Bierma-Zeinstra, Sita MA

Kloprogge, Sabine E.

Szilagyi, Ingrid A.

Journal of Physiotherapy

English

Sabine E Kloprogge

Ingrid A Szilagyi

Sita MA Bierma-Zeinstra

Directory of Open Access Journals

Critically appraised paper: Stable supportive shoes improved knee pain more than flat flexible shoes in people with moderate to severe radiographic medial knee osteoarthritis [commentary]

EUR Research Repository

AppraisalCritically appraised paper: Stable supportive shoes improved knee painmore than flat flexible shoes in people with moderate to severe radiographicmedial knee osteoarthritisSynopsisSummary of: Paterson KL, Bennell KL, Campbell PK, Metcalf BR, WrigleyTV, Kasza J, Hinman RS. The effect of flat flexible versus stable supportiveshoes on knee osteoarthritis symptoms: a randomized trial. Ann InternMed. 2021;174:462–471.Question: Are flat flexible shoes superior to stable supportive shoes inimproving walking knee pain and physical dysfunction in people withmoderate to severe radiographic medial knee osteoarthritis? Design: Su-periority randomised controlled trial with concealed allocation and blindedoutcome assessment. Setting: Community participants from Melbourne,Australia. Participants: Adults aged  50 years with knee pain on mostdays of the past month; knee pain during walking in the past week of  4on an 11-point numerical rating scale; and moderate to severe radiographictibiofemoral osteoarthritis (Kellgren-Lawrence grade 3 to 4). Main exclu-sion criteria were: lateral  medial joint space narrowing, recent (past 6months) or planned (next 6 months) knee surgery, and/or currently usingshoe orthoses or customised shoes. Randomisation of 164 participantsallocated 82 to flat flexible footwear and 82 to stable supportive footwear.Interventions: Flat flexible shoes had heel height, 15 mm, shoe pitch, 10mm, no arch support, minimal sole rigidity and weighed  200 grams.Stable supportive shoes had heel height . 30 mm, shoe pitch . 10 mm,arch support, rigid sole and weighed . 300 grams. Participants chose twodifferent pairs within their allocated group and were advised to increaseshoe wear by 1 hour/day until wearing the shoes as much as possible ( 6hours/day) for 6 months. Outcome measures: Primary outcomes were6-month change in: average walking pain over the previous week via an11-point numerical rating scale (0 = no pain, 10 = worst pain possible); andphysical function via the Western Ontario and McMaster UniversitiesOsteoarthritis Index function subscale (0 = no dysfunction, 68 = maximumdysfunction). Secondary outcome measures were Knee Injury and Osteo-arthritis Outcome Score subscales, pain in back/hips/knees/feet/ankles,health-related quality of life, physical activity and global changes in painand physical function. Results: In total, 161 (98%) participants completedthe study. There was no evidence found at 6 months that flat flexible shoeswere superior to stable supportive shoes regarding any primary or sec-ondary outcome. There was evidence showing a between-group differencein change in pain favouring stable supportive shoes (1.1 units, 95% CI 0.5 to1.8), but not function (2.3 units, 95% CI –0.9 to 5.5). Fewer participantsreported adverse events with stable supportive shoes (n = 12, 15%)compared with flat flexible shoes (n = 26, 32%) (risk difference –0.17, 95% CI–0.30 to –0.05). Conclusion: Flat flexible shoes were not superior to stablesupportive shoes. Stable supportive footwear resulted in greater reductionsin walking knee pain over 6 months and may be a useful self-managementstrategy in this subgroup of patients with knee osteoarthritis.Provenance: Invited. Not peer reviewed.Nina ØsteråsDivision of Rheumatology and Research, Diakonhjemmet Hospital, Oslo,Norwayhttps://doi.org/10.1016/j.jphys.2021.08.006CommentaryA recent overview of international guideline recommendations onnonpharmacological and nonsurgical interventions for osteoarthritis re-ported conflicting advice on shoes for knee osteoarthritis.1 This timely,high-quality randomised controlled trial addressed this issue bycomparing two types of shoes for knee osteoarthritis patients. The authorshypothesised that flat flexible shoes would lead to greater improvementsin knee pain and physical function compared to stable supportive shoesover 6 months. Interestingly, contrary to what they expected, stablesupportive footwear led to greater reductions in knee pain duringwalking.The study was well conducted with high internal validity. However,there were some limitations. First, the authors concluded that stablesupportive footwear led to greater reductions in knee pain, but the dif-ferences with the flat flexible shoes did not meet the pre-specified min-imum clinically important difference.2 Second, the generalisability toclinical practice is limited, as guidelines state that you do not needradiography for non-surgical treatment of knee osteoarthritis.3Approximately half of the eligible patients with no or mild radiographicor non-medial osteoarthritis were excluded. The authors justified theseinclusion criteria because people with moderate to severe knee osteoar-thritis are more likely than those with mild disease to benefit fromfootwear designed to reduce medial knee loading. However, this contra-dicts their statement in the discussion that it is unlikely that their findingswould differ in the subgroup with mild knee osteoarthritis.Overall, this high-quality randomised controlled trial brings us a stepcloser to answering the question of which shoes are most suitable inreducing pain in knee osteoarthritis.Provenance: Invited. Not peer reviewed.Sabine E Kloprogge, Ingrid A Szilagyi and Sita MA Bierma-ZeinstraDepartment of General Practice, Erasmus MC, University Medical Center,Rotterdam, The Netherlandshttps://doi.org/10.1016/j.jphys.2021.08.005References1. Bierma-Zeinstra S, et al. Best Prac Res Clin Rheumatol. 2020;34:101564.2. Chan LS. Am J Public Health. 2013;103:e24–e25.3. Sakellariou G, et al. Ann Rheum Dis. 2017;76:1484–1494.Journal of Physiotherapy 67 (2021) 3101836-9553/© 2021 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).journa l homepage: www.elsevier.com/ locate/ jphys

Critically appraised paper:Stable supportive shoes improved knee pain more than flat flexible shoes in people with moderate to severe radiographic medial knee osteoarthritis [commentary]

https://pure.eur.nl/files/42905050/Stable_supportive_shoes_improved_knee_pain_more_than_flat_flexible_shoes_in_people_with_moderate_to_severe_radiographic_medial_knee_osteoarthritis_commentary_.pdf

Critically appraised paper:Stable supportive shoes improved knee pain more than flat flexible shoes in people with moderate to severe radiographic medial knee osteoarthritis [commentary]

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

EUR Research Repository

EUR Research Repository