A cohort-controlled trial of the addition of customized foot orthotics to standard care in fibromyalgia

Abstract

Customized foot orthotics are widely prescribed for patients with chronic, non-specific low back pain and lower limb pain, but there are few trials demonstrating effectiveness, and none for fibromyalgia. A total of 67 consecutive patients presenting with chronic, widespread pain, who met the 1990 American College of Rheumatology criteria for fibromyalgia, were included in the study. A total of 32 subjects were prescribed a spinal exercise therapy program along with analgesics. These subjects formed the Control group. A second group, comprised of 35 subjects, received the same therapy, along with customized foot orthotics (Orthotics group). All subjects completed the Revised Fibromyalgia Impact Questionnaire (FIQR) at the initiation of the study and at 8 weeks follow-up. The number of subjects using any type of prescription analgesic or other medication for chronic pain at baseline and at 8 weeks was also recorded. A total of 30 subjects in the Control group and 33 in the Orthotics group completed the study. All subjects completed the baseline and 8-week FIQR. The two groups were well matched in terms of age (45.3 ± 11.5 years in the Orthotics group vs. 47.2 ± 8.7 years in the cohort Control), medication use, duration of pain (6.5 ± 4.3 years in the Orthotics group vs. 6.2 ± 3.4 years in the cohort Control group), as well as baseline FIQR scores (55.2 ± 11.0 in the Orthotics group vs. 56.3 ± 12.2 in the cohort Control group). At 8 weeks, the Orthotics group had a greater reduction in the FIQR score than the cohort Control group (reduction of 9.9 ± 5.9 vs. 4.3 ± 4.4, respectively), and this was mainly due to changes in the 'function' domain of the FIQR (reduction of 19.6 ± 9.4 in the Orthotics group vs. 8.1 ± 4.3 in the cohort Control group). As part of a complex intervention, in a cohort-controlled trial of primary care patients with fibromyalgia, the addition of custom-made foot orthotics to usual care appears to improve functioning in the short term.

Influence of multidisciplinary therapeutic approach on fibromyalgia patients

“…The scores of the parameters vary between different investigations, as well as between different countries. For instance, the FIQ total score was on average 54.8 in a French study (20), 55.8 in a Canadian sample (25), 68 in a Mexican FM population (26) and 70.8 in a Turkish investigation (27). In the present study, the FIQ average score, prior to commencing the program was 65.9.…”

A systematic review of questionnaires to assess patient satisfaction with limb orthoses

“…Functional characteristics of an orthosis are closely linked to its utilization. 7 The most frequently assessed characteristics were influence on activity, 13–15,18,19,21,23,28,31,39,42,49,56,57,60,66,71,75–77,79–81,84,87,93,94,96,97,99–101,107–110 pain relief 13,17,18,21,23,28,32,56,57,59–62,72,73,77,81,84,87–89,93,94,99–101,105,106 and time of use. 12,…”

“…In contrast, 39 articles (36.8%) discussed questionnaires with known psychometric characteristics. However, 24 of them used questionnaires measuring functional outcome (Carpal Tunnel Questionnaire, 18 Disabilities of the Arm, Shoulder and Hand questionnaire, 18 Michigan Hand Outcomes, 24,34 Knee injury and Osteoarthritis Outcome Score, 56 Western Ontario and McMaster osteoarthritis index, 57,60 Foot Health Status Questionnaire, 73,75,77,81,86,93,99 Fibromyalgia Impact Questionnaire, 101 Oswestry Disability Questionnaire, 94 Foot Function Index 76,79,80,96,97,99,100,102 and Oxford Ankle Foot Questionnaire for Children 113 ) to assess the patient’s opinion about orthotic efficacy. They did not analyse other important features related to PSwO, such as intrinsic characteristics of the orthosis and patient perception as regards weight, aesthetic appeal, ease in donning/doffing and comfort, which are the most assessed features in the other questionnaires.…”

“…Keeping the orthosis clean 28,43,47, [90][91][92] • Cost 15,37,38, 71 Functional characteristics General efficacy 10,11,21,23,32,35,36,42,62,73,75,77,81,84,93,94,[99][100][101][107][108][109][110]114,115 • • Perception of joint stability 46,47,49,53,57,60,[90][91][92]97,104,[107][108][109][110]112 • • Influence on activity [13][14][15]18,19,21,23,28,31,39,…”

Quality of life related to foot health status in women with fibromyalgia: a case-control study

“…Future interventional studies, i.e. generic treatments such as pregabalin [35] or specific interventions such as foot trigger points dry needling [36, 37] and custom-made foot orthotics [38] in women with fibromyalgia, could use these clinical differences as key references in order to normalize the specific foot and general health-related quality of life. In line with prior research [8], we highlight that health authorities should pay more attention to improving the general and foot specific health-related quality of life in women with fibromyalgia.…”