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Question clinique
Is individually calibrated biomechanical footwear therapy effective for reducing pain and improving function in adults with knee degenerative joint disease?
L’Essentiel
In adults with symptomatic knee degenerative joint disease (DJD), the use of biomechanical footwear statistically significantly reduced pain compared with control footwear. The overall mean pain reduction score was approximately 1 on a visual analog scale of 0–10 (a difference of 2 or more is generally considered clinically significant). No between-group differences occurred in overall quality-of-life scores. 1b
Référence
Plan de l'etude: Randomized controlled trial (single-blinded)
Financement: Industry + foundation
Cadre: Outpatient (any)
Sommaire
A biomechanical footwear system consists of shoes with 2 convex pods on the outsoles, which can be individually calibrated to alter limb biomechanics and reduce stress on osteoarthritic knees. These investigators identified adults (N = 220), 40 years or older, with symptomatic radiologically confirmed knee DJD lasting at least 6 months. Eligible participants randomly received (via concealed assignment) either the biomechanical footwear or control footwear specifically designed to have a similar appearance but no capacity to be individually calibrated. Patients masked to their treatment group assignment self-assessed outcomes using validated pain, function, and quality-of-life scoring tools. Complete follow-up occurred for 96.8% of patients at 24 weeks. Using intention-to-treat analysis, the mean pain score improved from 4.3 at baseline to 1.3 in the biomechanical footwear group and from 4.0 to 2.6 in the control group (between-group difference, -1.3; 95% CI -1.8 to -0.9; range 0–10, where 0 = no symptoms and 10 = extreme symptoms). Significantly more patients in the biomechanical footwear group achieved a 50% reduction in pain scores compared with patients in the control footwear group (83% vs 42%; number needed to treat = 3; 1 - 4). Similar results occurred for function scores, but there were no significant between-group differences for overall quality-of-life improvement. Similarly, the rate of rescue analgesic use did not differ between groups.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC