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Hung YJ, Couverette F, Hamon J, Willard D. Acute and Acclimated Effects of Wearing Compression Garments on Balance Control in Community-Dwelling Older Adults. Motor Control 2024; 28:326-340. [PMID: 38580304 DOI: 10.1123/mc.2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/07/2024]
Abstract
Falls are very serious health concerns among older adults. Providing additional cutaneous and proprioceptive feedback to older adults may enhance their balance control and therefore reduce the incidents of falls. This study aimed to investigate the acute and acclimated effect of wearing waist-to-above-ankle compression garments (CGs) on balance control in community-dwelling older adults. Thirty-one older adults participated in the study. The Timed Up and Go, Berg Balance Scale, and the Fall Risk Test of the Biodex Balance System were used in a random order to examine balance control in three testing sessions 1 week apart. Results indicated wearing CGs had a significant impact on the Timed Up and Go test (p < .001), Berg Balance Scale (p = .001), and the Fall Risk Test (p = .001). For the Timed Up and Go test, participants exhibited significant improvement in both the acute (8.68 vs. 7.91 s) and acclimated effect (7.91 vs. 7.41 s) of wearing CGs. For the Berg Balance Scale, participants showed significant improvement after wearing CGs for 1 week in comparison to the no CGs condition (55.77 vs. 55.39 points). For the Fall Risk Test, participants showed a significant improvement in the acute effect of wearing CGs in comparison to the no CGs condition (1.55° vs. 1.31°). This exploratory study showed that wearing waist-to-above-ankle CGs provided a positive impact on balance control in healthy community-dwelling older adults. It lays the foundation for future studies with a larger sample size to investigate the potential benefits of wearing CGs in individuals with balance control deficits and/or other comorbidities.
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Affiliation(s)
- You-Jou Hung
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | | | - Jeffrey Hamon
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Dustyn Willard
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
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2
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Dzidotor GK, Moorhead JB, Ude CC, Ogueri KS, Ghosh D, Laurencin CT. Functions and Effectiveness of Unloader, Patellofemoral, and Knee Sleeve Orthoses: A Review. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2024; 10:147-171. [PMID: 38983777 PMCID: PMC11233114 DOI: 10.1007/s40883-023-00313-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2024]
Abstract
Background Knee orthoses have been extensively used as a nonsurgical approach to improving knee deficiencies. Currently, arthritic knee conditions remain the leading cause of disability, and this number is expected to increase. As the use of knee orthoses varies widely, so has their effectiveness which is still largely debatable. Here, we present the functions and effectiveness of the three most prominent knee orthotic models dedicated to supporting knee osteoarthritis-unloader, patellofemoral, and knee sleeves. Purpose/Research Question Considering the depth and diversity of the many clinical studies and documented laboratory reports published to date, this literature review was created to educate the clinician, patient, and researcher on common knee orthoses used for the management of arthritic knee conditions. In doing so, we discuss their design, biomechanical effects, and clinical efficacy, as well as broader outcomes, limitations, and recommendations for use. Results/Synthesis The knee orthoses discussed within the scope of this paper are dedicated to protecting the knee against strenuous compressive loads that may affect the patellofemoral and tibiofemoral joints of the knee. Since the knee has multiple axes of motion and articulating surfaces that experience different loads during functional activities, it can be implied that, to a large extent, knee brace designs can differ drastically. Unloader knee orthoses are designed to decrease tibiofemoral and patellofemoral joint pressures. Patellofemoral knee orthoses are designed to decrease strain on the patellofemoral and quadriceps tendons while stabilizing the patella. Knee sleeves are designed to stabilize movements, reduce pain in joints, and improve proprioception across the knee joint. Conclusion Although patients often report benefits from wearing braces, these benefits have not been confirmed by clinicians and scientific investigators. Results from these three orthosis types show that clinical efficacy is still elusive due to the different methodologies used by researchers. Layman Summary Knee orthoses also referred to as knee brace are commonly used for support and stability of the knee. Unloader knee braces are designed to relieve and support those suffering from knee osteoarthritis by improving physical impairment and reducing pain. Patellofemoral knee braces aim to help patients manage patellofemoral pain syndrome. Rehabilitative compression sleeves, also known as knee sleeves, are often used to assist patients suffering from knee pain and laxity. Important findings on the three knee braces discussed show discrepancies in results. Their effectiveness and validity are yet to be understood.
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Affiliation(s)
- Godwin K. Dzidotor
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
| | - Jeffrey B. Moorhead
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Chinedu C. Ude
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
| | - Kenneth S. Ogueri
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Institute of Materials Science, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Materials Science and Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
| | - Debolina Ghosh
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
| | - Cato T. Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut Health, Farmington, CT, USA
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, CT, USA
- Institute of Materials Science, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Materials Science and Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Biomedical Engineering, University of Connecticut, Mansfield Rd, Storrs, CT, USA
- Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA
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Sacco ICN, Trombini-Souza F, Suda EY. Impact of biomechanics on therapeutic interventions and rehabilitation for major chronic musculoskeletal conditions: A 50-year perspective. J Biomech 2023; 154:111604. [PMID: 37159980 DOI: 10.1016/j.jbiomech.2023.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
The pivotal role of biomechanics in the past 50 years in consolidating the basic knowledge that underpins prevention and rehabilitation measures has made this area a great spotlight for health practitioners. In clinical practice, biomechanics analysis of spatiotemporal, kinematic, kinetic, and electromyographic data in various chronic conditions serves to directly enhance deeper understanding of locomotion and the consequences of musculoskeletal dysfunctions in terms of motion and motor control. It also serves to propose straightforward and tailored interventions. The importance of this approach is supported by myriad biomechanical outcomes in clinical trials and by the development of new interventions clearly grounded on biomechanical principles. Over the past five decades, therapeutic interventions have been transformed from fundamentally passive in essence, such as orthoses and footwear, to emphasizing active prevention, including exercise approaches, such as bottom-up and top-down strengthening programs for runners and people with osteoarthritis. These approaches may be far more effective inreducing pain, dysfunction, and, ideally, incidence if they are based on the biomechanical status of the affected person. In this review, we demonstrate evidence of the impact of biomechanics and motion analysis as a foundation for physical therapy/rehabilitation and preventive strategies for three chronic conditions of high worldwide prevalence: diabetes and peripheral neuropathy, knee osteoarthritis, and running-related injuries. We conclude with a summary of recommendations for future studies needed to address current research gaps.
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Affiliation(s)
- Isabel C N Sacco
- Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Francis Trombini-Souza
- Department of Physical Therapy, University of Pernambuco, Petrolina, Pernambuco, Brazil; Master's and Doctoral Programs in Rehabilitation and Functional Performance, University of Pernambuco, Petrolina, Pernambuco, Brazil
| | - Eneida Yuri Suda
- Postgraduate Program in Physiotherapy, Universidade Ibirapuera, São Paulo, Brazil
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Wu H, Yao R, Wu J, Wen G, Wang Y. Does kinesio taping plus exercise improve pain and function in patients with knee osteoarthritis?: A systematic review and meta-analysis of randomized controlled trials. Front Physiol 2022; 13:961264. [PMID: 36160871 PMCID: PMC9500481 DOI: 10.3389/fphys.2022.961264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Kinesio taping (KT) and exercise are described for improving pain and function of knee osteoarthritis (KOA) patients in most studies. However, the question remains if KT plus exercise is better than only exercise treatment.Objective: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effects of KT plus exercise in improving pain and knee function of KOA patients.Methods: The databases PubMed, Cochrane Library, EMBASE, Springer, web of science and China National Knowledge Internet (CNKI) were searched till July 2022. People diagnosed with KOA were included. The intervention was KT plus exercise, but the comparison group was intervened only with exercise. Outcome measures were the Visual Analogue Scale (VAS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Timed Up and Go (TUG). Only RCTs were included. The Review Manager software (Version 5.3.5) was used to assess risk of bias, statistical heterogeneity and meta-analysis.Results: The inclusion criteria were satisfied by 642 individuals from sixteen RCTs. There was a significant difference between KT plus exercise group and only exercise group in terms of VAS score after intervention (mean difference (MD) = −0.86; 95% CI = −1.32 to −0.40; p = 0.0003). In terms of VAS at follow-up period (MD = −0.58; 95% CI = −1.41 to 0.25; p = 0.17), WOMAC score (MD = 0.28; 95% CI = −9.16 to 9.71; p = 0.95) and TUG after intervention (MD = −0.74; 95% CI = −1.72 to 0.24; p = 0.14), no significant difference was found.Conclusion: Although KT plus exercise reduced pain better than exercise, it did not enhance knee function in patients with KOA. These conclusions may change when more high-quality research is conducted.
