The effects of prolonged wear of textured shoe insoles on gait, foot sensation and proprioception in people with multiple sclerosis: study protocol for a randomised controlled trial

Immediate effects of wearing textured versus smooth insoles on standing balance and spatiotemporal gait patterns when walking over even and uneven surfaces in people with multiple sclerosis

PURPOSE

To investigate the immediate effects of wearing novel sensory-stimulating textured insoles on balance and gait in 41 people with multiple sclerosis (pwMS).

MATERIALS AND METHODS

Assessments of balance (firm/foam surface; eyes open/closed) and walking (when negotiating even/uneven surfaces) were performed wearing textured insoles, smooth insoles, shoes only, and barefoot. Outcome measures were centre of pressure (CoP) movement during standing (elliptical area, sway path velocity) and spatiotemporal gait patterns (stride/step width, stride time, double-limb support time, stride length, velocity).

RESULTS

Wearing textured insoles led to reductions in CoP velocity measures when standing on foam with eyes open and closed when compared to barefoot (p values ≤0.02). Textured insoles did not appear to be consistently superior to smooth insoles or shoes only for improving gait. Relative to the insole/shoe conditions, walking barefoot led to poorer gait performance for the even and uneven surface tasks (p values ≤0.03).

CONCLUSIONS

For pwMS, stimulating the foot with "texture" appears to provide enhanced sensory input with the capacity to improve CoP movement control during standing; offering a potential new treatment option for balance rehabilitation. Further research is needed to identify which individuals may benefit most from textured insoles.Implications for rehabilitationTextured shoe insoles, designed to stimulate plantar mechanoreceptors, are a novel approach to improve standing balance and walking patterns in people with multiple sclerosis (pwMS).Wearing textured insoles for the first time can lead to improvements in centre of pressure movement control when standing on an unstable compliant supporting surface.Textured insoles offer a potential new treatment technique for balance rehabilitation in pwMS who show early signs of diminished foot sensation.

Effects of wearing textured versus smooth shoe insoles for 12 weeks on gait, foot sensation and patient-reported outcomes, in people with multiple sclerosis: a randomised controlled trial

BACKGROUND

Innovative shoe insoles, designed to enhance sensory information on the plantar surface of the feet, could help to improve walking in people with Multiple Sclerosis.

OBJECTIVE

To compare the effects of wearing textured versus smooth insoles, on measures of gait, foot sensation and patient-reported outcomes, in people with Multiple Sclerosis.

METHODS

A prospective, randomised controlled trial was conducted with concealed allocation, assessor blinding and intention-to-treat analysis. Thirty ambulant men and women with multiple sclerosis (MS) (Disease Steps rating 1-4) were randomly allocated to wear textured or smooth insoles for 12 weeks. Self-reported insole wear and falls diaries were completed over the intervention period. Laboratory assessments of spatiotemporal gait patterns, foot sensation and proprioception, and patient-reported outcomes, were performed at Weeks 0 (Baseline 1), 4 (Baseline 2) and 16 (Post-Intervention). The primary outcome was the size of the mediolateral base of support (stride/step width) when walking over even and uneven surfaces. Independent t-tests were performed on change from baseline (average of baseline measures) to post-intervention.

RESULTS

There were no differences in stride width between groups, when walking over the even or uneven surfaces (P ≥ 0.20) at post-intervention. There were no between-group differences for any secondary outcomes including gait (all P values > 0.23), foot sensory function (all P values ≥ 0.08) and patient-reported outcomes (all P values ≥ 0.23).

CONCLUSIONS

In our small trial, prolonged wear of textured insoles did not appear to alter walking or foot sensation in people with MS who have limited foot sensory loss. Further investigation is needed to explore optimal insole design.

CLINICAL TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry (ACTRN12615000421538).

Effect of Foot Orthoses and Shoes in Parkinson's Disease Patients: A PRISMA Systematic Review

Reduced plantar foot sensation, postural instability, and gait difficulties are characteristic of Parkinson´s disease patients. A systematic review was carried out to determine the effect of the different types of insoles and shoes in these patients. Several databases were used to search for relevant articles reporting Parkinson´s disease patients undergoing treatment with any type of insole and footwear. All titles and abstracts were reviewed independently by two reviewers and the available data were extracted. The study eligibility criteria were any type of experimental study that included Parkinson’s disease patients treated with any type of insole or footwear. Eight studies were selected. Interventions used were textured insoles, footwear modifications, and habitual footwear. Three different outcomes were evaluated in each study: gait parameters, balance, and plantar sensation. According to the data available from this systematic review, the most important conclusion is that more controlled studies are needed in this research field. There are indications to suggest that textured insoles have positive effects on gait parameters, balance, and plantar sensation in Parkinson’s disease patients.

The Effect of Total Body Resistance Exercise on Mobility, Proprioception, and Muscle Strength of the Knee in People With Multiple Sclerosis

CONTEXT

Muscle weakness and sensory deficits cause impaired balance and walking abilities that are prerequisites for independent activity of daily living in people with multiple sclerosis (MS). Recent physical exercises tailored to improve the activity of daily living people with MS have focused on the functional training.

OBJECTIVE

To investigate the effect of total body resistance exercise suspension training on mobility, proprioception, and muscle strength of the knee in people with MS.

DESIGN

Single-blind pretest and posttest control group design.

SETTING

Referral Center of Multiple Sclerosis Society.

PARTICIPANTS

Thirty-four women with relapsing-remitting MS were participated in this study. The mean (SD) of their age was 36.44 (4.88) years, and the Expanded Disability Status Scale was 2.35 (0.94). The participants were divided into 2 groups: control group (n = 15) and training group (n = 19).

INTERVENTION

The training group performed the total body resistance exercise program for 8 weeks, 3 sessions per week. The control group received their usual care and daily activities. Outcomes were measured presessions and postsessions.

MAIN OUTCOME MEASURES

Mobility was assessed with Timed Up and Go test, 10-m walk maximum test, 2 minute walk test, and 5-time sit-to-stand test. Knee proprioception absolute error and isometric strength of knee flexor and extensor muscles were measured by using a biodex isokinetic dynamometer.

RESULTS

In the training group, mobility (P = .001), maximal voluntary isometric contraction of knee flexor and extensor muscles in both legs (P > .05), and the knee proprioception absolute error in nondominant leg at 60° knee flexion (P = .02) improved significantly compared with the control group.

CONCLUSION

Total body resistance exercise is a functional and safe intervention that can improve the mobility and muscles strength of the knee in a short period in people with MS.

Effects of Masai Barefoot Technology Footwear Compared with Barefoot and Oxford Footwear on Gait

BACKGROUND

Shoes, with their biomechanical features, affect the human body and function as clothing that protects the foot. This study aimed to investigate the effects of Masai Barefoot Technology (MBT) shoes on gait in healthy, young individuals compared with bare feet and classic stable shoes.

METHODS

The study was conducted in 67 healthy females aged 18 to 30 years. All volunteers walked barefoot, in Oxford shoes, and in MBT shoes and were evaluated in the same session. Kinematic gait analyses were performed. The three performances were compared using repeated-measures analysis of variance to study the variance in the groups themselves, and the Friedman and Wilcoxon paired two-sample tests were used for the intragroup comparisons.

RESULTS

We found that the single support time and the swing phase ratio increased during walking in MBT shoes compared with walking in stable shoes, whereas the double support ratio, stride length, cadence, gait speed, loading response ratio, and preswing phase ratio decreased. However, it was found that the step and stride length, step width, and gait speed increased and the preswing phase extended during walking in stable shoes compared with walking barefoot.

CONCLUSIONS

These results support the hypothesis that MBT shoes facilitate foot cycles as they reduce the loading response and the preswing and stance phase ratios.

Wearable Solutions for Patients with Parkinson's Disease and Neurocognitive Disorder: A Systematic Review

Prevalence of neurocognitive diseases in adult patients demands the use of wearable devices to transform the future of mental health. Recent development in wearable technology proclaimed its use in diagnosis, rehabilitation, assessment, and monitoring. This systematic review presents the state of the art of wearables used by Parkinson’s disease (PD) patients or the patients who are going through a neurocognitive disorder. This article is based on PRISMA guidelines, and the literature is searched between January 2009 to January 2020 analyzing four databases: PubMed, IEEE Xplorer, Elsevier, and ISI Web of Science. For further validity of articles, a new PEDro-inspired technique is implemented. In PEDro, five statistical indicators were set to classify relevant articles and later the citations were also considered to make strong assessment of relevant articles. This led to 46 articles that met inclusion criteria. Based on them, this systematic review examines different types of wearable devices, essential in improving early diagnose and monitoring, emphasizing their role in improving the quality of life, differentiating the various fitness and gait wearable-based exercises and their impact on the regression of disease and on the motor diagnosis tests and finally addressing the available wearable insoles and their role in rehabilitation. The research findings proved that sensor based wearable devices, and specially instrumented insoles, help not only in monitoring and diagnosis but also in tracking numerous exercises and their positive impact towards the improvement of quality of life among different Parkinson and neurocognitive patients.

