Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses

doi:10.1016/j.apmr.2017.04.029

Archives of Physical Medicine and Rehabilitation

Volume 99, Issue 1, January 2018, Pages 153-163

https://doi.org/10.1016/j.apmr.2017.04.029 Get rights and content

Abstract

Objectives

To systematically review and synthesize the effects of soft braces on pain and on self-reported and performance-based physical function in patients with knee osteoarthritis.

Data Sources

The following electronic databases were searched from inception to April 20, 2016: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, SPORTDiscus, Web of Science, and PEDro.

Study Selection

Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs), such as controlled clinical trials, crossover studies, and case-control studies, were included. Two reviewers independently screened articles and determined inclusion through predefined criteria.

Data Extraction

Data related to participant demographics, study design and methods, interventions, and outcomes, including numerical means and SDs, were extracted by 1 reviewer. Methodological quality assessment was independently performed by 2 reviewers.

Data Synthesis

Eleven studies were identified, including 6 RCTs and 5 non-RCTs. The methodological quality of included RCTs was low. There was a moderate improvement in pain (standardized mean difference [SMD]=.52; 95% confidence interval [CI], .14–.89; P=.007; 284 participants) in favor of wearing a brace compared with not wearing a brace for the immediate, within-group comparison. There was a moderate improvement in pain (SMD=.61; 95% CI, .33–.89; P<.001; 206 participants) and a small to moderate improvement in self-reported physical function (SMD=.39; 95% CI, .11–.67; P=.006; 206 participants) in favor of patients receiving a soft brace versus standard care for the prolonged effect, between-group comparison.

Conclusions

Currently available evidence indicates that soft braces have moderate effects on pain and small to moderate effects on self-reported physical function in knee osteoarthritis. These findings highlight the importance of soft braces as a technique to improve pain and physical function in both the short- and long-term. Additional high-quality studies are warranted to improve confidence in the findings.

Section snippets

Protocols and registration

A detailed protocol for the present study has been previously published in PROSPERO, an international database of prospectively registered systematic reviews in health and social care (PROSPERO record registration no.: CRD42016037375). The article is written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.⁷

Study types

Randomized controlled trials (RCTs) and non-RCTs, such as controlled clinical trials, crossover studies, and case-control studies, were

Study selection

The literature search resulted in a total number of 1661 hits. After duplicate removal, 1121 hits were screened on title and abstract. This resulted in 28 full-text articles that were studied for eligibility, of which 11 articles were included in the systematic review (fig 1).

Characteristics of included studies

Six studies24, 25, 26, 27, 28, 29 were RCTs and 54, 30, 31, 32, 33 were non-RCTs. In 9 studies,4, 26, 27, 28, 29, 30, 31, 32, 33 the degree of knee OA was scored according to K&L grade, American College of Rheumatology

Discussion

The objective of this study was to investigate whether soft braces reduce pain and improve physical function in knee OA. To our knowledge, this is the first, most definitive, up-to-date and comprehensive systematic review with meta-analyses on the effects of soft braces on pain, and self-reported and performance-based physical function in patients with knee OA. We observed that wearing a brace resulted in a reduction of pain in the immediate-term. Prolonged improvement in both pain and

Conclusions

Within the limitations of this systematic review, the results suggest that current soft bracing strategies for knee OA result in moderate improvements in pain and small to moderate improvements in self-reported physical function. These findings highlight the importance of soft braces as a technique to affect pain and physical function in both the short- and long-term. Additional high-quality studies investigating the efficacy of soft braces for knee OA are warranted to improve confidence in the

Supplier

a.
Review Manager (RevMan 5.3) computer software; The Nordic Cochrane Centre, The Cochrane Collaboration, 2014. Available at: http://ims.cochrane.org/revman.

