Knee osteoarthritis (OA) refers to a common disabling disorder that leads to considerable pain, immobility, functional impairment and reduced quality of life.
The
results of this study indicate the use of the unloading knee
brace in combination with usual care as a safe and superior therapy in
relieving global pain and improving motion as compared to routine care.
Knee osteoarthritis (OA) refers to a common disabling disorder that leads to considerable pain, immobility, functional impairment and reduced quality of life. It becomes prevalent as the age of the population increases. This medical condition affects one (unilateral) or both (bilateral) knees and may encompass all three joint compartments. The management of knee OA consists of a combination of both pharmacological (analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs [NSAIDs], and intra-articular corticosteroids) and non-pharmacological (exercise programs, self-management and education adaptation of activities, biomechanical interventions like, knee braces, foot orthoses) treatments.
In this randomised controlled clinical trial, the effect of unloading knee braces has been studied to apply corrective forces in an area away from the damaged compartment. These forces are implemented using a three-point pressure system, which distributes load away from the damaged compartment that decreases pain intensity and improves function.
Rationale behind research:
The unloading knee brace therapy can be used to diminish stress and pain across the knee. Pain reduction after brace use can be due to the neutral alignment of the knee and application of three-point pressures, and this research was conducted to clarify the above hypothesis.
Objective:
This study aimed to assess the additive effect of unloading knee brace for adjusting corrective forces, in the conservative treatment of medial OA.
Study outcomes
Time
Points: Baseline and 6
weeks
Outcomes:
Baseline: The baseline pain scores and Lequesne index were
high, indicating that symptomatic OA was associated with pain and very severe
disability
Study outcomes:
The results of this trial showed that a combination of the
REBEL RELIEVER unloading knee brace with usual care was superior to routine
care alone in terms of improvement of the last 24h-pain, pain on motion,
disease evolution, functional disability, assessed by both the patient and the
investigator, and clinical response rate after a 6-week treatment period.
Consistency has been observed among previously published data and the study
results, suggesting that treatment with unloader braces improves pain and
physical function. A significant decrease in knee adduction impulse (KAI) and
peak knee adduction moment (KAM) in the second half of the stance phase was
also observed at both 2 and 8 weeks compared to baseline. A reduction of more
than 40 mm last 24h-pain score on a 100-mm VAS and 50 mm in pain on motion
score in the Brace Group compared to baseline. The OMERACT-OARSI responder rate
was 75%, which is superior to that observed in previous clinical trials with
other products to reduce pain and improve function in medial knee
osteoarthritis patients.
The key strengths of this study are the robustness of its
design (randomised, comparative study, objective endpoints, data collection
methods, missing data [MD] handling, and ITT analysis). Additional strengths of
the ROTOR study were the excellent observance of the brace (observance index
>90%) and the low number of drops-out.
The study suggests that the 6-week
treatment with the unloading knee brace combined with usual care was found to
be safe and superior to routine care alone in relieving pain and improving
motion.
Philippe Thoumie et al. Scientific Reports. (2018) 8:10519
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