Interventions for preventing falls in people with multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is one of the most prevalent diseases of the central nervous system with recent prevalence estimates indicating that MS directly affects 2.3 million people worldwide. Fall rates of 56% have been reported among people with MS in a recent meta-analysis. Clinical guidelines do not outline an evidence-based approach to falls interventions in MS. There is a need for synthesised information regarding the effectiveness of falls prevention interventions in MS.

OBJECTIVES

The aim of this review was to evaluate the effectiveness of interventions designed to reduce falls in people with MS. Specific objectives included comparing: (1) falls prevention interventions to controls and; (2) different types of falls prevention interventions.

SEARCH METHODS

We searched the Trials Register of the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Group, Cochrane Central Register of Controlled Trials (2018 Issue 9); MEDLINE (PubMed) (1966 to 12 September 2018); Embase (EMBASE.com) (1974 to 12 September 2018); Cumulative Index to Nursing and Allied Health Literature (EBSCOhost) (1981 to 12 September 2018); Latin American and Caribbean Health Science Information Database (Bireme) (1982 to 12 September 2018); ClinicalTrials.gov; and World Health Organization International Clinical Trials Registry Platform; PsycINFO (1806 to 12 September 2018; and Physiotherapy Evidence Database (1999 to 12 September 2018).

SELECTION CRITERIA

We selected randomised controlled trials or quasi-randomised trials of interventions to reduce falls in people with MS. We included trials that examined falls prevention interventions compared to controls or different types of falls prevention interventions. Primary outcomes included: falls rate, risk of falling, number of falls per person and adverse events.

DATA COLLECTION AND ANALYSIS

Two review authors screened studies for selection, assessed risk of bias and extracted data. We used a rate ratio (RaR) and 95% confidence interval to compare falls rate between groups. For risk of falling, we used a risk ratio (RR) and 95% CI based on the number of fallers in each group.

MAIN RESULTS

A total of 839 people with MS (12 to 177 individuals) were randomised in the 13 included trials. The mean age of the participants was 52 years (36 to 62 years). The percentage of women participants ranged from 59% to 85%. Studies included people with all types of MS. Most trials compared an exercise intervention with no intervention or different types of falls prevention interventions. We included two comparisons: (1) Falls prevention intervention versus control and (2) Falls prevention intervention versus another falls prevention intervention. The most common interventions tested were exercise as a single intervention, education as a single intervention, functional electrical stimulation and exercise plus education. The risk of bias of the included studies mixed, with nine studies demonstrating high risk of bias related to one or more aspects of their methodology. The evidence was uncertain regarding the effects of exercise versus control on falls rate (RaR of 0.68; 95% CI 0.43 to 1.06; very low-quality evidence), number of fallers (RR of 0.85; 95% CI 0.51 to 1.43; low-quality evidence) and adverse events (RR of 1.25; 95% CI 0.26 to 6.03; low-quality evidence). Data were not available on quality of life outcomes comparing exercise to control. The majority of other comparisons between falls interventions and controls demonstrated no evidence of effect in favour of either group for all primary outcomes. For the comparison of different falls prevention interventions, the heterogeneity of intervention types across studies prohibited the pooling of data. In relation to secondary outcomes, there was evidence of an effect in favour of exercise interventions compared to controls for balance function with a SMD of 0.50 (95% CI 0.09 to 0.92), self-reported mobility with a SMD of 16.30 (95% CI 9.34 to 23.26) and objective mobility with a SMD of 0.28 (95% CI 0.07 to 0.50). Secondary outcomes were not assessed under the GRADE criteria and results must be interpreted with caution.

AUTHORS' CONCLUSIONS

The evidence regarding the effects of interventions for preventing falls in MS is sparse and uncertain. The evidence base demonstrates mixed risk of bias, with very low to low certainty of the evidence. There is some evidence in favour of exercise interventions for the improvement of balance function and mobility. However, this must be interpreted with caution as these secondary outcomes were not assessed under the GRADE criteria and as the results represent data from a small number of studies. Robust RCTs examining the effectiveness of multifactorial falls interventions on falls outcomes are needed.

Optimization of the Effects of Physical Activity on Plantar Sensation and Postural Control With Barefoot Exercises in Institutionalized Older Adults: A Pilot Study

Increasing somatosensory information from the foot by exercising barefoot can potentially optimize the effectiveness of physical exercise interventions on falls prevention in the older adults. This pilot study was then undertaken to explore the effects of increased somatosensory information from the foot by exercising barefoot on balance, gait, and plantar cutaneous sensitivity in institutionalized older adults involved in multimodal exercise intervention. Participants were assigned to three groups: a control group which did not perform any physical exercise and two groups in which they were involved in a multimodal exercise program performed barefoot or shod. Postural, gait, and plantar cutaneous sensitivity parameters were collected. The results showed that the exercise program produced larger effects on balance and plantar cutaneous sensitivity when exercises were performed barefoot, without any noticeable effect on gait. Hence, barefoot exercising could be a relevant means to optimize the fall-prevention exercise programs in institutionalized older adults.

Textured shoe insoles to improve balance performance in adults with diabetic peripheral neuropathy: study protocol for a randomised controlled trial

INTRODUCTION

Peripheral neuropathy is a major risk factor for falls in adults with diabetes. Innovative footwear devices which artificially manipulate the sensory environment at the feet, such as textured shoe insoles, are emerging as an attractive option to mitigate balance and walking problems in neuropathic populations. This study aims to explore whether wearing textured insoles for 4 weeks alters balance performance in adults with diabetic peripheral neuropathy.

METHODS AND ANALYSIS

A prospective, single-blinded randomised controlled trial with parallel groups will be conducted on 70 adults with diabetic peripheral neuropathy. Adults with a diagnosis of peripheral neuropathy (secondary to type 2 diabetes), aged ≥18 years, ambulant over 20 m (with/without an assistive device), will be recruited. Participants will be randomised to receive a textured insole (n=35) or smooth insole (n=35), to be worn for 4 weeks. During baseline and post intervention assessments, standing balance (foam/firm surface; eyes open/closed) and walking tasks will be completed barefoot, wearing standard shoes only, and two different insoles (smooth, textured). The primary outcome measure will be centre of pressure (CoP) velocity, with higher values indicating poorer balance. Secondary outcome measures include walking quality (gait velocity, base of support, stride length and double-limb support time), physical activity levels, foot sensation (light-touch pressure, vibration) and proprioception (ankle joint position sense), and other balance parameters (CoP path length, anteroposterior and mediolateral excursion). Patient-reported outcomes will be completed evaluating foot health, frequency of falls and fear of falling. Data will be analysed using a repeated measures mixed models approach (including covariates) to establish any differences between-groups, for all outcome measures, over the intervention period.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the institutional Human Research Ethics Committee (#2017000098). Findings will be disseminated at national and international conferences, through peer-reviewed journals, workshops and social media.

TRIAL REGISTRATION NUMBER

ACTRN12617000543381; Pre-results.

Musculoskeletal problems and attitudes towards footwear among university students

BACKGROUND AND OBJECTIVE

Footwear preferences and habits may be related to musculoskeletal system problems. This study was designed to determine the relationship between the selection of footwear, musculoskeletal problems and the affecting factors among university students from that different division.

METHODS

Four hundred and sixty-six university students in the divisions of Physiotherapy Rehabilitation, Nursing and Business Administration participated in this study. The data was collected using a questionnaire developed by the researchers and the Extended Nordic Musculoskeletal Questionnaire.

RESULTS

Of the participants, 68.5% preferred to wear sports shoes; 24.0% of the participants had foot pain. Comfort, robustness and quality come to the fore in the behavioural patterns of young and healthy individuals regarding footwear. Those who experienced foot and lower back pain considered such parameters as quality, fitness for foot health, flexibility and lightness in footwear.

CONCLUSIONS

While patterns such as foot health, flexibility and lightness are reflected in the footwear preferences of those who have lower back pain, those who have pain or problems in their feet take into consideration the quality, lightness, fitness to foot health. The relationship determined in the present study shows that those who experience pain are more selective in their footwear preferences.

Shoe-Insole Technology for Injury Prevention in Walking

Impaired walking increases injury risk during locomotion, including falls-related acute injuries and overuse damage to lower limb joints. Gait impairments seriously restrict voluntary, habitual engagement in injury prevention activities, such as recreational walking and exercise. There is, therefore, an urgent need for technology-based interventions for gait disorders that are cost effective, willingly taken-up, and provide immediate positive effects on walking. Gait control using shoe-insoles has potential as an effective population-based intervention, and new sensor technologies will enhance the effectiveness of these devices. Shoe-insole modifications include: (i) ankle joint support for falls prevention; (ii) shock absorption by utilising lower-resilience materials at the heel; (iii) improving reaction speed by stimulating cutaneous receptors; and (iv) preserving dynamic balance via foot centre of pressure control. Using sensor technology, such as in-shoe pressure measurement and motion capture systems, gait can be precisely monitored, allowing us to visualise how shoe-insoles change walking patterns. In addition, in-shoe systems, such as pressure monitoring and inertial sensors, can be incorporated into the insole to monitor gait in real-time. Inertial sensors coupled with in-shoe foot pressure sensors and global positioning systems (GPS) could be used to monitor spatiotemporal parameters in real-time. Real-time, online data management will enable ‘big-data’ applications to everyday gait control characteristics.

Should Ballet Dancers Vary Postures and Underfoot Surfaces When Practicing Postural Balance?

BACKGROUND

Postural balance (PB) is an important component skill for professional dancers. However, the effects of different types of postures and different underfoot surfaces on PB have not adequately been addressed.

PURPOSE

The main aim of this study was to investigate the effect of different conditions of footwear, surfaces, and standing positions on static and dynamic PB ability of young ballet dancers.

METHODS

A total of 36 male and female young professional ballet dancers (aged 14-19 years) completed static and dynamic balance testing, measured by head and lumbar accelerometers, while standing on one leg in the turnout position, under six different conditions: (1) "relaxed" posture; (2) "ballet" posture; (3) barefoot; (4) ballet shoes with textured insoles; (5) barefoot on a textured mat; and (6) barefoot on a spiky mat.

RESULTS

A condition effect was found for static and dynamic PB. Static PB was reduced when dancers stood in the ballet posture compared with standing in the relaxed posture and when standing on a textured mat and on a spiky mat (p < .05), and static PB in the relaxed posture was significantly better than PB in all the other five conditions tested. Dynamic PB was significantly better while standing in ballet shoes with textured insoles and when standing on a spiky mat compared with all other conditions (p < .05).

CONCLUSIONS

The practical implications derived from this study are that both male and female dancers should try to be relaxed in their postural muscles when practicing a ballet aligned position, including dance practice on different types of floors and on different types of textured/spiky materials may result in skill transfer to practice on normal floor surfaces, and both static and dynamic PB exercises should be assessed and generalized into practical dance routines.

Textured and stimulating insoles for balance and gait impairments in patients with multiple sclerosis and Parkinson's disease: A systematic review and meta-analysis

The aim of this systematic review with meta-analysis was to investigate if using textured or other types of stimulating insoles improve gait characteristics and balance/postural control in patients with multiple sclerosis and Parkinson's disease. Primary outcomes for balance were the center of pressure (CoP) displacement and CoP velocity/sway rate. Primary outcomes for gait were the cadence, velocity, and step length. Standardized mean differences (SMD) were used to verify the efficacy of wearing the insoles on gait and balance outcome measures. Study quality was evaluated using the checklist of the CONSORT- Statement. Six studies were included in the review. Five studies had low methodological quality, scoring <17/37 on the checklist, one study had moderate methodological quality, scoring 27/37 on the checklist. Due to designs of the included studies, only immediate effects could be calculated. Among the primary outcome measures cadence, gait velocity and step length, there was no evidence of an effect of using textured/stimulating insoles compared with the respective control condition (Totals: SMD -0.09, 95% CI -0.35 to 0.16; SMD 0.18, 95% CI -0.17 to 0.53; SMD -0.13, 95% CI -0.31 to 0.05). Furthermore, among the primary outcome measures CoP displacement and CoP velocity, no evidence of an effect was found as well (Subtotals multiple sclerosis: SMD 0.07, 95% CI -0.15 to 0.28; SMD -0.08, 95% CI -0.55 to 0.39). Therefore, using textured or other types of stimulating insoles for the treatment of balance and gait impairments in patients with multiple sclerosis and Parkinson's disease seem to have no effect.