A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions.

BACKGROUND: Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE: The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS: Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS: A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS: At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness

A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis