Physical therapy and orthopaedic equipment-induced reduction in the biomechanical risk factors related to knee osteoarthritis: a systematic review and Bayesian network meta-analysis of randomised controlled trials

Abstract

ObjectiveAre physical therapy or orthopaedic equipment efficacious in reducing the biomechanical risk factors in people with tibiofemoral osteoarthritis (OA)? Is there a better therapeutic intervention than others to improve these outcomes?DesignSystematic review with network meta-analysis (NMA) of randomised trials.Data sourcesPubMed, Web of Science, Cochrane Library, Embase and MEDLINE were searched through January 2021.Eligibility criteria for selecting studiesWe included randomised controlled trials exploring the benefits of using physical therapy or orthopaedic equipment in reducing the biomechanical risk factors which included knee adduction moment (KAM) and knee adduction angular impulse (KAAI) in individuals with tibiofemoral OA.Data extraction and synthesisTwo authors extracted data independently and assessed risk of bias. We conducted an NMA to compare multiple interventions, including both direct and indirect evidences. Heterogeneity was assessed (sensitivity analysis) and quantified (I2 statistic). Grading of Recommendations Assessment, Development and Evaluation assessed the certainty of the evidence.ResultsEighteen randomised controlled trials, including 944 participants, met the inclusion criteria, of which 14 trials could be included in the NMA. Based on the collective probability of being the overall best therapy for reducing the first peak KAM, lateral wedge insoles (LWI) plus knee brace was closely followed by gait retraining, and knee brace only. Although no significant difference was observed among the eight interventions, variable-stiffness shoes and neuromuscular exercise exhibited an increase in the first peak KAM compared with the control condition group. And based on the collective probability of being the overall best therapy for reducing KAAI, gait retraining was followed by LWI only, and lower limb exercise.ConclusionThe results of our study support the use of LWI plus knee brace for reducing the first peak KAM. Gait retraining did not rank highest but it influenced both KAM and KAAI and therefore it was the most recommended therapy for reducing the biomechanical risk factors.

Managing Genu Varum in Adolescents to Reduce Risks of Progression to Knee Osteoarthrosis

“…Intervention, including lower extremity exercises 22,23 and lateral wedged insole (LWI), has also been reported to reduce genu varum and EKAM in young adults. Strengthening the external hip rotators has been reported to reduce the magnitude of postural genu varum in young adults.…”

Association of the Degree of Varus Thrust during Gait Assessed by an Inertial Measurement Unit with Patient-Reported Outcome Measures in Knee Osteoarthritis

“…For example, several systematic reviews showed that foot orthosis, such as the lateral wedge insole, could reduce the degree of VT and knee adduction moment, which is strongly related to VT [ 51 , 52 ]. Additionally, Huang et al suggested that gait retraining and the use of knee braces, in addition to the insole, could be another approach to achieve greater improvements in the degree of VT using network meta-analysis of randomized trials [ 53 ]. Further studies, such as those with a prospective design or controlled trials, are strongly warranted to confirm the associations reported in this study and the effectiveness of the interventions to improve PROMs for patients with VT.…”

Gait Classification and Physical Function Characteristics in Maintenance Hemodialysis Patients

“…In physical therapy for patients with knee osteoarthritis, who have similar gait characteristics as hemodialysis patients, a strategy to reduce mechanical stress in the knee joint on the frontal plane associated with knee joint deformity is applied [35]. However, the treatment strategy for hemodialysis patients is usually different because there is no obvious deformity in the frontal plane.…”