Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders

Abstract

ObjectivesTo assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder.DesignA systematic review of primary studies.SettingCommunity.ParticipantsAdults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee.InterventionsOrthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material.Primary and secondary outcome measuresCondition-specific or generic patient-reported outcome measures assessing function, disability, independence, activities of daily living, quality of life or psychosocial outcomes; pain; walking ability; functional assessments; biomechanical analysis; adverse effects; usage; patient satisfaction and the acceptability of a device; and resource utilisation data.ResultsTwenty-one studies including 478 patients were included. Orthotic devices were evaluated in patients with postpolio syndrome, poststroke syndrome, inclusion body myositis and spinal cord injury. The review included 2 randomised controlled trials (RCTs), 3 non-randomised controlled studies and 16 case series. Most were small, single-centre studies with only 6 of 21 following patients for 1 year or longer. They met between one and five of nine quality criteria and reported methods and results poorly. They mainly assessed outcomes related to gait analysis and energy consumption with limited use of standardised, validated, patient-reported outcome measures. There was an absence of evidence on outcomes of direct importance to patients such as reduction in pain and falls.ConclusionsThere is a need for high-quality research, particularly RCTs, of orthotic devices for knee instability related to neuromuscular and central nervous system conditions. This research should address outcomes important to patients. There may also be value in developing a national registry.Registration number systematic reviewPROSPERO (CRD42014010180).

Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: qualitative interview study of patient perspectives

“…As part of the same project, we also undertook a systematic review of the evidence on effectiveness of orthotic devices for the management of knee instability in adults with a neuromuscular or CNS disorder 23. The review found that effectiveness studies focused on outcomes such as gait quality and energy consumption, assessed in the clinic setting.…”

Report: NIA workshop on translating genetic variants associated with longevity into drug targets

“…To date, candidate gene and genome-wide association studies (GWAS) have led to the discovery of longevity-associated variants (LAVs; mostly single nucleotide polymorphisms (SNPs)), such as those identified in the FOXO3A and APOE genes. Many of these LAVs have been replicated in multiple population cohorts and are thought to not only enhance longevity but potentially protect individuals from diseases as well (Flachsbart et al 2017 ; Nebel et al 2011 ; Willcox et al 2006 ; Pilling et al 2017 ; McDaid et al 2017 ; Joshi et al 2016 ; Sebastiani et al 2017a ; Partridge et al 2018 ). As a result, it is believed that the identification of LAVs can lead to the identification of therapeutic targets to enhance outcomes, e.g., cardiovascular health, metabolic function, healthy aging, and ultimately life span.…”

Early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke

“…Postural support requires the ability to load stance limbs without collapsing, and external supports are recommended to prevent knee collapse24 ) . Previous systematic reviews reported that KAFOs are used when the mechanical control of a knee joint is required for weight-bearing14, 25, 26 ) . AFOs are often used in a similar manner to KAFOs, and previous research on the effects of AFOs on standing balance have suggested that wearing AFOs to stabilize the ankle joint improved weight bearing on paretic lower limbs and decreased body sway in static standing16,17,18 ) .…”

“…Conversely, a knee-ankle-foot orthosis (KAFO) is usually provided only to people with severe motor impairment2, 13 ) when bracing with an AFO is insufficient to adequately control knee instability14, 15 ) . A KAFO controls knee instability while weight bearing and is used to enable people with severe stroke to stand and walk early after stroke onset.…”