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The Cochrane Database of Systematic... 2001Lateral epicondylitis (tennis elbow) is a frequently reported condition. A wide variety of treatment strategies has been described. As of yet, no optimal strategy has... (Review)
Review
BACKGROUND
Lateral epicondylitis (tennis elbow) is a frequently reported condition. A wide variety of treatment strategies has been described. As of yet, no optimal strategy has been identified.
OBJECTIVES
The objective of this review was to assess the effectiveness of orthotic devices for treatment of tennis elbow.
SEARCH STRATEGY
An electronic database search was conducted using Medline, Embase, Cinahl, the Cochrane Controlled Trial Register, Current Contents and reference lists from all retrieved articles. Experts on the subjects were approached for additional trials.
SELECTION CRITERIA
All randomised clinical trials (RCT) describing individuals with diagnosed lateral epicondylitis and comparing the use of an orthotic device as a treatment strategy were evaluated for inclusion.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed the validity of the included trials and extracted data on relevant outcome measures. Dichotomous outcomes were expressed as Relative Risks (RRs) and continuous outcomes as Standardised Mean Differences (SMD), both with corresponding 95% confidence intervals (95% CI). Statistical pooling and subgroup analyses were intended
MAIN RESULTS
Five small-size RCTs (N per group 7-49) were included. Validity score ranged from 3-9 positive items out of 11. Subgroup analyses were not performed due to the small number of trials. The limited number of included trials present few outcome measures and limited long-term results. Pooling was not possible due to large heterogeneity amongst trials.
REVIEWER'S CONCLUSIONS
No definitive conclusions can be drawn concerning effectiveness of orthotic devices for lateral epicondylitis. More well-designed and well-conducted RCTs of sufficient power are warranted.
Topics: Humans; Orthotic Devices; Randomized Controlled Trials as Topic; Tennis Elbow
PubMed: 11406011
DOI: 10.1002/14651858.CD001821 -
Journal of Neuroengineering and... Dec 2018Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities.... (Review)
Review
BACKGROUND
Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention.
MAIN BODY
This paper will principally discuss the case of upper limb rehabilitation in Childhood Dyskinesia (CD), a complex motor disease that affects paediatric patients. Through a critical review of the present solutions and a discussion about the neurophysiological characteristics of the disease, the study will lead to the formulation of desirable features of a possible new upper-limb orthosis.
CONCLUSIONS
Design principles will be derived to provide specialised orthoses for the dynamic control of posture and the stabilisation of voluntary movements: those include using biomechanical actions and enhanced proprioception to support the sensorimotor rehabilitation of the children affected by CD. A similar approach could be advantageously applied in other MD-related conditions, especially with hyperkinetic and/or hypertonic traits.
Topics: Child; Female; Humans; Male; Movement Disorders; Orthotic Devices; Upper Extremity
PubMed: 30547807
DOI: 10.1186/s12984-018-0466-8 -
American Family Physician Jul 2017
Review
Topics: Adolescent; Calcaneus; Child; Humans; Orthotic Devices; Osteochondritis; Pain Measurement; Shoes
PubMed: 28762709
DOI: No ID Found -
BMC Health Services Research Feb 2017People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with...
BACKGROUND
People with disabilities have the right to personal mobility and available and affordable assistive technology, according to the Convention of Rights of Persons with Disabilities. The aims were to investigate similarities and differences between Sierra Leone and Malawi concerning participants' mobility and satisfaction with their lower-limb prosthetic or orthotic device and related service delivery, and to identify variables associated with patients' satisfaction with assistive devices and associated services in the entire study group from these two low-income countries.
METHODS
Questionnaires, including QUEST, were answered by 222 patients in Sierra Leone and Malawi.
RESULTS
Eighty-six per cent of assistive devices were in use, but half needed repair. One third of participants reported pain when using their assistive device. A higher percentage (66%) of participants in Sierra Leone had difficulties or could not walk at all on uneven ground compared with 42% in Malawi. The majority in both countries had difficulties or could not walk at all up and down hills, or on stairs. Participants in both countries were quite satisfied (mean 3.7-3.9 of 5) with their assistive device. Participants were most dissatisfied with: comfort (46%), dimensions (39%), and safety (38%) of their assistive device. In Sierra Leone participants were less satisfied than in Malawi with service delivery (mean 3.7; 4.4, p < .001). Access to repairs and servicing of their assistive device was considered the most important item. In Sierra Leone patients were less satisfied with follow-up services (41%) than patients in Malawi were (22%). The strongest association with satisfaction with assistive device was pain, and for satisfaction with service, country. The general condition of devices and the ability to walk on uneven ground were associated with both satisfaction with assistive devices and service received.
CONCLUSIONS
Participants reported high levels of use and mobility with their assistive device, in spite of pain and difficulties walking on uneven ground, which were also associated with the level of satisfaction with the assistive device. Access to repairs and follow-up services were the most important to patients, and should be addressed. Country was associated with satisfaction with service, with participants in Sierra Leone significantly less satisfied.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Disabled Persons; Female; Humans; Lower Extremity; Malawi; Male; Middle Aged; Orthotic Devices; Patient Satisfaction; Self-Help Devices; Sierra Leone; Surveys and Questionnaires; Walking; Young Adult
PubMed: 28143549
DOI: 10.1186/s12913-017-2044-3 -
Journal of Neuroengineering and... Jan 2015: Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many... (Review)
Review
: Technological advancements have led to the development of numerous wearable robotic devices for the physical assistance and restoration of human locomotion. While many challenges remain with respect to the mechanical design of such devices, it is at least equally challenging and important to develop strategies to control them in concert with the intentions of the user.This work reviews the state-of-the-art techniques for controlling portable active lower limb prosthetic and orthotic (P/O) devices in the context of locomotive activities of daily living (ADL), and considers how these can be interfaced with the user's sensory-motor control system. This review underscores the practical challenges and opportunities associated with P/O control, which can be used to accelerate future developments in this field. Furthermore, this work provides a classification scheme for the comparison of the various control strategies.As a novel contribution, a general framework for the control of portable gait-assistance devices is proposed. This framework accounts for the physical and informatic interactions between the controller, the user, the environment, and the mechanical device itself. Such a treatment of P/Os--not as independent devices, but as actors within an ecosystem--is suggested to be necessary to structure the next generation of intelligent and multifunctional controllers.Each element of the proposed framework is discussed with respect to the role that it plays in the assistance of locomotion, along with how its states can be sensed as inputs to the controller. The reviewed controllers are shown to fit within different levels of a hierarchical scheme, which loosely resembles the structure and functionality of the nominal human central nervous system (CNS). Active and passive safety mechanisms are considered to be central aspects underlying all of P/O design and control, and are shown to be critical for regulatory approval of such devices for real-world use.The works discussed herein provide evidence that, while we are getting ever closer, significant challenges still exist for the development of controllers for portable powered P/O devices that can seamlessly integrate with the user's neuromusculoskeletal system and are practical for use in locomotive ADL.
Topics: Activities of Daily Living; Electromyography; Gait; Humans; Locomotion; Lower Extremity; Orthotic Devices; Prostheses and Implants; Prosthesis Design
PubMed: 25557982
DOI: 10.1186/1743-0003-12-1 -
The Cochrane Database of Systematic... Jan 2009Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no... (Review)
Review
BACKGROUND
Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of the knee, active training devices, knee sleeves and inlay soles to support the foot have been advocated to treat this condition.
OBJECTIVES
To assess the effectiveness of foot and knee orthotics for treatment of patellofemoral pain syndrome.