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Fundamentals of osteoarthritis. Rehabilitation: Exercise, diet, biomechanics, and physical therapist-delivered interventions
2023, Osteoarthritis and Cartilage
Insights related to the pathogenesis of osteoarthritis (OA) have informed rehabilitative treatments that aim to mitigate the influence of several known impairments and risk factors for OA, with the goal to improve pain, function, and quality of life. The purpose of this invited narrative review is to provide fundamental knowledge to non-specialists about exercise and education, diet, biomechanical interventions, and other physical therapist-delivered treatments. In addition to summarizing the rationale for common rehabilitative therapies, we provide a synthesis of current core recommendations. Robust evidence based on randomized clinical trials supports exercise with education and diet as core treatments for OA. Structured, supervised exercise therapy is advised. The mode of exercise may vary but should be individualized. The dose should be based on an initial assessment, the desired physiological changes, and progressed when appropriate. Diet combined with exercise is strongly recommended and studies demonstrate a dose–response relationship between the magnitude of weight loss and symptom improvement. Recent evidence suggests the use of technology to remotely deliver exercise, diet and education interventions is cost-effective. Although several studies support the mechanisms for biomechanical interventions (e.g., bracing, shoe inserts) and physical therapist-delivered (passive) treatments (e.g., manual therapy, electrotherapeutic modalities) fewer rigorous randomized trials support their clinical use; these therapies are sometimes recommended as adjuncts to core treatments. The mechanisms of action for all rehabilitative interventions include contextual factors such as attention and placebo effects. These effects can challenge our interpretation of treatment efficacy from clinical trials, yet also provide opportunities to maximize patient outcomes in clinical practice. When evaluating rehabilitative interventions, the field may benefit from increased emphasis on research that considers contextual factors while evaluating mechanistic, longer-term, clinically-important and policy-relevant outcome measures.
Nonpharmacologic and Rehabilitative Strategies to Address Chronic Pain
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Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis
2021, Mayo Clinic Proceedings
Citation Excerpt :
There are limited studies on the harms and benefits of weight loss in OA of the hip in overweight and obese patients. Bracing with soft braces (defined by study authors as a nonelastic, nonadhesive material) or either valgus or varus knee braces may improve pain and self-reported physical function in the knee.21,22 For bracing, although the evidence did not specifically identify harms associated with the use of bracing, the work group recognized that bracing can lead to atrophy and functional loss if appropriate exercise is also not undertaken.
In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine’s tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched (ie, Cochrane Database of Systematic Reviews, EMBASE, MEDLINE PreMEDLINE, PubMed, and the Agency for Healthcare Research and Quality website) and evaluated the literature, created a simple 1-page algorithm, and advanced 19 recommendations using the Grading of Recommendations Assessment, Development, and Evaluation system. This synopsis summarizes key recommendations in all 6 topics covered in the guideline. These topics are diagnosis, self-management, physical therapy, pharmacotherapy, orthobiologics, and complementary and integrative health.
Intermittent vibrational stimulation enhances mobility during stair navigation in patients with knee pain
2021, Gait and Posture
Citation Excerpt :
Intermittent stimulus was selected to prevent adaptation of cutaneous receptors to continuous stimulus [26,27]. Treatment B (passive, pressure only) was a commercially available passive dual knee band, marketed for knee pain relief (Hueglo®) (Fig. 1a), selected on the basis of applying isolated compression, shown to reduce knee pain in persons with knee OA [28,29]. Subjects were tested using a single-center, single-blind randomized longitudinal crossover study design.
Reduced quadriceps function and proprioception can cause decreased mobility during stair navigation in patients with knee pain. Patients can benefit from interventions to mitigate pain and restore quadriceps function. Activating the somatosensory system via intermittent vibrational stimulation has the potential to improve stair navigation mobility in patients with knee pain by moderating quadriceps inhibition and enhancing proprioception.
What are the effects of intermittent vibrational stimulus synchronized to stair ambulation on muscle activity, kinematics, kinetics, and pain using a randomized controlled clinical trial design.
Thirty-eight patients with knee pain were enrolled into a blinded cross-over study, and twenty-nine patients completed all assessments and analyses. Subjects were randomly assigned sequentially to both an active Treatment A (active) and passive Treatment B (passive) worn at the knee during ambulation for 4 weeks with a 2-week washout period between treatments.
Knee pain during stair navigation was significantly reduced only with Treatment A (P = 0.007). During ascent, Treatment A (active) significantly increased vastus lateralis activation (P = 0.01), increased knee flexion moment (P = 0.04) and decreased trunk flexion angles (P = 0.015) between baseline and 4-week follow-up. After using passive Treatment B, there were no significant differences in pain (P = 0.19), knee flexion moment (P = 0.09), and trunk flexion angles (P = 0.23). Changes in muscle function correlated significantly with changes in knee flexion moment and trunk flexion with Treatment A (P < 0.015).
Descending differed from ascending in response to Treatment A with significantly decreased knee flexion moment(P = 0.04), hip(P = 0.02) and ankle(P = 0.04) flexion angles. Treatment B significantly reduced hip flexion angles (P = 0.005) but not knee flexion moment (P = 0.85).
The results of this study suggest that intermittent vibration can improve joint motion and loading during stair navigation by enhancing quadriceps function during stair ascent and improving movement control during stair descent by modifying an adaptive flexed movement pattern in the lower limb.
Two Weeks of Wearing a Knee Brace Compared With Minimal Intervention on Kinesiophobia at 2 and 6 Weeks in People With Patellofemoral Pain: A Randomized Controlled Trial
2020, Archives of Physical Medicine and Rehabilitation
To investigate the effect of a knee brace compared with minimal intervention on self-reported kinesiophobia and function, objective function, and physical activity level in people with patellofemoral pain (PFP).
Single-blind randomized controlled trial (1:1), parallel.
Individuals with PFP (N=50).
Primary: kinesiophobia (Tampa Scale for Kinesiophobia). Secondary: self-reported function (Anterior Knee Pain Scale), physical activity level (International Physical Activity Questionnaire), and objective function (forward step-down test). Outcomes were assessed at baseline (T₀), at the end of the intervention (2wk) (T₁), and at 6 weeks after baseline (T₂).
Participants were randomly assigned to 1 of 2 interventions groups: (1) use of knee brace for 2 weeks during daily living, sports, or painful tasks (brace group) and (2) educational leaflet with information about PFP (leaflet group).
The knee brace reduced kinesiophobia in people with PFP compared with minimal intervention with moderate effect size at T₁=mean difference (95% CI) −5.56 (−9.18 to −1.93) and T₂=−5.24 (−8.58 to −1.89). There was no significant difference in self-reported and objective function and physical activity level.
The knee brace improved kinesiophobia immediately after intervention (at 2wk) and at 6-week follow-up in people with PFP compared with minimal intervention. A knee brace may be considered within clinically reasoned paradigms to facilitate exercise therapy interventions for people with PFP.
An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)
2019, Seminars in Arthritis and Rheumatism
The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) sought to revisit the 2014 algorithm recommendations for knee osteoarthritis (OA), in light of recent efficacy and safety evidence, in order to develop an updated stepwise algorithm that provides practical guidance for the prescribing physician that is applicable in Europe and internationally.
Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process, a summary of evidence document for each intervention in OA was provided to all members of an ESCEO working group, who were required to evaluate and vote on the strength of recommendation for each intervention. Based on the evidence collected, and on the strength of recommendations afforded by consensus of the working group, the final algorithm was constructed.
An algorithm for management of knee OA comprising a stepwise approach and incorporating consensus on 15 treatment recommendations was prepared by the ESCEO working group. Both “strong” and “weak” recommendations were afforded to different interventions. The algorithm highlights the continued importance of non-pharmacological interventions throughout the management of OA. Benefits and limitations of different pharmacological treatments are explored in this article, with particular emphasis on safety issues highlighted by recent literature analyses.
The updated ESCEO stepwise algorithm, developed by consensus from clinical experts in OA and informed by available evidence for the benefits and harms of various treatments, provides practical, current guidance that will enable clinicians to deliver patient-centric care in OA practice.

