Braces and orthoses for treating osteoarthritis of the knee

 

Abstract

Background

Patients with osteoarthritis of the knee can be treated with a brace or orthosis (insole). The main purpose of these aids is to reduce pain, improve physical function and, possibly, to slow disease progression. This review was originally published in Issue 1, 2005.

Objectives

To assess the effectiveness of a brace or orthosis in the treatment of osteoarthritis of the knee.

Search methods

Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) up to October 2002 in the original review and in this update until May 2007. Reference lists of identified trials were screened.

Selection criteria

Randomised and controlled clinical trials investigating all types of braces and orthoses for osteoarthritis of the knee.

Data collection and analysis

Three reviewers independently selected trials, extracted data and assessed trial quality. Due to the heterogeneity of the studies, pooling of outcomes was not possible.

Main results

Five studies (n=589) were included: two knee brace and three orthoses studies. In the longer follow-up studies (1 to 2 years) many patients stopped their brace or insole treatment.

The pain and function scores of a brace and a neoprene sleeve group showed greater improvement at six months compared with a control group. In a second brace study, the pain and function scores were improved in the brace group compared with the controls, but only the walking distance was significantly longer.

In one study there was a significantly less intake of NSAIDs and significantly better compliance in a lateral wedge group compared with a neutral wedge group, but there were no significant differences in function scores at 6 and 24 months.

In another insole study at 6 months follow up, the pain score was significantly improved in the strapped insole group compared with the traditional lateral wedge group (relative percentage difference (RPD=29%). The femorotibial angle was significantly improved in the strapped insole group at 6 and 24 months (RPDs at both timepoints= -1.1%). The pain and function scores were not significantly different at 24 months.

Authors' conclusions

Based on two brace and three insole studies, we conclude that there is 'silver' level evidence (www.cochranemsk.org) that a brace and a lateral wedge insole have small beneficial effect.
There is 'silver' level evidence that strapped insoles correct leg alignment. However, long-term adherence to brace and insole treatment is low. There is no evidence whether a brace is more effective than an insole.

 

Plain language summary

Braces and orthoses for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of braces and orthoses for osteoarthritis (OA) of the knee.

The review shows that in people with OA of the knee :

wearing a knee brace compared to no brace:

increases the distance you are able to walk.
may not lead to any difference in pain, knee function, or quality of life.

wearing a laterally wedged orthosis compared to wearing a neutral wedge:

may not lead to any difference in pain, knee function or overall well-being.

wearing an elastically strapped insole compared to wearing a traditional lateral wedge after 6 months:

may improve pain and function.

We often do not have precise information about side effects and complications. Possible side effects may include pain in the back of the knee, low back pain, foot sole pain, skin irritation and poor fit.

An assessment of any changes in the x-rays of the joints over the long term was not measured in these studies.

What is osteoarthritis and what are braces and orthoses?
Osteoarthritis (OA) is the most common form of arthritis that can affect the hands, hips, shoulders and knees. In OA, the cartilage that protects the ends of the bones breaks down and causes pain and swelling. OA can occur in different areas of the knee or the whole knee. Depending on the area, OA can change the alignment of joints. Braces and orthoses are devices that you wear to support your knee joint. Orthoses are insoles that fit comfortably inside your shoes. Braces are made of combinations of metal, foam, plastic, elastic material and straps. A knee brace can be fitted especially for the person wearing it.

Best estimate of what happens to people with OA who use a knee brace:

Walking distance: People were able to walk 1.8 km longer after wearing a knee brace for one year. These results are based on high quality evidence.

Best estimate of what happens to people with OA who wear foot or ankle orthoses:

Pain: People's pain was reduced by 14 more points on a scale of 0 to 100 after wearing an orthoses for 6 months. These results are based on low quality evidence.

The numbers given are our best estimate. When possible, we have also presented a range because there is a 95 percent chance that the true effect of the treatment lies somewhere between that range.

 

摘要

背景

支架及輔具用於治療膝退化性膝關節炎

膝退化性關節炎可以支架及輔具(鞋墊)治療，目標為減少疼痛、改善功能及減緩惡化。本文原本發表在2005年第一期。

目標

研究支架及輔具治療膝退化性關節炎的效果。

搜尋策略

在原本的回顧中搜尋包括Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE (Current contents, Health STAR) (直到2002年10月)。在這個更新中搜尋至2007年5月，同時審查所有試驗的參考文獻

選擇標準

包含所有比較支架及輔具治療膝退化性關節炎之隨機對照試驗及對照控制試驗。

資料收集與分析

三位作者獨立進行資料摘錄，並對每篇試驗研究的品質進行評估。因研究間有異質性所以無法進行統合分析。

主要結論

包括了5個研究包含589例病患，包括2篇支架及3篇輔具治療退化性關節炎的研究。較長的追蹤研究﹝1到2年﹞顯示許多病患停止支架及鞋墊使用。有篇研究支架及氯丁橡膠套，在6個月改善疼痛與功能。另一研究顯示支架改善疼痛與功能，但只有走路距離顯著長一些。有篇研究顯示側面楔形鞋墊減少非類固醇消炎藥使用及醫囑順從性比正中楔形鞋墊好，但在6個月及24個月兩組之功能分數無顯著差異。有篇鞋墊研究顯示在6個月追蹤，繞紮固定鞋墊比傳統側面楔形鞋墊減少疼痛分數(相對減少百分比29%)。繞紮固定鞋墊組之脛股骨角度，在6個月及24個月較進步(相對減少百分比在2個時間點皆為 1.1%)。24個月時兩組之疼痛及功能分數無顯著差異。

作者結論

包括2篇支架及3篇鞋墊治療退化性關節炎的研究指出，有銀級的證據(www.cochranemsk.org)顯示支架及側面楔形鞋墊使用有小的效果。有銀級的證據顯示繞紮固定鞋墊矯正腳的姿勢。但支架及鞋墊治療的長期遵囑低。無證據顯示支架比鞋墊好。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

此Cochrane回顧摘要了我們從研究所知道有關支架及輔具對膝蓋退化性關節炎的效果。回顧顯示， 在膝蓋退化性關節炎患者：比較穿戴膝蓋支架與不穿支架：增加能走路距離，但可能不會對疼痛，膝關節功能，或生活品質有差別。 比較穿側面楔形鞋墊與正中楔形鞋墊：可能不會導致任何疼痛，膝關節功能或整體健康的差異。 比較穿彈性繞紮固定鞋墊與傳統的外側楔形鞋墊6個月後，穿彈性繞紮固定鞋墊可以改善疼痛和功能。 我們往往沒有確切關於副作用和併發症的資訊。 可能的副作用可能包括膝蓋後部疼痛，下背痛，足底疼痛，皮膚刺激和不適應。但這些研究沒有作長期關節X光的評估。 什麼是退化性關節炎和什麼是支架及輔具？ 退化性關節炎是關節炎會最常見的形式，會影響手、髖部、肩膀和膝蓋。在退化性關節炎，保護兩端骨頭的軟骨破損，導致疼痛和腫脹。退化性關節炎可以發生在膝蓋不同區域或整個膝蓋。根據不同的區域，退化性關節炎可以改變關節排列。支架和輔具是穿來支撐膝關節的設備。輔具是放在鞋子內的鞋墊可以讓腳舒適。支架是由金屬，泡沫，塑料，彈性材料和肩帶組成。膝關節支架在穿著時特別合身。 退化性關節炎病患穿戴膝關節支架，最樂觀估計會發生什麼事：步行距離：在穿著支架一年後，病患可以步行1.8公里。這些結果是基於高品質的證據。 退化性關節炎病患穿戴足部或腳踝輔具，最樂觀估計會發生什麼事：疼痛：在穿著輔具6個月後，病患疼痛減少了最少14分(其量表為 0到100)。這些結果是根據低品質的證據。列舉的數字是我們最好的估計。如果可能，我們也提出了一個範圍，因為有95% 的機會真正的治療效果是介於這個範圍之間。