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Affiliation(s)
- Haiyang Wu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruoyu Yao
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Junhao Wu
- Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guowei Wen
- Huangpu Branch, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiru Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yiru Wang,
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Steingrebe H, Stetter BJ, Sell S, Stein T. Effects of Hip Bracing on Gait Biomechanics, Pain and Function in Subjects With Mild to Moderate Hip Osteoarthritis. Front Bioeng Biotechnol 2022; 10:888775. [PMID: 35898647 PMCID: PMC9309805 DOI: 10.3389/fbioe.2022.888775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Hip Osteoarthritis (HOA) is a common joint disease with serious impact on the quality of life of the affected persons. Additionally, persons with HOA often show alterations in gait biomechanics. Developing effective conservative treatment strategies is of paramount importance, as joint replacement is only indicated for end-stage HOA. In contrast to knee osteoarthritis, little is known about the effectiveness of hip bracing for the management of HOA. Studies analysing mechanically unloading hip braces partly showed beneficial results. However, methodological limitations of these studies, such as small sample sizes or lack of control groups, limit the applicability of the results. Additionally, mechanically unloading braces might impose restrictions on motion and comfort and thus, might not be suitable for people with only mild or moderate symptoms. The aim of this study was to comprehensively quantify the effects of unilateral HOA as well as functional hip bracing on gait biomechanics, pain, proprioception and functional capacity in people with mild to moderate HOA. Hip and pelvis biomechanics during walking were analysed in 21 subjects with mild to moderate HOA under three bracing conditions: unbraced, immediately after brace application and after 1 week of brace usage. Additionally, pain, hip proprioception and functional capacity were assessed. A matched group of 21 healthy subjects was included as reference. Kinematic and kinetic data were collected using a 16-camera infrared motion capturing system and two force plates. Visual analogue scales, an angle reproduction test and a 6-min walking test were applied to measure pain, hip proprioception and functional capacity, respectively. Subjects with HOA walked slower, with reduced step length, sagittal hip range of motion and peak extension angle and had a reduced functional capacity. After 1 week of brace application step length, walking speed and functional capacity were significantly increased. Additionally, pain perception was significantly lower in the intervention period. These results encourage the application of functional hip braces in the management of mild to moderate HOA. However, as key parameters of HOA gait such as a reduced peak extension angle remained unchanged, the underlying mechanisms remain partly unclear and have to be considered in the future.
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Affiliation(s)
- Hannah Steingrebe
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- *Correspondence: Hannah Steingrebe,
| | - Bernd J. Stetter
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Stefan Sell
- Sports Orthopedics, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
- Joint Center Black Forest, Hospital Neuenbürg, Neuenbürg, Germany
| | - Thorsten Stein
- BioMotion Center, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
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Efficacy of unloader knee orthosis and lateral wedge insole on static balance in medial knee osteoarthritis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2022. [DOI: 10.1177/22104917221095256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Medial knee osteoarthritis can contribute to pain and stiffness, interfere with balance and limit functional activities of daily living. Unloader knee orthosis or lateral wedged insoles are current conservative approaches used to treat these conditions. The aim of this study was to identify and compare the effects of them on the balance parameters. Methods 66 subjects with mild to moderate medial knee osteoarthritis were randomly assigned to wear unloader knee brace or full-length 6° lateral wedge insole. Primary outcome balance parameters were stability %, path length and average velocity of center of pressure and mobility score which were investigated by HUMAC® Balance and Tilt system. Secondary outcome measures were knee function score using Knee Injury and Osteoarthritis Outcome Score scale. Assessment was performed at baseline and six months post orthotic intervention period. Findings Both orthoses improved all parameters compared to the baseline condition (p < 0.05). Unloader knee orthosis showed a significant improvement in all balance parameters compared to lateral wedged insoles (p < 0.001) except mobility scores (p = 0.527). Except activities of daily living (p = 0.752) and sports and recreational activities (p = 0.437), unloader knee orthosis had a greater effect on the pain (p = 0.002) and symptoms (p < 0.001) sub scales than lateral wedged insoles. However, quality of life sub-scale scores for insoles were more effective than the knee orthosis. Interpretation Unloader knee orthosis improved balance and knee function scores more than lateral wedged insole, though both orthoses produced significantly improved results compared to baseline assessment.
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Rucinski K, Williams J, Crecelius CR, Redington L, Guess TM, Cook JL. Are All Unloader Braces Created Equal? Recommendations for Evidence-Based Implementation of Unloader Braces for Patients with Unicompartmental Knee OA. J Knee Surg 2022; 35:249-254. [PMID: 34952554 DOI: 10.1055/s-0041-1740931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Unicompartmental knee osteoarthritis (UKOA) is a complex issue that is estimated to affect roughly 28% of patients with knee OA, and can result in severe cartilage degeneration, meniscus deficiency, and concomitant varus or valgus malalignment. This malalignment results in abnormally high joint reaction forces in the affected compartment, which can elicit pain, cause dysfunction, and exacerbate joint degradation. For more than two decades, the use of knee unloader braces has been advocated as a cost-effective option for symptomatic management of UKOA.During bipedal ambulation with a normal lower extremity mechanical axis, ground reaction forces create a knee adduction moment (KAM) such that the medial compartment of the knee experiences approximately 60% of joint loading and the lateral compartment experiences approximately 40% of joint loading. UKOA disrupts the mechanical axis, altering KAM and joint loading and causing pain, dysfunction, and disease progression. In theory, knee unloader braces were designed to mitigate the symptoms of UKOA by normalizing KAM via shifts in the lever arms about the knee. However, studies vary, and suggest that push-mechanism knee unloaders do not consistently provide significant biomechanical benefits for medial or lateral UKOA. Current evidence suggests that pull-mechanism unloaders may be more effective, though contrasting data have also been reported, such that further validation is necessary. The purpose of our study was to synthesize current best evidence for use of knee unloader braces for management of UKOA to suggest evidence-based best practices as well as gaps in knowledge to target for future studies. Unloader bracing for patients with UKOA appears to be a cost-effective treatment option for patients with medial UKOA who have insurance coverage. Pull-mechanism unloader bracing should be considered in conjunction with other nonoperative management therapies for those who are willing to adhere to consistent brace use for weight-bearing activities.
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Affiliation(s)
- Kylee Rucinski
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
| | - Jonathan Williams
- Thompson Laboratory for Regenerative Orthopedics, University of Missouri System, Columbia, Missouri
| | - Cory R Crecelius
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
| | - Lindsey Redington
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Department of Physical Therapy and Orthopedic Surgery, University of Missouri, Columbia, Missouri
| | - James L Cook
- Department of Orthopedic Surgery, Missouri Orthopedic Institute, University of Missouri, Columbia, Missouri
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Baker HP, Krishnan P, Meghani O, Athiviraham A, Ho S, Owens BD. Protective Sport Bracing for Athletes With Mid-Season Shoulder Instability. Sports Health 2022; 15:105-110. [PMID: 35081842 PMCID: PMC9808839 DOI: 10.1177/19417381211069069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
CONTEXT In-season glenohumeral instability is a common clinical dilemma faced by physicians who care for athletes. Both nonoperative and operative management of athletes with in-season glenohumeral instability have been well described. Functional bracing remains less understood as a treatment modality. This review aims to provide an update on the most recent literature regarding the use of functional bracing for shoulder instability. EVIDENCE ACQUISITION MEDLINE (PubMed and Ovid platforms), Web of Science, Embase, and Cochrane Database of Systemic Reviews were searched for articles available in English through June 1, 2021. The search terms shoulder brace, shoulder instability, athlete, in-season, glenohumeral instability, anterior shoulder instability, posterior shoulder instability, and bracing were used. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Research on the clinical outcomes of functional bracing remains mixed for patients with shoulder instability. Two studies have demonstrated improved return to play with functional bracing, while 1 study demonstrated no difference in return to play between braced athletes and nonbraced athletes with anterior instability. One previous study demonstrated that prophylactic use of bilateral shoulder stabilizing braces significantly decreased time lost due to injury in athletes with posterior instability. Previous biomechanical studies have demonstrated improved proprioception with brace wear as well as successful limitation of active shoulder range of motion. CONCLUSION Bracing in athletes with shoulder instability remains an important nonoperative treatment modality. While clinical benefits are yet to be validated through high-quality studies, preliminary results suggest a potential benefit to recovery, with minimal downsides. Nevertheless, the use of bracing remains an individual choice but is especially recommended in settings of high-risk sports for shoulder instability, such as football.