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: Supported by the European Union Marie Skłodowska-Curie Actions - Initial Training Networks, Seventh Framework Programme, under grant number 607510. European Union did not contribute to design, interpretation of data, drafting, and final approval of the manuscript.

: Disclosures: none.

View full text

Review article (meta-analysis)Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses

Abstract

Objectives

Data Sources

Study Selection

Data Extraction

Data Synthesis

Conclusions

Section snippets

Protocols and registration

Study types

Study selection

Characteristics of included studies

Discussion

Conclusions

Supplier

Osteoarthr Cartil

Joint Bone Spine

Osteoarthr Cartil

Osteoarthr Cartil

Aust J Physiother

Am J Prev Med

Control Clin Trials

Osteoarthr Cartil

Kaohsiung J Med Sci

Knee

Clin Biomech (Bristol, Avon)

J Orthop Sci

Braces and orthoses for treating osteoarthritis of the knee

Cochrane Database Syst Rev

Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis

Ann Rheum Dis

The effect of elastic bandages on human knee proprioception in the uninjured population

Am J Sports Med

The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration

BMJ

Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association

Arthritis Rheum

Radiological assessment of osteo-arthrosis

Ann Rheum Dis

A hierarchy of patient-reported outcomes for meta-analysis of knee osteoarthritis trials: empirical evidence from a survey of high impact journals

Arthritis

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

BMJ

The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions

J Epidemiol Community Health

Review article (meta-analysis)
Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses