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Clinical Orthopaedics and Related... Feb 2020To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To improve ankle stability in patients who have experienced an ankle sprain with residual symptoms of instability and/or objective joint laxity, external supports (such as taping, bracing, and orthotic insoles) are used sometimes. However, available randomized trials have disagreed on whether restraints improve balance in those individuals. In this situation, a network meta-analysis can help because it allows for comparing multiple treatments simultaneously, taking advantage not only of direct but also indirect evidence synthesis.
QUESTIONS/PURPOSES
The aim of this network meta-analysis was to assess (1) the impact of taping and orthotic devices on dynamic postural control in individuals with ankle instability and (2) the presence of a placebo effect in participants treated with sham taping and complications resulting from the administered treatments.
METHODS
We searched the PubMed, Scopus, and CENTRAL databases up to February 13, 2019 for completed studies. Randomized trials assessing the results of real and/or sham taping, wait-and-see protocols, ankle bracing, and foot orthotics for ankle instability as determined by one or more ankle sprains followed by ongoing subjective symptoms and/or mechanical laxity were included. We evaluated dynamic postural control in terms of the Star Excursion Balance Test in the posteromedial direction (SEBT-PM), which is considered the most representative of balance deficits in patients with ankle instability. Standardized mean differences were re-expressed to percentage differences in SEBT-PM, with higher scores representing possible improvement. Subsequently, those data were checked against the established minimal detectable change of 14% for this scale to make judgements on clinical importance. We also assessed the presence of a placebo effect by comparing the results of sham taping with no treatment and complications resulting from the administered treatments. Additionally, we judged the quality of trials using the Cochrane risk of bias tool and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A total of 22 trials met our inclusion criteria, 18 of which were deemed to be at a low risk of bias. A network of treatments consisting of 13 studies was created, and the level of evidence was judged to be high. As far as participants' allocation to treatment arms, 85 patients followed a wait-and-see protocol, 29 received placebo taping, 99 were treated with taping, 16 were treated with bracing, 27 were administered insoles, and six individuals were offered a combination of insoles with bracing. Of note, with statistical power set at 80%, a minimum of 16 patients per treatment group was required to provide sufficient statistical power and detect a SEBT-PM percentage difference of 14%.
RESULTS
A network meta-analysis did not demonstrate a benefit of taping or bracing over no treatment (percentage difference in SEBT-PM between taping and bracing versus control: -2.4 [95% CI -6 to 1.1]; p = 0.18, and -7.5 [95% CI -15.9 to 1]; p = 0.08, respectively). This was also the case for sham taping because the measurement increase failed to exceed the minimal detectable change (percentage difference in SEBT-PM between sham taping and untreated control: -1.1 [95% CI -6.9 to 4.7]; p = 0.72). Importantly, there were no reported adverse events after treatment application.
CONCLUSIONS
Evidence of moderate strength indicated that external supports of any type were no more effective than controls in improving dynamic postural control in patients with at least one ankle sprain and residual functional or mechanical deficits. Therefore, implementing those tools as a standalone treatment does not appear to be a viable strategy for the primary management of ankle instability. It is conceivable that combinations of rehabilitation and external supports could be more effective than external supports alone, and future trials should evaluate the potential of such combinations in enhancing not only clinician-reported but also patient-oriented outcomes using long-term follow-up measurements.
LEVEL OF EVIDENCE
Level I, therapeutic study.
Topics: Ankle Injuries; Ankle Joint; Athletic Tape; Biomechanical Phenomena; Chronic Disease; Equipment Design; Humans; Joint Instability; Network Meta-Analysis; Orthopedic Procedures; Orthotic Devices; Postural Balance; Randomized Controlled Trials as Topic; Range of Motion, Articular; Recovery of Function; Treatment Outcome
PubMed: 31625960
DOI: 10.1097/CORR.0000000000000946 -
Clinics in Podiatric Medicine and... Jan 2020The article discusses the nuances required to effectively perform the biomechanical examination in children and assess the findings. The author covers several factors in... (Review)
Review
The article discusses the nuances required to effectively perform the biomechanical examination in children and assess the findings. The author covers several factors in children that make the examination different in certain respects than in that of adults, including growth, osseous maturation, gait development, and interpretation of symptoms as conveyed by the child. Further delineation is made for prewalkers, foot-flat to foot-flat walkers, and heel-to-toe walkers. Segmental review of the lower extremity is covered by age bracket, with clinical pearls inserted where relevant to assist the clinician. A brief discussion of shoe wear and orthoses is made as well.
Topics: Adolescent; Age Factors; Biomechanical Phenomena; Child; Child, Preschool; Foot Deformities; Gait; Humans; Infant; Orthotic Devices; Patient Selection; Physical Examination; Shoes
PubMed: 31735264
DOI: 10.1016/j.cpm.2019.08.001 -
Physical Medicine and Rehabilitation... Aug 2021The goals of bracing in polio and postpolio are to optimize joint position and support weak muscles with the goal of reducing falls, reducing deformities, and optimizing... (Review)
Review
The goals of bracing in polio and postpolio are to optimize joint position and support weak muscles with the goal of reducing falls, reducing deformities, and optimizing energy conservation. Orthoses are primarily used in the lower extremities to optimize gait. Less frequently, upper extremity orthoses are required. Polio survivors are at increased risk of falls and injuries. Appropriate bracing and compliance with the prescribed device can prevent falls and injuries. The best orthotic results are often achieved with patients who have significant deficits but walk regularly, are well motivated, and are willing to adapt their gait for orthotic use.
Topics: Equipment Design; Gait Disorders, Neurologic; Humans; Lower Extremity; Orthotic Devices; Poliomyelitis; Postpoliomyelitis Syndrome; Upper Extremity
PubMed: 34175010
DOI: 10.1016/j.pmr.2021.03.001 -
Foot and Ankle Clinics Jun 2020Stage 4 flatfoot represents only a small proportion of flatfoot cases and is likely to become even rarer. The evidence base to guide treatment is limited to case series... (Review)
Review
Stage 4 flatfoot represents only a small proportion of flatfoot cases and is likely to become even rarer. The evidence base to guide treatment is limited to case series and expert opinion. Therefore, a pragmatic approach to treatment must be taken. Low-demand individuals may manage well with conservative treatment. Surgical management is complex, likely to require staging, and has a significant complication profile. Patients should be fully informed and understanding of this. First principles of surgery should be followed, including restoring hindfoot and ankle joint alignment, appropriate soft tissue balancing, and optimizing function by limiting arthrodeses and subsequent stiffness.
Topics: Flatfoot; Humans; Orthopedic Procedures; Orthotic Devices; Posterior Tibial Tendon Dysfunction
PubMed: 32381314
DOI: 10.1016/j.fcl.2020.02.002 -
Der Orthopade Jan 2021
Topics: Artificial Limbs; Humans; Orthotic Devices; Prostheses and Implants; Prosthesis Implantation
PubMed: 33464370
DOI: 10.1007/s00132-020-04030-3 -
BMC Musculoskeletal Disorders Feb 2024Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed...
Over the past years, the field of prosthetics and orthotics has seen incredible innovations that used to be perceived as science fiction. This editorial aims to shed light on such exciting developments, exploring how they are addressing the challenges faced by individuals with limb impairments and musculoskeletal conditions.
Topics: Humans; Artificial Limbs; Prosthesis Implantation; Orthotic Devices; Extremities
PubMed: 38347514
DOI: 10.1186/s12891-024-07246-y -
Primary Care Sep 2022With benefits on pain and pain-related outcomes and low-risk profile, there has been an emphasis on nonpharmacologic management of chronic pain. Physical therapy uses... (Review)
Review
With benefits on pain and pain-related outcomes and low-risk profile, there has been an emphasis on nonpharmacologic management of chronic pain. Physical therapy uses exercises, manual therapies, and electrotherapy. Exercises include aerobic, strengthening, and flexibility exercises. Aquatic exercises have similar efficacy to land-based exercises. Multidisciplinary care uses a biopsychosocial approach. All are effective for pain-related outcomes. Occupational therapy focuses on ergonomics, joint protection, orthoses, and assistive devices. Limited evidence exists for taping, orthoses, assistive devices, thermotherapy, and education on pain-related outcomes. Weight loss in patients who are overweight or obese is effective for pain reduction in knee arthritis.
Topics: Chronic Pain; Exercise Therapy; Humans; Orthotic Devices; Physical Therapy Modalities; Weight Loss
PubMed: 36153082
DOI: 10.1016/j.pop.2022.01.006 -
Prosthetics and Orthotics International Aug 2019Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring... (Review)
Review
BACKGROUND
Variables that influence orthotic and prosthetic patient outcomes beyond direct care are poorly conceptualized for orthotic and prosthetic students. Restructuring educational curricula around important clinical reasoning variables (i.e. factors that may influence outcomes) could improve teaching, learning, and clinical practice.
OBJECTIVES
To propose an orthotic and prosthetic education framework to enhance the development of orthotic and prosthetic students' clinical reasoning skills.
STUDY DESIGN
Scoping review.
METHODS
We conducted a scoping review, identified variables of orthotic and prosthetic usability, and performed a qualitative thematic analysis through the lens of orthotic and prosthetic clinical educators to develop a conceptual framework for orthotic and prosthetic education.
RESULTS
Sorting of variables identified from the literature resulted in three thematic areas: (1) the state of functioning, disability, and health (International Classification of Functioning, Disability and Health); (2) orthotic and prosthetic technical properties, procedures, and appropriateness; and (3) professional service as part of orthotic and prosthetic interventions. The proposed orthotic and prosthetic education framework includes these three areas situated within the context of patient-centered care.
CONCLUSIONS
A conceptual framework was developed from variables identified in peer-reviewed literature. This orthotic and prosthetic education framework provides a structure to explore orthotic and prosthetic clinical reasoning and advance our teaching and assessment of students' clinical reasoning skills.
CLINICAL RELEVANCE
The proposed orthotic and prosthetic (O&P) education framework is intended to promote conversation about variables (e.g. health condition, procedures, services, and O&P principles) that influence O&P clinical practice outcomes and further advance our teaching and assessment of students' clinical reasoning skills.
Topics: Clinical Competence; Curriculum; Health Personnel; Humans; Orthopedics; Orthotic Devices; Prostheses and Implants; Students, Health Occupations
PubMed: 31199192
DOI: 10.1177/0309364619852455 -
Prosthetics and Orthotics International Dec 2020There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the... (Review)
Review
There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users' quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.
Topics: Clinical Competence; Communication; Curriculum; Evidence-Based Medicine; Health Personnel; History, 20th Century; History, 21st Century; Humans; Orthotic Devices; Prostheses and Implants
PubMed: 33164659
DOI: 10.1177/0309364620968644 -
Prosthetics and Orthotics International Oct 2022
Topics: Humans; Orthotic Devices; Prostheses and Implants
PubMed: 36215055
DOI: 10.1097/PXR.0000000000000186