orthoses for Managing Medial Knee Osteoarthritis: Lateral Wedge with Subtalar Strap While Barefoot Versus Lateral Wedged Insole Fitted Within Sandal. Indian J Orthop 2021; 56:319-326. [PMID: 35140864 PMCID: PMC8789969 DOI: 10.1007/s43465-021-00477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 08/02/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Using foot orthoses for managing medial knee osteoarthritis (MKOA) is common, although its effectiveness is in debate. Most orthoses are placed inside the shoe as a lateral wedged insole. Thus, most studies in this area have focused on the effect of insoles used with shoes. This study compared the effects of a lateral wedge with subtalar strap (combined insole) used while barefoot and lateral wedged insole fitted within sandal on pain, function and external knee adduction moment (EKAM) in patients with MKOA to consider which orthotic treatment is better. METHODS In this quasi-experimental pretest-posttest study, 29 participants with medial knee osteoarthritis were divided into two groups: (1) combined insole (n = 15) and (2) sandal (n = 14) groups. We recorded their gait while walking with and without orthoses using a motion analysis system. We evaluated their pain and performance with visual analog scale, Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire, 30 s chair stand, and Timed Up and Go functional tests. The pain and performance evaluations were repeated after one month. RESULTS The pain immediately decreased after walking with both orthoses (p < 0.001). There was no significant difference in EKAM results between the two orthoses. Pain and performance improved in both groups after a one month using the orthoses (p < 0.01). CONCLUSION Both types of orthoses have similar effect and lead to better performance and less pain after 1 month.
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Affiliation(s)
- Maryam Falahatgar
- grid.411746.10000 0004 4911 7066Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran Ave., Shahnazari St., Mirdamad Blvd., Tehran, Iran
| | - Maryam Jalali
- grid.411746.10000 0004 4911 7066Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran Ave., Shahnazari St., Mirdamad Blvd., Tehran, Iran ,grid.411746.10000 0004 4911 7066Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran Ave., Shahnazari St., Mirdamad Blvd., Tehran, Iran
| | - Taher Babaee
- grid.411746.10000 0004 4911 7066Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran Ave., Shahnazari St., Mirdamad Blvd., Tehran, Iran ,grid.411746.10000 0004 4911 7066Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran Ave., Shahnazari St., Mirdamad Blvd., Tehran, Iran
| | - Zahra Safaeepour
- grid.267167.30000 0000 8555 8003Department of Human Performance and Health, University of South Carolina Upstate, Spartanburg, SC USA
| | - Ali Torkaman
- grid.411746.10000 0004 4911 7066Department of Knee Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Baniasad
- grid.412553.40000 0001 0740 9747Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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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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