TY - JOUR
T1 - Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders
AU - O'Connor, Joanne
AU - Rodriguez-Lopez, Roccio
AU - McCaughan, Dorothy
AU - Bowers, Roy
AU - Iglesias, Cynthia
AU - Lalor, Simon
AU - O'Connor, Rory
AU - Phillips, Margaret
AU - Ramdharry, Gita
AU - McDaid, Catriona
AU - Fayter, Deborah
AU - Booth, Alison
N1 - Note: This work was supported by the National Institute for Health Research (NIHR) HTA Programme (project number 13/30/02) and has been published in full in Health Technol Assess 2016;20(55).
PY - 2017/9/5
Y1 - 2017/9/5
N2 - Objectives To assess the effectiveness of orthotic devices
for the management of instability of the knee in adults
with a neuromuscular disorder or central nervous system
disorder.
Design A systematic review of primary studies.
Setting Community.
Participants Adults with a neuromuscular disorder or
central nervous system disorder and impaired walking
ability due to instability of the knee.
Interventions Orthoses with the clinical aim of controlling
knee instability, for example, knee-ankle-foot orthoses,
ankle-foot orthoses and knee orthoses or mixed design
with no restrictions in design or material.
Primary and secondary outcome measures Conditionspecific
or generic patient-reported outcome measures
assessing function, disability, independence, activities of
daily living, quality of life or psychosocial outcomes; pain;
walking ability; functional assessments; biomechanical
analysis; adverse effects; usage; patient satisfaction and
the acceptability of a device; and resource utilisation
data.
Results Twenty-one studies including 478 patients were
included. Orthotic devices were evaluated in patients
with postpolio syndrome, poststroke syndrome, inclusion
body myositis and spinal cord injury. The review included
2 randomised controlled trials (RCTs), 3 non-randomised
controlled studies and 16 case series. Most were small,
single-centre studies with only 6 of 21 following patients
for 1 year or longer. They met between one and five of nine
quality criteria and reported methods and results poorly.
They mainly assessed outcomes related to gait analysis
and energy consumption with limited use of standardised,
validated, patient-reported outcome measures. There was
an absence of evidence on outcomes of direct importance
to patients such as reduction in pain and falls.
Conclusions There is a need for high-quality research,
particularly RCTs, of orthotic devices for knee instability
related to neuromuscular and central nervous system
conditions. This research should address outcomes
important to patients. There may also be value in
developing a national registry
AB - Objectives To assess the effectiveness of orthotic devices
for the management of instability of the knee in adults
with a neuromuscular disorder or central nervous system
disorder.
Design A systematic review of primary studies.
Setting Community.
Participants Adults with a neuromuscular disorder or
central nervous system disorder and impaired walking
ability due to instability of the knee.
Interventions Orthoses with the clinical aim of controlling
knee instability, for example, knee-ankle-foot orthoses,
ankle-foot orthoses and knee orthoses or mixed design
with no restrictions in design or material.
Primary and secondary outcome measures Conditionspecific
or generic patient-reported outcome measures
assessing function, disability, independence, activities of
daily living, quality of life or psychosocial outcomes; pain;
walking ability; functional assessments; biomechanical
analysis; adverse effects; usage; patient satisfaction and
the acceptability of a device; and resource utilisation
data.
Results Twenty-one studies including 478 patients were
included. Orthotic devices were evaluated in patients
with postpolio syndrome, poststroke syndrome, inclusion
body myositis and spinal cord injury. The review included
2 randomised controlled trials (RCTs), 3 non-randomised
controlled studies and 16 case series. Most were small,
single-centre studies with only 6 of 21 following patients
for 1 year or longer. They met between one and five of nine
quality criteria and reported methods and results poorly.
They mainly assessed outcomes related to gait analysis
and energy consumption with limited use of standardised,
validated, patient-reported outcome measures. There was
an absence of evidence on outcomes of direct importance
to patients such as reduction in pain and falls.
Conclusions There is a need for high-quality research,
particularly RCTs, of orthotic devices for knee instability
related to neuromuscular and central nervous system
conditions. This research should address outcomes
important to patients. There may also be value in
developing a national registry
KW - Allied health professions and studies
UR - http://bmjopen.bmj.com/content/7/9/e015927.long
U2 - 10.1136/bmjopen-2017-015927
DO - 10.1136/bmjopen-2017-015927
M3 - Article
C2 - 28877943
SN - 2044-6055
VL - 7
JO - BMJ Open
JF - BMJ Open
M1 - e015927
ER -