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The effects of mechanical interventions in the management of knee osteoarthritis

BACKGROUND

Biomechanical factors are believed to play a key role in the etiology of knee OA. Therefore, one broad class of interventions for managing knee OA involves application, or wear, of devices aimed at presumably altering an individual’s biomechanics to modify or reduce joint loads. Such interventions include bracing, taping, orthotics, footwear, or mobility aids such as canes. The Osteoarthritis Society International (OARSI) guidelines conditionally recommend use of gait aids and wedged insoles for knee OA management, but conditionally to strongly recommend against taping and bracing, reportedly based on low quality evidence and lack of clear efficacy. However, knee OA is a heterogeneous condition, and it may be that more appropriately identified subgroups of patients may be more likely to respond to mechanical interventions.

We aim to: (i) evaluate relative efficacy of mechanical interventions (i.e., bracing, taping, orthoses, footwear, or canes) in managing knee OA symptoms; (ii) identify subgroups of individuals who respond to mechanical interventions; and (iii) identify mediators of the effect of these interventions on outcomes.

METHODS

We are conducting a systematic review and individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs) of adults with knee OA. We will include any intervention involving use or wear of mechanical devices (e.g., bracing, taping, orthotics, footwear, cane) that is evaluated after more than one day or application of wear/use, in comparison to any non-surgical intervention. Our primary outcome will be pain, and we will also include outcomes of function, quality of life, global perceived change, OA feature severity, and biomechanics. For all included studies, we will invite lead investigators to share anonymized IPD. We will conduct meta-analyses following a two-stage approach, analyzing each trial separately first, then analyzing across trials.

STATUS

Ongoing. We submitted our study protocol to the International Prospective Register of Systematic Reviews (PROSPERO) on October 23, 2019, and as of February 28, 2020 are waiting for the protocol to be evaluated and published. We are currently screening studies for inclusion to our review.

LINKS

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MEMBERS

Erin M Macri 1

Michael Callaghan 2

Marienke van Middelkoop 1

Sita MA Bierma-Zeinstra 1

1. Erasmus MC Medical University Center Rotterdam, Department of General Practice, The Netherlands; 2. Manchester Metropolitan University, Department of Health Professions, Manchester, UK; Manchester University Hospital Foundation Trust, Department of Physiotherapy, Manchester, UK; Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK.

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