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Affiliation(s)
- Hayden P. Baker
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois,Hayden Baker, MD,
Department of Orthopaedic Surgery, The University of Chicago, 5758 South
Maryland Avenue, Department 4B, Chicago, IL 60637 (
)
| | - Pranav Krishnan
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois
| | - Ozair Meghani
- Brown University Alpert Medical School,
Providence, Rhode Island
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois
| | - Sherwin Ho
- Department of Orthopaedic Surgery, The
University of Chicago, Chicago, Illinois
| | - Brett D. Owens
- Brown University Alpert Medical School,
Providence, Rhode Island
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Wang Y, Wu Z, Chen Z, Ye X, Chen G, Yang J, Zhang P, Xie F, Guan Y, Wu J, Chen W, Ye Z, Xu X. Proprioceptive Training for Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:699921. [PMID: 34778281 PMCID: PMC8581183 DOI: 10.3389/fmed.2021.699921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/04/2021] [Indexed: 12/04/2022] Open
Abstract
Background: There is increased interest in proprioceptive training for knee osteoarthritis (KOA). However, little consensus supports the effectiveness of this intervention. Objective: This meta-analysis aimed to assess the effects of proprioceptive training on symptoms, function, and proprioception in people with KOA. Methods: The PubMed, Cochrane Library, Web of Science, and EMBASE databases were systematically searched from the inception dates to April 16, 2021 for relevant randomized controlled trials (RCTs). Data were pooled by calculating the standardized mean differences (SMDs) and 95% confidence intervals (CIs). A random-effects model was used for the analyses. Results: A total of 24 RCTs involving 1,275 participants were included in our analysis. This study indicated that compared to no intervention, proprioceptive training significantly improved pain, stiffness, physical function, joint position sense (JPS), muscle strength, mobility, and knee ROM (P < 0.05) in people with KOA. When compared to other non-proprioceptive training, proprioceptive training provided better results in terms of JPS (SMD = −1.28, 95%CI: [−1.64, −0.92], I2 = 0%, P < 0.00001) and mobility (timed walk over spongy surface) (SMD = −0.76, 95%CI: [−1.33, −0.18], I2 = 64%, P = 0.01), and other results are similar. When proprioceptive training plus other non-proprioceptive training compared to other non-proprioceptive training, the two groups showed similar outcomes, but there was a greater improvement for JPS (SMD = −1.54, 95%CI: [−2.74, −0.34], I2 = 79%, P = 0.01), physical function (SMD = −0.34, 95%CI: [−0.56, −0.12], I2 = 0%, P = 0.003), and knee ROM (P < 0.05) in the proprioceptive training plus other non-proprioceptive training group. When proprioceptive training plus conventional physiotherapy compared against conventional physiotherapy, the two groups demonstrated similar outcomes, but there was a significant improvement for JPS (SMD = −0.95, 95%CI: [−1.73, −0.18], I2 = 78%, P = 0.02) in the proprioceptive training plus conventional physiotherapy group. Conclusions: Proprioceptive training is safe and effective in treating KOA. There is some evidence that proprioceptive training combined with general non-proprioceptive training or conventional physiotherapy appears to be more effective and should be considered as part of the rehabilitation program. However, given that the majority of current studies investigated the short-term effect of these proprioceptive training programs, more large-scale and well-designed studies with long-term follow up are needed to determine the long-term effects of these proprioceptive training regimes in KOA. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, PROSPERO, identifier: CRD42021240587.
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Affiliation(s)
- Yi Wang
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zugui Wu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zehua Chen
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangling Ye
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoqian Chen
- Department of Orthopaedic Surgery, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, China
| | - Jiaman Yang
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peiming Zhang
- Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang Xie
- Affiliated Changde Hospital, Hunan University of Traditional Chinese Medicine, Changde, China
| | - Yingxin Guan
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiatao Wu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weijian Chen
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zixuan Ye
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xuemeng Xu
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China.,Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
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10
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Alfatafta H, Onchonga D, Alfatafta M, Zhang L, Boncz I, Lohner S, Molics B. Effect of using knee valgus brace on pain and activity level over different time intervals among patients with medial knee OA: systematic review. BMC Musculoskelet Disord 2021; 22:687. [PMID: 34384421 PMCID: PMC8362244 DOI: 10.1186/s12891-021-04513-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background The Knee valgus brace is one of the accepted conservative interventions for patients with medial compartment knee osteoarthritis to correct the knee varus and increase functional activity level. Nevertheless, comprehensive overview of the effects of using this brace on self-reported pain activity level over time is not available. Thus, this study aimed to systematically review the effect of using this brace on pain and activity levels in the last 20 years in patients with medial compartment knee osteoarthritis. Methods Five databases were searched to find articles from the year 2000 to the end of November 2020: Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, PubMed, Web of Science, and Scopus. Two reviewers independently evaluated the available articles for eligibility and assessed quality. The risk of bias in each study was assessed by two reviewers independently according to the Strengthening the Reporting of Observational Studies in Epidemiology tool (STROBE) for the non-randomized controlled studies and the Cochrane risk-of-bias tool for the randomized controlled studies. Results Seven randomized controlled studies and 17 cohort studies (in total 579 participants) were included in the systematic review. Most of these studies found using a knee valgus brace effective in reducing pain and improving activity level over different time intervals. The majority of the included studies (14 studies) evaluated the impact of the brace for a considerably short-term (less than 6 months). Thus, limited evidence is available on the long-term use of the knee valgus brace and its associated complications. Conclusion The knee valgus brace is an effective conservative intervention to improve the quality of life and reduce pain during daily activities for some patients. However, the long term of using this brace is still not very convenient, and the patients who benefit most from using the brace should be identified with high methodological quality studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04513-0.
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Affiliation(s)
- Huda Alfatafta
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty utca 4, 7621, Pécs, Hungary.
| | - David Onchonga
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty utca 4, 7621, Pécs, Hungary
| | | | - Lu Zhang
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty utca 4, 7621, Pécs, Hungary
| | - Imre Boncz
- Faculty of Health Sciences, Institute for Health Insurance, University of Pecs, Pécs, Hungary
| | - Szimonetta Lohner
- Clinical Center, Medical School, Cochrane Hungary, University of Pécs, Pécs, Hungary
| | - Bálint Molics
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
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11
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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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12
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Zhai S, Huang B, Yu K. The efficacy and safety of Botulinum Toxin Type A in painful knee osteoarthritis: a systematic review and meta-analysis. J Int Med Res 2019; 48:300060519895868. [PMID: 31884849 PMCID: PMC7783274 DOI: 10.1177/0300060519895868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective A systematic review and meta-analysis was carried out to evaluate the
efficacy and safety of Botulinum Toxin Type A in painful knee
osteoarthritis. Methods The EMBASE and MEDLINE databases were searched to identify randomized
controlled trials (RCTs) of Botulinum Toxin Type A in the treatment of
painful knee osteoarthritis. The references of included literature were also
searched. Results Five articles involving 5 RCTs including 314 patients were included in this
analysis. There was a significant difference between Botulinum Toxin Type A
and placebo in the visual analog scale (VAS) pain scale and Western Ontario
& McMaster Universities Osteoarthritis Index (WOMAC) questionnaire score
in both the short-term (≤4 weeks) and long-term (≥8 weeks) treatment period.
There were no serious adverse events in the Botulinum Toxin Type A
groups. Conclusions This meta-analysis suggests that Botulinum Toxin Type A is effective and safe
in the painful knee OA treatment. However, high-quality randomized
controlled studies are still needed to further confirm our findings.
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Affiliation(s)
- Shuchao Zhai
- Department of Orthopedics, Tianjin Fifth Central Hospital Tianjin, China
| | - Botao Huang
- Department of Orthopedics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Kai Yu
- Department of Orthopedics, Tianjin Fifth Central Hospital Tianjin, China
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13
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Hsieh LF, Lin YT, Wang CP, Liu YF, Tsai CT. Comparison of the effect of Western-made unloading knee brace with physical therapy in Asian patients with medial compartment knee osteoarthritis-A preliminary report. J Formos Med Assoc 2019; 119:319-326. [PMID: 31204145 DOI: 10.1016/j.jfma.2019.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/29/2019] [Accepted: 05/27/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare the effect of unloading knee brace with physical therapy (PT) in Asian patients with osteoarthritis (OA) of the knee. METHOD This is a non-random, two-group comparative study. Patients with medial compartment knee OA (n = 41) were assigned to either the brace group (n = 20) or PT group (n = 21). Patients in the brace group were fitted with an unloading knee brace for three months and the PT group received a 60-min session of physiotherapy over the affected knee, three times a week, for three months. The primary outcome measures were the pain visual analogue scale (VAS) and the Western Ontario McMaster University Osteoarthritis Index (WOMAC); the second outcome measures were the 36-item Short-Form Health Survey (SF-36) and patient's satisfaction. The patients were evaluated at baseline, and at one month and three months. RESULTS Group comparison showed no significant difference regarding pain VAS, WOMAC, SF-36, and patient's satisfaction, except stiffness in WOMAC (P = .006) and social functioning in SF-36 (P = .007). Time and group interaction revealed significant differences only in general health (P = .007) and mental health (P = .006) of SF-36. Within-group comparison found that pain VAS and WOMAC decreased significantly at one months and three months in both groups. CONCLUSION The effect of brace fitting in patients with knee OA was similar to that of physical therapy. A Western-made unloading knee brace is acceptable in some Asian people with knee OA. CLINICAL TRIAL REGISTRATION NUMBER NCT02712710.
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Affiliation(s)
- 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
| | - Yu-Ting Lin
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chun-Ping Wang
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ya-Fang Liu
- Department of Education and Research, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Tsung Tsai
- Department of Physical Therapy and Rehabilitation, Da Chien General Hospital, Miao Li City, Taiwan.
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14
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Ochi A, Ohko H, Ota S, Shimoichi N, Takemoto T, Mitsuke K. Custom-made hinged knee braces with extension support can improve dynamic balance. J Exerc Sci Fit 2019; 16:94-98. [PMID: 30662501 PMCID: PMC6323182 DOI: 10.1016/j.jesf.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 08/20/2018] [Accepted: 08/29/2018] [Indexed: 12/26/2022] Open
Abstract
Background/Objective: We investigated whether custom-made hinged knee braces can facilitate knee extensor and flexor strength and influence functional performance as compared with other knee braces. Methods We enrolled 28 healthy young participants with no history of physical activity or brace use. The participants executed functional performance tests under the following 5 conditions: 1) without a knee brace, 2) wearing a knee sleeve, 3) wearing a hinged knee brace without assistance, 4) wearing a knee brace with extension support (KBE), and 5) wearing a knee brace with flexion support (KBF). The KBE and KBF were custom-made hinged knee braces equipped with rubber tubes. The functional performance tests performed assessed maximal isokinetic strength, single-leg jumping height/distance, anterior and posterior reach distance on a single leg, and dynamic balance ability. Results The benefit of the custom-made hinged knee brace was observed only during the anterior reach distance on a single leg. The KBE allowed a significantly greater single-leg anterior reach distance when compared to that in the no brace condition. There was a significant relationship between the improvement in the single leg anterior reach distance with KBE and the changes in isokinetic knee extension with KBE compared to the no brace condition. With regard to other parameters, there were no differences compared with the use of other knee braces and thus no apparent benefit. Conclusion Our findings suggest that using a KBE enhances performance during dynamic balance activity in individuals who benefit from improved knee extension strength.
