The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis

Abstract

BackgroundWe aimed to (i) evaluate the immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence, and (ii) to assess the difference in effect between a non-tight and a tight soft brace in patients with knee osteoarthritis (OA).MethodsForty-four patients with knee OA and self-reported knee instability participated in the single-session, laboratory, experimental study. A within-subject design was used, comparing a soft brace with no brace, and comparing a non-tight with a tight soft brace. The outcome measures were pain, self-reported knee instability and knee confidence during level and perturbed walking on the treadmill and activity limitations (10-m walk test and the get up and go (GUG) test). Linear mixed-effect model analysis for continuous outcomes and logistic generalized estimating equations for categorical outcomes were used to evaluate the effect of wearing a soft brace.ResultsWearing a soft brace significantly reduced pain during level walking (B − 0.60, P = 0.001) and perturbed walking (B − 0.80, P < 0.001), reduced the time to complete the 10-m walk (B − 0.23, P < 0.001) and the GUG tests (B − 0.23, P = 0.004), reduced self-reported knee instability during level walking (OR 0.41, P = 0.002) and perturbed walking (OR 0.36, P < 0.001), and reduced lack of confidence in the knees during level walking (OR 0.45, P < 0.001) and perturbed walking (OR 0.56, P < 0.001), compared with not wearing a soft brace. There was no difference in effects between a non-tight and tight brace, except for the 10-m walk test. Wearing a tight brace significantly reduced the time to complete the 10-m walk test in comparison with wearing a non-tight brace (B − 0.11, P = 0.03).ConclusionThe results of this study indicate that a soft brace is an efficacious intervention targeting pain, activity limitations, self-reported knee instability, and knee confidence in the immediate term in patients with knee OA. Further studies are needed evaluating the mode of action based on exerted pressure, and on the generalization to functioning in daily life.Trial registrationtrialregister.nl, NTR6363. Retrospectively registered on 15 May 2017.

Lower-Limb Exosuits for Rehabilitation or Assistance of Human Movement: A Systematic Review

“…To clinically evaluate lower-limb exosuits, various tasks were performed and monitored, including walking, balancing and activities of daily living. Walking was the most common task performed, including walking for several minutes (3 min [40], 5 min [7], 6 min [23,28] and 8 min walking [31]), walking at self-selected velocity or Froude velocity [27] (selected based on leg length) and walking for a determined distance of 10 m (10 MWT) [8,28,30,32,33,35,38,39] or 12 m [26]. The 10 MWT was the most common test in 8 of 19 studies.…”

“…The 10 MWT was the most common test in 8 of 19 studies. Activity-specific tasks included "get up and go" (GUG) [33], "timed get up and go" (TUG) [42], "sit-to-stand" test [34], perturbed walk [33], the functional independence measure [23], "Fugl-Meyer assessment of Motor Recovery after Stroke" [37] and the Barthel index [23]. Energy expenditure by the user was assessed by indirect calorimetry [8,28,31], oxygen consumption, heart rate and respiratory rate [23].…”

“…Muscle activity in the lower extremities was measured in four studies, using surface electromyography (EMG) [31,32,41,42]. Questionnaires were used in three studies to gather data about subjective parameters via an 11-point numerical rating scale (NRS) [33,39] or a custom questionnaire with rating from 0-5 [29]. Even though symptoms such as pain are difficult to measure due to their multifaceted and subjective nature [55], self-reported measures can be a reliant input in this kind of study [56].…”

“…The peak of knee adduction moment was also diminished by incorporating an inflatable air bladder into the design of a knee brace [26]. Furthermore, soft knee braces had an immediate positive effect on pain, activity limitations, self-reported knee instability and knee confidence in osteoarthritis [33]. Stretching elastic elements over hip, knee and ankle improved gait velocity [35], cadence, step length and stride length [38] in post-stroke subjects.…”

Objective parameters to measure (in)stability of the knee joint during gait: A review of literature

“…These include, correlation with self-reporting; sensitivity to interventions with known effects (e.g. knee braces [35,105] or muscle strengthening [34]); and test-retest reliability. All of these goals will require efforts from groups from the international community.…”