Impact of cane use on pain, function, general health and energy expenditure during gait in patients with knee osteoarthritis: a randomised controlled trial

Abstract

Objective To assess the impact of daily cane use during gait in relation to pain, function, general health and energy expenditure among patients with knee osteoarthritis. Method Sixty-four patients were randomly assigned to an experimental group (EG) or control group (CG). The EG used a cane every day for 2 months, whereas the CG did not use a cane in this period. The fi rst outcome was pain and the second were function (Lequesne and WOMAC), general health (SF-36) and energy expenditure (gas analysis during the 6-minute walk test (6MWT) with and without a cane). Evaluations were performed at baseline, 30 and 60 days. Results The groups were homogeneous for all parameters at baseline. Compared with the CG, the EG signifi cantly improved pain (ES 0.18), functionLequesne (ES 0.13), some domains of SF-36 (role physical, ES 0.07 and bodily pain, ES 0.08) and distance on the 6MWT with the cane (ES 0.16). At the end of the 6MWT with the cane, the EG signifi cantly improved energy expenditure (ES 0.21), carbon dioxide production (ES 0.12) and metabolic equivalents (ES 0.15) compared with the CG.

A Biomechanical Perspective on Physical Therapy Management of Knee Osteoarthritis

“…22 Contralateral cane use can also effectively diminish pain and improve function and some aspects of quality of life in patients with knee OA. 103 Recent randomized clinical trials of patients with knee OA demonstrated significantly diminished pain and improved physical function after 2 months of daily cane use. 103,135 For optimal efficacy, patients with knee OA should be instructed to use a cane on the contralateral side and as far laterally as possible to optimize reductions in knee loads.…”

“…103 Recent randomized clinical trials of patients with knee OA demonstrated significantly diminished pain and improved physical function after 2 months of daily cane use. 103,135 For optimal efficacy, patients with knee OA should be instructed to use a cane on the contralateral side and as far laterally as possible to optimize reductions in knee loads. Placing the cane at a longer lateral distance can create neutralizing knee abduction moments to further counteract and decrease KAM during gait.…”

“…The prescription of cane use for novice users should take into account the substantial increase in energy expenditure at the onset of cane use, 102 which decreases over time through an ongoing process of adaptation to using an assistive device. 103 Clinicians should also be reminded that, although cane use appears to be an effective offloading strategy, lack of patient compliance is a significant clinical obstacle, due to a common patient perception that canes are for frail, elderly people and imply aging.…”

Managing osetoarthritis

“…6 Mobility aids such as a stick (used in the opposite hand), knee braces and foot orthoses can also diminish pain and improve function. [7][8][9] Obesity is the single most important modifiable risk factor. 2,10 A meta-analysis found that a 5% decrease in weight within a 20-week period is beneficial for knee osteoarthritis.…”

Evidence-Based Recommendations for the Management of Knee Osteoarthritis: A Consensus Report of the Turkish League Against Rheumatism

“…A study which evaluated the effect of using walking sticks revealed that for patients who used them for two months, a small but significant amount of improvement occurred in their pain and function (effect sizes 0.18, 95% CI -0.42-0.87 and 0,13, 95% CI -0.11-0.42, respectively) (LOE Ib). [27] If involvement is unilateral, sticks or crutches should be used contralaterally. In case of bilateral involvement, simple walkers or walkers with rollers should be the preference.…”