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Affiliation(s)
- Akira Ochi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Hiroshi Ohko
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Susumu Ota
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Nami Shimoichi
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Tsukasa Takemoto
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
| | - Kaho Mitsuke
- Division of Physical Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Toukai-City, Aichi, 476-8588, Japan
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15
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Thoumie P, Marty M, Avouac B, Pallez A, Vaumousse A, Pipet LPT, Monroche A, Graveleau N, Bonnin A, Amor CB, Coudeyre E. Effect of unloading brace treatment on pain and function in patients with symptomatic knee osteoarthritis: the ROTOR randomized clinical trial. Sci Rep 2018; 8:10519. [PMID: 30002395 PMCID: PMC6043544 DOI: 10.1038/s41598-018-28782-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/21/2018] [Indexed: 11/09/2022] Open
Abstract
Evidence is still inconclusive for the benefits of bracing in patients with knee osteoarthritis. To assess the effect of REBEL RELIEVER unloading knee brace in conservative treatment of knee osteoarthritis, a randomized controlled trial was conducted in 67 patients with symptomatic medial knee osteoarthritis, who randomly received 6-week treatment with either REBEL RELIVER unloading knee brace + usual care (Brace group, N = 32) or usual care alone (Control group, N = 35). Primary outcome was the global last 24h-pain relief (100-mm visual analogic scale [VAS]) at 6 weeks. Secondary endpoints included pain on motion (100-mm VAS), function (Lequesne index), safety and observance. At 6 weeks, mean [SD] last 24h-pain decreased significantly more in Brace group versus Control group (-41.35 [3.37] vs -15.37 [3.23], difference -25.98, 95% CI -41.64 to -10.33, P < 0.0001). Higher mean [SD] pain on motion decrease (-51.91 [3.49] vs -19.91 [3.34], difference -32.01, 95% CI -48.21 to -15.80, P < 0.0001) and better improvement of Lequesne index score (-5.8 [0.5] vs -2.3 [0.5], difference -3.5, 95% CI -5.0 to -2.0, P < 0.0001) were observed in Brace group. Safety and observance to the brace were excellent. The additive clinical benefit of wearing REBEL RELIEVER unloading knee brace was demonstrated in knee osteoarthritis patients.
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Affiliation(s)
- Philippe Thoumie
- APHP Hôpital Rothschild and Sorbonne University Agathe INSERM U-1150, Service de Médecine Physique et Réadaptation, Paris, 75012, France.
| | - Marc Marty
- Nukléus, Paris, 75013, France.,Hôpital Henri Mondor, Service de Rhumatologie, Créteil, 94000, France
| | - Bernard Avouac
- Hôpital Henri Mondor, Service de Rhumatologie, Créteil, 94000, France
| | | | | | | | | | | | - Armand Bonnin
- CHU Clermont-Ferrand, Service de Médecine Physique et de Réadaptation, Université Clermont Auvergne, INRA UNH UMR 1019, Clermont-Ferrand, 63003, France
| | | | - Emmanuel Coudeyre
- CHU Clermont-Ferrand, Service de Médecine Physique et de Réadaptation, Université Clermont Auvergne, INRA UNH UMR 1019, Clermont-Ferrand, 63003, France
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16
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Abstract
BACKGROUND The deterioration in the somatosensory and motor systems observed with increasing age can cause balance problems. Studies have shown that the use of infrapatellar bandages can enhance proprioception and improve postural balance. AIMS To evaluate the effect of an infrapatellar bandage on static balance and mobility in elderly female fallers and non-fallers. METHODS Forty older women (20 fallers and 20 non-fallers) were evaluated. Mobility (Timed Up and Go test) and balance (force platform) were measured in the presence and absence of additional sensory information (elastic infrapatellar bandage). RESULTS Mobility differed in fallers (p = 0.0001), but not in non-fallers (p = 0.27), when the patellar bandage was applied. Additional sensory information did not improve static balance in either group (p > 0.05), but a trend towards improvement was observed in fallers. CONCLUSION Additional sensory input from an infrapatellar bandage improves mobility but not bipedal stance in elderly fallers.
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17
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de Vries AJ, van den Akker-Scheek I, Haak SL, Diercks RL, van der Worp H, Zwerver J. Effect of a patellar strap on the joint position sense of the symptomatic knee in athletes with patellar tendinopathy. J Sci Med Sport 2017; 20:986-991. [PMID: 28549903 DOI: 10.1016/j.jsams.2017.04.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/10/2017] [Accepted: 04/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The primary aim of this study was to investigate the effect of a patellar strap on the proprioception of the symptomatic leg in PT. Secondary aims were to investigate a possible difference in effectiveness between athletes with high and low proprioceptive acuity, and whether predictors of effectiveness could be found. DESIGN Randomised cross-over pilot study. METHODS 24 athletes with PT (age 27.3±9.0, VISA-P 50.6±11.2) performed a joint position sense test with and without a patellar strap. The difference between both conditions was analysed using linear mixed-model analysis. RESULTS No improvement in the joint position sense using the strap for the whole group was found, while those classified as having low proprioceptive acuity did improve using the strap (p=0.015, 17.2%). A larger knee girth, longer duration of symptoms and more tendon abnormalities were negatively associated with the strap's effectiveness. CONCLUSIONS The use of a patellar strap improves the knee joint proprioception - measured with joint position sense - of the symptomatic leg in athletes with poor proprioceptive acuity. Especially athletes with relatively small knee girth, short duration of symptoms and small tendon abnormalities might benefit from the strap. As proprioception plays an important role in motor control, and deficits in proprioception may put an athlete at risk for (re-)injury, these findings may be relevant for prevention as well as rehabilitation purposes in those PT athletes with low proprioceptive acuity.
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Affiliation(s)
- Astrid J de Vries
- University of Groningen, University Medical Center Groningen, Center for Sports Medicine, The Netherlands.
| | - Inge van den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Center for Sports Medicine, The Netherlands
| | - Svenja L Haak
- University of Groningen, University Medical Center Groningen, Center for Sports Medicine, The Netherlands
| | - Ron L Diercks
- University of Groningen, University Medical Center Groningen, Center for Sports Medicine, The Netherlands
| | - Henk van der Worp
- University of Groningen, University Medical Center Groningen, Center for Sports Medicine, The Netherlands
| | - Johannes Zwerver
- University of Groningen, University Medical Center Groningen, Center for Sports Medicine, The Netherlands
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Ojoawo AO, Olaogun MOB, Hassan MA. Comparative effects of proprioceptive and isometric exercises on pain intensity and difficulty in patients with knee osteoarthritis: A randomised control study. Technol Health Care 2017; 24:853-863. [PMID: 27434280 DOI: 10.3233/thc-161234] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The study compared the effects of isometric quadriceps exercise and proprioceptive exercise on pain, joint stiffness and physical difficulties of patients with knee osteoarthritis. SUBJECTS Forty-five patients with history of knee osteoarthritis were randomly allocated into two groups; A with 23 subjects and B with 22 subjects. METHODS All subjects received infrared radiation for 20 minutes and kneading massage with methyl salicylate ointment. Group A underwent proprioceptive exercises while Group B had isometric quadriceps exercise. Each exercise session lasted for 10 minutes according to standard protocol, twice in a week for six weeks. Pre-treatment, 3rd week and 6th week pain intensity, joint stiffness and physical difficulties were assessed using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical package for social sciences (SPSS) version 17 was used to analyse the data while descriptive and inferential statistics were used to summarise the result. RESULTS Proprioceptive exercises reduced pain intensity significantly (F = 4.76; p = 0.00) at 6th week with effect size of 2.79, and physical difficulty (F = 3.69; p < 0.04) with effect size of 7.53 better than isometric exercises. There was a significant reduction in the pain intensity (F = 12.08; p < 0.001), and physical difficulties (F = 3.69, p = 0.04) in pre-treatment, 3rd week and 6th week in both Group A and B. CONCLUSION Both exercises are effective but proprioceptive exercises may be more effective in the management of patients with knee osteoarthritis (KOA) than isometric exercises.
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19
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Effects of joint stabilizers on proprioception and stability: A systematic review and meta-analysis. Phys Ther Sport 2017; 25:65-75. [DOI: 10.1016/j.ptsp.2016.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 03/31/2016] [Accepted: 05/10/2016] [Indexed: 11/19/2022]
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Mine K, Nakayama T, Milanese S, Grimmer K. The effectiveness of braces and orthoses for patients with knee osteoarthritis: A systematic review of Japanese-language randomised controlled trials. Prosthet Orthot Int 2017; 41:115-126. [PMID: 27117012 DOI: 10.1177/0309364616640926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knee osteoarthritis is common. The evidence regarding the effectiveness of braces and orthoses for patients with knee osteoarthritis is inconclusive according to English-language literature. English-language reviews to date have not included Japanese-language studies. OBJECTIVES This study aimed to collect and synthesise Japanese-language randomised controlled trials investigating the effectiveness of braces and orthoses for patients with knee osteoarthritis. STUDY DESIGN Systematic review. METHODS Eight databases were systematically searched from inception to 29 July 2015. Only Japanese-language randomised controlled trials were included. Risk of bias was assessed using Physiotherapy Evidence Database scale. A meta-analysis was not appropriate due to the heterogeneity in the included studies. RESULTS Seven randomised controlled trials with low to high risks of bias were included. Six of seven included studies were conducted by the same author group. Limited evidence supported the positive effects of short-lever elastic knee braces to improve pain and functional disability in specific outcomes. No evidence was found to support the use of foot orthoses, such as laterally wedged insoles, medial arch support and metatarsal arch pad. CONCLUSION Our systematic review found no conclusive evidence about the effectiveness of any braces and orthoses for patients with medial knee osteoarthritis. Future Japanese-language studies should address methodological flaws exposed in this review and strengthen the international evidence base. Clinical relevance This is the first systematic review of Japanese-language randomised controlled trials investigating orthoses for patients with knee osteoarthritis. Clinicians can consider the use of short-lever elastic knee braces to improve specifically pain on squat or walking. Evidence found in this review does not support the use of foot orthoses.
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Affiliation(s)
- Koya Mine
- 1 International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - Takashi Nakayama
- 2 School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Steve Milanese
- 1 International Centre for Allied Health Evidence, University of South Australia, Adelaide, SA, Australia
| | - Karen Grimmer
- 2 School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
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21
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Hsieh LF, Wu CW, Chou CC, Yang SW, Wu SH, Lin YJ, Hsu WC. Effects of Botulinum Toxin Landmark-Guided Intra-articular Injection in Subjects With Knee Osteoarthritis. PM R 2016; 8:1127-1135. [PMID: 27210235 DOI: 10.1016/j.pmrj.2016.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 05/02/2016] [Accepted: 05/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Increasing evidence has suggested that botulinum toxin A (BoNT/A) can inhibit the release of selected neuropeptide transmitters from primary sensory neurons. Thus, intra-articular (IA) injection therapies with BoNT/A may reduce pain in patients with knee osteoarthritis (OA). OBJECTIVE To investigate the effects of landmark-guided IA injection of BoNT/A on patients with knee OA. DESIGN A prospective randomized controlled trial. SETTING A rehabilitation clinic of a private teaching hospital. PATIENTS A total of 46 patients with symptomatic knee OA (mostly Kellgren-Lawrence grade 2-3). METHODS The patients were randomly assigned to 1 of the following groups: BoNT/A group (BoNT/A injection; n = 21) or control group (education only; n = 20). The patients in the BoNT/A group received an IA injection of 100 units of BoNT/A into the affected knee. MAIN OUTCOME MEASURES The short-term (1 week posttreatment) and long-term (6 months posttreatment) effects were evaluated using a pain visual analogue scale (VAS) and questionnaires concerning functional status, including the Lequesne and Western Ontario and McMaster Universities (WOMAC) indexes. RESULTS The between-group comparison revealed significant differences with regard to the pain VAS score at 1 week (P < .001) and at 6 months (P = .001) posttreatment. Similar findings for the between-group comparison were observed for the WOMAC and Lequesne indexes at 6 months (P < .05) posttreatment. The pain VAS score in the BoNT/A group significantly decreased from 5.05 ± 1.12 (pretreatment) to 2.89 ± 1.04 at 1 week (P < .001) and 3.45 ± 1.70 at 6 months posttreatment (P < .001) but not in the control group (P = .476). CONCLUSIONS The IA injection of BoNT/A provided pain relief and improved functional abilities in patients with knee OA in both the short- and long-term follow-up. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, Republic of China(∗)
| | - Chia-Wei Wu
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Republic of China(†)
| | - Ching-Chieh Chou
- Neuromuscular Research Laboratory, Department of Physical Therapy, Chang Gung University, Tao-Yuan, Taiwan, Republic of China(‡)
| | - Sai-Wei Yang
- Department of Biomedical Engineering, National Yang-Ming University, No. 155, Section 2, Li-Nong Street, Taipei, Taiwan, Republic of China(§).
| | - Shih-Hui Wu
- Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, Taipei, Taiwan, Republic of China(‖)
| | - Yi-Jia Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China(¶)
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China; National Defense Medical Center, Taipei, Taiwan, Republic of China(#)
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de Vries AJ, van den Akker-Scheek I, Diercks RL, Zwerver J, van der Worp H. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy. J Sci Med Sport 2016; 19:278-82. [DOI: 10.1016/j.jsams.2015.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/20/2015] [Accepted: 04/30/2015] [Indexed: 11/24/2022]
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23
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Steadman JR, Briggs KK, Pomeroy SM, Wijdicks CA. Current state of unloading braces for knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:42-50. [PMID: 25236680 DOI: 10.1007/s00167-014-3305-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/03/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Unicompartmental knee osteoarthritis (OA) is often treated with the prescription of an unloading knee brace to decrease pain and stiffness. Braces have been shown to improve the quality of life by applying an external moment to offset increased compressive tibiofemoral contact loads, but evidence regarding mechanical efficacy at the joint is controversial. Thus, the purpose of this study was to review the current state of unloading braces on knee mechanics, clinical impact, and long-term disease progression. METHODS A literature search was performed through the PubMed MEDLINE database for the search terms "osteoarthritis," "knee," "brace," and derivatives of the keyword "unload." Articles published since January 1, 1980 were reviewed for their relevance. Evidence for the effectiveness of unloading braces for disease management both biomechanically and clinically was considered. RESULTS While significant research has been done to show improvement in OA symptoms with the use of an unloading brace, current literature suggests a debate regarding the effectiveness of these braces for biomechanical change. Clinical findings reveal overall improvements in parameters such as pain, instability, and quality of life. CONCLUSION Although clinical evidence supports brace use to improve pain and functional ability, current biomechanical evidence suggests that unloading of the affected knee compartment does not significantly hinder disease progression. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J Richard Steadman
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Karen K Briggs
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
| | - Shannon M Pomeroy
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Coen A Wijdicks
- Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 W. Meadow Drive, Suite 1000, Vail, CO, 81657, USA
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Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Valgus bracing for knee osteoarthritis: a meta-analysis of randomized trials. Arthritis Care Res (Hoboken) 2015; 67:493-501. [PMID: 25201520 DOI: 10.1002/acr.22472] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 09/02/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effects of valgus knee bracing on pain and function, and compliance and complications, in patients with medial knee osteoarthritis (OA). METHODS A meta-analysis of randomized controlled trials that compared changes in patient-reported pain and/or function in patients with medial knee OA was performed. Seven databases were searched from their inception to January 2014. Two reviewers independently determined study eligibility, rated risk of bias, and extracted data. Pooled estimates and 95% confidence intervals (95% CIs) for standardized mean differences (SMDs) for the improvement in pain (and function) were calculated. Event rates (proportions) were calculated for studies that reported complications. RESULTS Six studies were included in the meta-analysis. Overall, there was a statistically significant difference favoring the valgus brace group for improvement in pain (SMD 0.33 [95% CI 0.13, 0.52], P = 0.001) and function (SMD 0.22 [95% CI 0.02, 0.41], P = 0.03). When compared to a control group that did not use an orthosis, the effect size was moderate for pain (SMD 0.56 [95% CI 0.03, 1.09], P = 0.04) and function (SMD 0.48 [95% CI 0.02, 0.95], P = 0.04). When compared to a control group that used a control orthosis, only a small, statistically significant effect for pain remained (SMD 0.33 [95% CI 0.08, 0.58], P = 0.01). Instructions for brace use varied considerably and compliance ranged from 45% to 100%. Up to 25% of patients reported minor complications with brace use. CONCLUSION Meta-analysis of randomized trials suggests valgus bracing for medial knee OA results in small-to-moderate improvements in pain. Effect sizes vary based on study design and warrant future research.
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Ornetti P, Fortunet C, Morisset C, Gremeaux V, Maillefert JF, Casillas JM, Laroche D. Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis. Ann Phys Rehabil Med 2015; 58:126-31. [PMID: 26004814 DOI: 10.1016/j.rehab.2015.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Evaluation of the clinical effectiveness and safety of a new custom-made valgus knee brace (OdrA) in medial knee osteoarthritis (OA) in terms of pain and secondary symptoms. METHODS Open-label prospective study of patients with symptomatic medial knee OA with clinical evaluation at 6 and 52 weeks (W6, W52). We systematically assessed pain on a visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), spatio-temporal gait variables, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic-sparing effects of the brace and tolerance. Mean scores were compared at baseline, W6 and W52 and the effect size (ES) and 95% confidence intervals (95% CIs) were calculated. RESULTS We included 20 patients with knee OA (mean age 64.2±10.2 years, mean body mass index 27.2±5.4 kg/m2). VAS pain and KOOS were improved at W6 and W52: pain (ES=0.9 at 1 year), amelioration of other symptoms (ES=0.4), and function in activities of daily living (ES=1.1), sports and leisure (ES=1.5), quality of life (ES=0.9) and gait speed (ES=0.41). In total, 76% of patients showed clinical improvement at 1 year. Analgesic and NSAIDs consumption was significantly decreased at W6 and W52. One serious adverse effect noted was lower-limb varices, and observance was deemed satisfactory at 1 year. CONCLUSION This new unloader brace appeared to have good effect on medial knee OA, with an acceptable safety profile and good patient compliance.
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Affiliation(s)
- P Ornetti
- Service de rhumatologie, CHU Bocage, 21078 Dijon, France; Inserm U1093, université de Bourgogne, 21079 Dijon, France.
| | - C Fortunet
- Service de rhumatologie, centre hospitalier William-Morey, 71321 Chalon-sur-Saône, France
| | - C Morisset
- CIC-P Inserm 803, plateforme d'investigation technologique, CHU de Dijon, 21078 Dijon, France
| | - V Gremeaux
- Inserm U1093, université de Bourgogne, 21079 Dijon, France; Service de médecine physique et réadaptation, CHU de Dijon, 21078 Dijon, France
| | - J F Maillefert
- Service de rhumatologie, CHU Bocage, 21078 Dijon, France; Inserm U1093, université de Bourgogne, 21079 Dijon, France
| | - J M Casillas
- Inserm U1093, université de Bourgogne, 21079 Dijon, France; Service de médecine physique et réadaptation, CHU de Dijon, 21078 Dijon, France
| | - D Laroche
- Inserm U1093, université de Bourgogne, 21079 Dijon, France; CIC-P Inserm 803, plateforme d'investigation technologique, CHU de Dijon, 21078 Dijon, France
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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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Moyer RF, Birmingham TB, Bryant DM, Giffin JR, Marriott KA, Leitch KM. Biomechanical effects of valgus knee bracing: a systematic review and meta-analysis. Osteoarthritis Cartilage 2015; 23:178-88. [PMID: 25447975 DOI: 10.1016/j.joca.2014.11.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/20/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
To review and synthesize the biomechanical effects of valgus knee bracing for patients with medial knee osteoarthritis (OA). Electronic databases were searched from their inception to May 2014. Two reviewers independently determined study eligibility, rated study quality and extracted data. Where possible, data were combined into meta-analyses and pooled estimates with 95% confidence intervals (CI) for standardized mean differences (SMD) were calculated. Thirty studies were included with 478 subjects tested while using a valgus knee brace. Various biomechanical methods suggested valgus braces can decrease direct measures of medial knee compressive force, indirect measures representing the mediolateral distribution of load across the knee, quadriceps/hamstring and quadriceps/gastrocnemius co-contraction ratios, and increase medial joint space during gait. Meta-analysis from 17 studies suggested a statistically significant decrease in the external knee adduction moment (KAM) during walking, with a moderate-to-high effect size (SMD = 0.61; 95% CI: 0.39, 0.83; P < 0.001). Meta-regression identified a near-significant association for the KAM effect size and duration of brace use only (β, -0.01; 95% CI: -0.03, 0.0001; P = 0.06); with longer durations of brace use associated with smaller treatment effects. Minor complications were commonly reported during brace use and included slipping, discomfort and poor fit, blisters and skin irritation. Systematic review and meta-analysis suggests valgus knee braces can alter knee joint loads through a combination of mechanisms, with moderate-to-high effect sizes in biomechanical outcomes.
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Affiliation(s)
- R F Moyer
- Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
| | - T B Birmingham
- Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada.
| | - D M Bryant
- Faculty of Health Sciences, The University of Western Ontario, London, ON, Canada
| | - J R Giffin
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
| | - K A Marriott
- Health and Rehabilitation Sciences, The University of Western Ontario, London, ON, Canada
| | - K M Leitch
- Faculty of Biomedical Engineering, The University of Western Ontario, London, ON, Canada
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Bracing improves clinical outcomes but does not affect the medial knee joint space in osteoarthritic patients during gait. Knee Surg Sports Traumatol Arthrosc 2014; 22:2715-20. [PMID: 23846505 DOI: 10.1007/s00167-013-2596-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Osteoarthritis (OA) of the knee is commonly treated through the use of medial compartment unloading braces which have been shown to improve clinical symptoms. The objective of this study was to assess the effects of a medial compartment unloading brace on biomechanical measurements and clinical outcomes. We hypothesized that brace usage would lead to increased medial joint space and improved clinical outcomes. METHODS Ten patients with medial compartment OA were prescribed a medial compartment unloading brace and underwent dynamic biplane radiograph imaging while walking with and without the brace. The Western Ontario and McMaster University Osteoarthritis (WOMAC) Index was used to assess pain before brace wear and at the time of testing. The 3D position and orientation of the femur and tibia were determined using a model-based tracking technique. RESULTS Patients saw an average improvement of 33 % in their WOMAC scores (p = 0.01). This study failed to detect any statistically significant changes in the functional joint space, knee kinematics, or contact centre location between the braced and unbraced condition (n.s.). CONCLUSION The data from this study, using a highly accurate (±0.6 mm and ±0.6°) 3D radiograph analysis of dynamic tibiofemoral motion, suggest that the brace is ineffective at increasing joint space. However, it was shown to be effective in improving clinical outcome and therefore should continue to be prescribed to patients even though the mechanism of its effectiveness remains unknown. LEVEL OF EVIDENCE IV.
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Shirazi ZR, Shafaee R, Abbasi L. The effects of transcutaneous electrical nerve stimulation on joint position sense in patients with knee joint osteoarthritis. Physiother Theory Pract 2014; 30:495-9. [PMID: 24697730 DOI: 10.3109/09593985.2014.903547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To study the effects of transcutaneous electrical nerve stimulation (TENS) on joint position sense (JPS) in knee osteoarthritis (OA) subjects. METHODS Thirty subjects with knee OA (40-60 years old) using non-random sampling participated in this study. In order to evaluate the absolute error of repositioning of the knee joint, Qualysis Track Manager system was used and sensory electrical stimulation was applied through the TENS device. RESULTS The mean errors in repositioning of the joint, in two position of the knee joint with 20 and 60 degree angle, after applying the TENS was significantly decreased (p < 0.05). CONCLUSION Application of TENS in subjects with knee OA could improve JPS in these subjects.
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Affiliation(s)
- Zahra Rojhani Shirazi
- School of Rehabilitation Sciences, Shiraz University of Medical Sciences , Shiraz , Iran
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Pierrat B, Molimard J, Navarro L, Avril S, Calmels P. Evaluation of the mechanical efficiency of knee braces based on computational modeling. Comput Methods Biomech Biomed Engin 2013; 18:646-61. [PMID: 24050812 DOI: 10.1080/10255842.2013.832227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knee orthotic devices are commonly prescribed by physicians and medical practitioners for preventive or therapeutic purposes on account of their claimed effect: joint stabilisation and proprioceptive input. However, the force transfer mechanisms of these devices and their level of action remain controversial. The objectives of this work are to characterise the mechanical performance of conventional knee braces regarding their anti-drawer effect using a finite element model of a braced lower limb. A design of experiment approach was used to quantify meaningful mechanical parameters related to the efficiency and discomfort tolerance of braces. Results show that the best tradeoff between efficiency and discomfort tolerance is obtained by adjusting the brace length or the strap tightening. Thanks to this computational analysis, novel brace designs can be evaluated for an optimal mechanical efficiency and a better compliance of the patient with the treatment.
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Affiliation(s)
- Baptiste Pierrat
- a Ecole Nationale Supérieure des Mines, CIS-EMSE , CNRS:UMR5307, LGF, F-42023 Saint-Etienne , France
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A kinetic and kinematic analysis of the effect of stochastic resonance electrical stimulation and knee sleeve during gait in osteoarthritis of the knee. J Appl Biomech 2013; 30:104-12. [PMID: 23878205 DOI: 10.1123/jab.2012-0257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Extended use of knee sleeves in populations at risk for knee osteoarthritis progression has shown functional and quality of life benefits; however, additional comprehensive kinematic and kinetic analyses are needed to determine possible physical mechanisms of these benefits which may be due to the sleeve's ability to enhance knee proprioception. A novel means of extending these enhancements may be through stochastic resonance stimulation. Our goal was to determine whether the use of a knee sleeve alone or combined with stochastic resonance electrical stimulation improves knee mechanics in knee osteoarthritis. Gait kinetics and kinematics were assessed in subjects with medial knee osteoarthritis when presented with four conditions: control1, no electrical stimulation/sleeve, 75% threshold stimulation/sleeve, and control2. An increase in knee flexion angle throughout stance and a decrease in flexion moment occurring immediately after initial contact were seen in the stimulation/sleeve and sleeve alone conditions; however, these treatment conditions did not affect the knee adduction angle and internal knee abduction moment during weight acceptance. No differences were found between the sleeve alone and the stochastic resonance with sleeve conditions. A knee sleeve can improve sagittal-plane knee kinematics and kinetics, although adding the current configuration of stochastic resonance did not enhance these effects.
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Influence of a valgus knee brace on muscle activation and co-contraction in patients with medial knee osteoarthritis. J Electromyogr Kinesiol 2013; 23:490-500. [DOI: 10.1016/j.jelekin.2012.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 10/08/2012] [Accepted: 10/11/2012] [Indexed: 11/21/2022] Open
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Bennell KL, Wrigley TV, Hunt MA, Lim BW, Hinman RS. Update on the Role of Muscle in the Genesis and Management of Knee Osteoarthritis. Rheum Dis Clin North Am 2013; 39:145-76. [DOI: 10.1016/j.rdc.2012.11.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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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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Design and evaluation of a new type of knee orthosis to align the mediolateral angle of the knee joint with osteoarthritis. Adv Orthop 2012; 2012:104927. [PMID: 22577565 PMCID: PMC3345217 DOI: 10.1155/2012/104927] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Revised: 12/19/2011] [Accepted: 01/03/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Osteoarthritis (OA) is a disease which influences the performance of the knee joint. Moreover, the force and moments applied on the joint increase in contrast to normal subjects. Various types of knee orthoses have been designed to solve the mentioned problems. However, there are other problems in terms of distal migration during walking and the alignment of the orthosis which cannot be changed following the use of brace. Therefore, the main aim of the research was to design an orthosis to solve the aforementioned problems. Method. A new type of knee orthosis was designed with a modular structure. Two patients with knee OA participated in this research project. The force applied on the foot, moment transmitted through the knee joint, and spatiotemporal gait parameters were measured by use of a motion analysis system. Results. The results of the research showed that the adduction moment applied on the knee joint decreased while subjects walked with the new knee orthosis (P-value < 0.05). Conclusion. The new design of the knee brace can be used as an effective treatment to decrease the loads applied on the knee joint and to improve the alignment whilst walking.
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The assessment of postural control with stochastic resonance electrical stimulation and a neoprene knee sleeve in the osteoarthritic knee. Arch Phys Med Rehabil 2012; 93:1123-8. [PMID: 22425291 DOI: 10.1016/j.apmr.2011.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 10/31/2011] [Accepted: 12/02/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine whether the combination of stochastic resonance (SR) electrical stimulation and a neoprene knee sleeve could improve center of pressure (COP) measures of postural sway during single-leg stance in those with knee osteoarthritis (OA). DESIGN Counterbalanced, repeated-measures intervention study of osteoarthritic adults during 6 different testing conditions: a control condition-control 1 (1); a counterbalance sequence of 4 treatment conditions-no stimulation with sleeve (2), 75% stimulation with sleeve (3), 100% stimulation with sleeve (4), and 150% stimulation with sleeve (5); and a second control condition-control 2 (6). SETTING University sports medicine research laboratory. PARTICIPANTS Subjects (N=52) with radiographically determined, minimal-to-moderate medial knee OA. INTERVENTIONS Neoprene knee sleeve and SR electrical stimulation. MAIN OUTCOME MEASURES COP displacement in the medial-lateral and anterior-posterior directions was collected to resolve the mean velocity, SD, range, and total path length. RESULTS No significant differences were found in the study measures between the testing conditions. Additionally, no significant differences were found between the 3 stimulation conditions or between the sleeve-alone and stimulation conditions for any of the study measures. CONCLUSIONS There were no significant improvements in balance with the use of a neoprene knee sleeve. Additionally, there was no added benefit of the SR stimulation as applied in the current configuration in this population.
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Hurley ST, Hatfield Murdock GL, Stanish WD, Hubley-Kozey CL. Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength? Arch Phys Med Rehabil 2012; 93:496-502. [PMID: 22244248 DOI: 10.1016/j.apmr.2011.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 08/24/2011] [Accepted: 09/04/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine whether there was a dose response for valgus unloader brace wear on knee pain, function, and muscle strength in participants with medial compartment knee osteoarthritis. DESIGN In this single-group study, participants with medial compartment knee osteoarthritis were followed for approximately 6 months. SETTING Recruitment was conducted in the general community, and testing was performed at a university laboratory. PARTICIPANTS A convenience sample of patients (N=32) who were prescribed a valgus unloader brace agreed to participate, met the inclusion criteria, and completed the baseline data collection. Twenty-four participants (20 men, 4 women) completed baseline and follow-up collections. INTERVENTION Participants wore their valgus unloader brace as needed. MAIN OUTCOME MEASURES Knee extensor, flexor, and plantar flexor strength was tested at baseline and follow-up. Participants filled out Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Medical Outcomes Study 36-Item Short-Form Health Survey questionnaires to assess pain and function. Self-selected walking velocity and stride length were objective measures of function. Brace usage (dose) and activity (step count) were recorded at least 4 days/week for the study duration. RESULTS Positive relationships existed between brace wear usage and percent change in step count (r=.59, P=.006) and percent change in hamstrings strength (r=.37, P=.072). At follow-up, there was significant improvement in hamstrings strength (P=.013), and trends toward improvements in WOMAC pain (P=.059) and WOMAC function (P=.089). CONCLUSIONS Our results indicate that greater brace use may positively affect physical activity level, but there was minimal effect of brace wear dosage on lower-limb muscle strength. Only knee flexion showed a positive relationship. Our finding of no decreased muscle strength indicates that increased brace use over a 6-month period does not result in muscle impairment.
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Affiliation(s)
- Sean T Hurley
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
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Stochastic resonance electrical stimulation to improve proprioception in knee osteoarthritis. Knee 2011; 18:317-22. [PMID: 20655753 DOI: 10.1016/j.knee.2010.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/28/2010] [Accepted: 07/04/2010] [Indexed: 02/02/2023]
Abstract
Proprioceptive deficits occur with knee osteoarthritis (OA) and improving proprioception may slow joint degeneration by allowing more appropriate joint loading. Stochastic resonance (SR) stimulation improves balance and the sensitivity of specific mechanoreceptors. Our purpose was to evaluate the effects of SR electrical stimulation combined with a knee sleeve on proprioception in subjects with knee OA. Joint position sense (JPS) was measured in 38 subjects with knee OA during four conditions in both a partial weight-bearing (PWB) and non weight-bearing (NWB) task: no electrical stimulation/no sleeve, no electrical stimulation/sleeve, 50 μA-RMS stimulation/sleeve, and 75 μA-RMS stimulation/sleeve. Subjects also reported their knee pain, stiffness, functionality (WOMAC), and instability. Repeated measures ANOVA and Spearman correlations were performed to investigate differences between the conditions and relationships among the outcome measures. JPS during the 75 μA-RMS stimulation/sleeve and sleeve alone conditions was significantly improved compared to the control condition in the PWB task. However, the 75 μA-RMS stimulation/sleeve and the sleeve alone conditions did not differ from each other. A moderate correlation was found between the improvements with the 75 μA-RMS stimulation/sleeve condition compared to the JPS of the control condition in the PWB task. No differences in JPS were found between the four conditions in the NWB task. Significant correlations were found between the control JPS and WOMAC indices (p<0.005). Improved proprioception during the PWB task was achieved with a sleeve alone and in combination with SR stimulation. The observed correlations suggest that subjects with larger proprioceptive deficits may benefit most from these therapies.
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Collins A, Blackburn JT, Olcott C, Yu B, Weinhold P. The impact of stochastic resonance electrical stimulation and knee sleeve on impulsive loading and muscle co-contraction during gait in knee osteoarthritis. Clin Biomech (Bristol, Avon) 2011; 26:853-8. [PMID: 21640451 DOI: 10.1016/j.clinbiomech.2011.04.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/27/2011] [Accepted: 04/28/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increased impulsive loading and muscle co-contraction during gait have been observed in individuals with knee osteoarthritis. Proprioceptive deficits in this population may contribute to these effects. Proprioception has been shown to improve with the combination of stochastic resonance electrical stimulation and a knee sleeve in knee osteoarthritis. Our goal was to determine whether stochastic resonance stimulation combined with a knee sleeve would decrease impulsive loading rates and muscle co-contraction during gait in knee osteoarthritis. METHODS Gait kinetics, kinematics and muscle activity were assessed during walking in subjects with knee osteoarthritis during three different conditions: no stochastic resonance/no sleeve (control), stochastic resonance at 75% threshold/sleeve, and no stochastic resonance/sleeve. Loading rates were calculated from the ground reaction force. Muscle co-contraction was calculated from the ratio of vastus lateralis to lateral hamstring activity. Differences between conditions were assessed using a repeated measures analysis of variance (P<0.05). FINDINGS The 75% threshold/sleeve and sleeve only conditions resulted in increased knee flexion at contact and reduced loading rates compared to the control condition (P<0.05). However, these measures did not significantly differ between the 75% threshold/sleeve and sleeve only conditions. Muscle co-contraction was found to decrease with the 75% threshold/sleeve condition compared to the other conditions. INTERPRETATION Increased knee flexion and decreased loading rates may be a result of proprioceptive improvements resulting from the sleeve or sleeve/stimulation combination. The stochastic resonance stimulation did not demonstrate an ability to enhance the effects of the sleeve with the exception of reductions in muscle co-contraction.
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Affiliation(s)
- Amber Collins
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, USA.
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Knoop J, Steultjens MPM, van der Leeden M, van der Esch M, Thorstensson CA, Roorda LD, Lems WF, Dekker J. Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Cartilage 2011; 19:381-8. [PMID: 21251988 DOI: 10.1016/j.joca.2011.01.003] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 12/16/2010] [Accepted: 01/03/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To give an overview of the literature on knee proprioception in knee osteoarthritis (OA) patients. METHOD A literature search was performed and reviewed using the narrative approach. RESULTS (1) Three presumed functions of knee proprioception have been described in the literature: protection against excessive movements, stabilization during static postures, and coordination of movements. (2) Proprioceptive accuracy can be measured in different ways; correlations between these methods are low. (3) Proprioceptive accuracy in knee OA patients seems to be impaired when compared to age-matched healthy controls. Unilateral knee OA patients may have impaired proprioceptive accuracy in both knees. (4) Causes of impaired proprioceptive accuracy in knee OA remain unknown. (5) There is currently no evidence for a role of impaired proprioceptive accuracy in the onset or progression of radiographic osteoarthritis (ROA). (6) Impaired proprioceptive accuracy could be a risk factor for progression (but not for onset) of both knee pain and activity limitations in knee OA patients. (7) Exercise therapy seems to be effective in improving proprioceptive accuracy in knee OA patients. CONCLUSIONS Recent literature has shown that proprioceptive accuracy may play an important role in knee OA. However, this role needs to be further clarified. A new measurement protocol for knee proprioception needs to be developed. Systematic reviews focusing on the relationship between impaired proprioceptive accuracy, knee pain and activity limitations and on the effect of interventions (in particular exercise therapy) on proprioceptive accuracy in knee OA are required. Future studies focusing on causes of impaired proprioceptive accuracy in knee OA patients are also needed, taking into account that also the non-symptomatic knee may have proprioceptive impairments. Such future studies may also provide knowledge of mechanism underlying the impact of impaired proprioceptive accuracy on knee pain and activity limitations.
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Affiliation(s)
- J Knoop
- Reade, Centre of Rehabilitation and Rheumatology (formerly Jan van Breemen Instituut), Department of Rehabilitation Research, Amsterdam, the Netherlands.
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Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review. Am J Phys Med Rehabil 2011; 90:247-62. [PMID: 21273902 DOI: 10.1097/phm.0b013e318206386b] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.
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Elbaz A, Mor A, Segal G, Debbi E, Haim A, Halperin N, Debi R. APOS therapy improves clinical measurements and gait in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2010; 25:920-5. [PMID: 20637534 DOI: 10.1016/j.clinbiomech.2010.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 06/21/2010] [Accepted: 06/21/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the study was to investigate the changes in gait patterns and clinical measurements following treatment with a novel biomechanical device on patients with knee osteoarthritis. METHODS Forty six patients with bilateral knee osteoarthritis were analyzed. Patients completed a gait test, Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire and SF-36 Health Survey at baseline and after 12 weeks. The biomechanical device was individually calibrated to each patient at baseline to allow training under reduced pain. FINDINGS Gait velocity, step length and single limb support improved significantly and toe out angle decreased significantly (10%, 6%, 1% and 2%, respectively). WOMAC-Pain and WOMAC-Function significantly decreased (26% and 34%, respectively), and SF-36 score significantly increased following the 12 weeks of treatment. INTERPRETATION Our results suggest an overall improvement in the gait patterns, level of pain and level of function of patients with knee osteoarthritis following 12 weeks of treatment with the novel biomechanical device.
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Affiliation(s)
- Avi Elbaz
- APOS Research Group, Herzliya, Israel
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Sanchez K, Eloumri A, Rannou F, Poiraudeau S. [Nonpharmacological and nonsurgical therapies for osteoarthritis: orthosis, exercises]. Presse Med 2010; 39:1172-9. [PMID: 20843651 DOI: 10.1016/j.lpm.2009.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/19/2009] [Indexed: 11/16/2022] Open
Abstract
Unloading valgus knee braces may be more effective than knee sleeves, to improve pain and disability for medial knee osteoarthritis, but have more adverse effects. A lateral-wedge insole could reduce pain in medial knee osteoarthritis. Cushioning insoles and footwear with shock absorbance could be proposed for hip osteoarthritis by authors' recommendations. Nocturnal splints for base-of-thumb osteoarthritis are recommended to reduce pain and disability. Aerobic, strengthening, range-of-motion and proprioceptive exercise are recommended to decrease pain and improve function and quality of life in knee and hip osteoarthritis. Strengthening and range-of-motion exercise is recommended for hand osteoarthritis.
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Affiliation(s)
- Katherine Sanchez
- Université Paris Descartes, AP-HP, hôpital Cochin, service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du Rachis, 75679 Paris cedex 14, France
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Hunt MA, McManus FJ, Hinman RS, Bennell KL. Predictors of single-leg standing balance in individuals with medial knee osteoarthritis. Arthritis Care Res (Hoboken) 2010; 62:496-500. [PMID: 20391504 DOI: 10.1002/acr.20046] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify factors related to single-leg standing balance in individuals with medial compartment knee osteoarthritis (OA). METHODS This cross-sectional study assessed clinical, demographic, and biomechanical measures in 57 individuals and their relationships with single-leg standing balance. Differences in age, mass, symptoms, knee pain, radiographic severity, lower extremity alignment, and hip and knee extension as well as hip abduction torques were compared between those who could and could not perform 3 trials of single-leg standing balance. Multiple regression was used to identify predictors of center of pressure (COP) path length in those who could complete the task. RESULTS Thirty-four individuals (60%) successfully completed all 3 single-leg standing balance trials and were significantly younger (P = 0.003) than those who could not. No other variable was significantly different between the groups. Disease severity, number of painful knees, lower extremity alignment, pain intensity, and quadriceps torque were all significant predictors of COP path length. Specifically, better single-leg standing balance (smaller COP path length) was related to more severe radiographic changes and stronger quadriceps, those with bilateral symptoms, and to less varus malalignment and knee pain. CONCLUSION Single-leg standing balance in those with medial knee OA is related to the modifiable factors lower extremity alignment, knee pain, and quadriceps strength. Given the reduced balancing ability in this patient population, interventions targeting these factors are necessary.
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Affiliation(s)
- Michael A Hunt
- Centre for Health, Exercise and Sports Medicine, Melbourne Physiotherapy School, University of Melbourne, Melbourne, Australia.
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Rannou F, Poiraudeau S. Non-pharmacological approaches for the treatment of osteoarthritis. Best Pract Res Clin Rheumatol 2010; 24:93-106. [PMID: 20129203 DOI: 10.1016/j.berh.2009.08.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
For the most part, non-pharmacological approaches are recommended for osteoarthritis treatment. This recommendation is based mainly on biomechanical observations leading to a modulation of the symptomatic loading joint. Approaches include orthoses, insoles, exercise, diet and patient education. The approach used for each osteoarthritis site must be adapted for the individual patient. Here, we use an evidence-based approach, including the European League Against Rheumatism (EULAR) and Osteoarthritis Research Society International (OARSI) recommendations, to summarise the non-pharmacological treatments available for knee, hip and hand osteoarthritis and to help the physician in daily clinical practice.
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Affiliation(s)
- François Rannou
- INSERM, U747, Laboratoire de Pharmacologie, Toxicologie et Signalisation Moléculaire, Paris F-75006, France.
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Rannou F, Poiraudeau S, Beaudreuil J. Role of bracing in the management of knee osteoarthritis. Curr Opin Rheumatol 2010; 22:218-22. [DOI: 10.1097/bor.0b013e32833619c4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Beaudreuil J, Bendaya S, Faucher M, Coudeyre E, Ribinik P, Revel M, Rannou F. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis. Joint Bone Spine 2009; 76:629-36. [PMID: 19467901 DOI: 10.1016/j.jbspin.2009.02.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 02/24/2009] [Indexed: 11/18/2022]
Affiliation(s)
- Johann Beaudreuil
- Service de rhumatologie, hôpital Lariboisière, université Paris-7, Paris, France
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Hunt MA, Birmingham TB, Jones IC, Vandervoort AA, Giffin JR. Effect of tibial re-alignment surgery on single leg standing balance in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2009; 24:693-6. [PMID: 19527918 DOI: 10.1016/j.clinbiomech.2009.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 03/31/2009] [Accepted: 05/11/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standing balance is impaired in individuals with knee osteoarthritis and is associated with disease severity. The effects of surgical interventions on standing balance have received little attention. The purpose of the present study was to examine measures of balance during tests of single-limb standing before and after medial opening wedge high tibial osteotomy--a lower limb re-alignment procedure for those with varus alignment and knee osteoarthritis. METHODS Standing balance was assessed in 49 individuals prior to and 12 months following medial opening wedge high tibial osteotomy. Participants performed three trials of single-limb balance lasting 10s each while standing on a force platform. Anteroposterior and mediolateral coordinates of the centre of pressure were obtained from the force platform and used to calculate the total centre of pressure path length as well as the range and variability (standard deviation) of the anteroposterior and mediolateral coordinates. FINDINGS Though all centre of pressure measures were lower following high tibial osteotomy, none reached statistical significance (P>0.05) and effect sizes were small (d<0.34). The largest mean improvement was 7.6% (95% confidence interval: -0.7-15.8%). INTERPRETATION Results indicate that standing balance in individuals with knee osteoarthritis is not significantly different following high tibial osteotomy surgery. Standing balance in this patient population is a complex process not entirely dictated by disease symptoms or structural factors such as alignment.
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Affiliation(s)
- Michael A Hunt
- Wolf Orthopaedic Biomechanics Laboratory, University of Western Ontario, London, ON, Canada
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Konservative Therapie der Arthrose. ARTHROSKOPIE 2009. [DOI: 10.1007/s00142-008-0481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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