SEARCH STRATEGY
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Controlled Trials register (Issue 2, 2000), MEDLINE (January 1966 to March 2000; EMBASE (January 1988 to March 2000); CINAHL (January 1982 to March 2000) and PEDro (up to March 2000). Relevant orthotic companies were contacted. The date of the most recent search was May 2000.
SELECTION CRITERIA
All randomised and quasi-randomised trials comparing the effectiveness of knee or foot orthotics for treatment of patellofemoral pain syndrome were selected. Trials describing the use of orthotic devices in conjunction with operative treatment were excluded.
DATA COLLECTION AND ANALYSIS
Three reviewers independently assessed methodological quality of the identified trials by use of a modified version of the Cochrane Bone, Joint and Muscle Trauma Group assessment tool, consisting of 11 items. Two reviewers extracted data without blinding. Trialists were contacted to obtain missing data.
MAIN RESULTS
Five trials involving 362 participants were included in this review. Five other trials await possible inclusion if further information can be obtained. Due to clinical heterogeneity, we refrained from statistical pooling and conducted analysis by grading the strength of scientific evidence. The level of obtained research-based evidence was graded as limited as all trials were of low methodological quality.This limited research-based evidence showed the Protonics brace at six week follow-up was significantly more effective for decrease in pain (weighted mean difference (WMD) between groups 3.2; 95% confidence interval (CI) 2.8 to 3.6), functional improvement on the Kujala score (WMD 45.6; 95% CI 43.4 to 47.7) and change in patellofemoral congruence angle (WMD 17.2; 95% CI 14.1 to 20.3) when compared to no treatment. A comprehensive programme including tape application was significantly superior to a monitored exercise programme without tape application for decrease in worst pain (WMD 1.6; 95% CI 0.4 to 2.8) and usual pain (WMD 1.2; 95% CI 0.2 to 2.1), and clinical change and functional improvement questionnaire scores at four weeks follow-up.The trials reported statistically significant differences in patient satisfaction after applied therapy (WMD 3.3; 95% CI 0.5 to 6.1) in favour of the McConnell regimen compared with the Coumans bandage at six weeks follow-up.
AUTHORS' CONCLUSIONS
The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of knee and foot orthotics for the treatment of patellofemoral pain. Future high quality trials in this field are warranted.
Topics: Arthralgia; Femur; Humans; Orthotic Devices; Patella; Randomized Controlled Trials as Topic; Syndrome
PubMed: 19160208
DOI: 10.1002/14651858.CD002267.pub2 -
Clinical Biomechanics (Bristol, Avon) Mar 2007Ground reaction forces from walking result in stress (pressure) and soft tissue strain at the plantar aspect of the foot. Excessive plantar pressure and tissue strain on...
BACKGROUND
Ground reaction forces from walking result in stress (pressure) and soft tissue strain at the plantar aspect of the foot. Excessive plantar pressure and tissue strain on the insensate foot may lead to ulceration. Our study investigated the effect of therapeutic footwear and custom-made orthotic inserts on pressure and tissue strain along the second ray of the plantar foot, and how these two variables are associated.
METHODS
Twenty subjects (mean age 57.3 [SD 9.3] years, 12 male, 8 female, body mass index 32.5 [SD 7.4] kg/m2) with diabetes mellitus, peripheral neuropathy, and a history of a plantar ulcer participated. Plantar pressure data were recorded during computed tomography scans for four conditions (barefoot, shoe, shoe+total contact insert, and shoe+total contact insert+metatarsal pad). For each condition tested, tissue strain and plantar pressure were determined at the second metatarsal head and at 15 other points along the second ray.
FINDINGS
Differences were noted between the 4 conditions for pressure (P<0.004) and soft tissue strain (P<0.042) at the second metatarsal head. Correlation coefficients demonstrated an association between pressure and strain (Barefoot r=0.81, Shoe r=0.75, Shoe+total contact insert r=0.73, and Shoe+total contact insert+metatarsal pad r=0.44).
INTERPRETATION
Footwear and orthotic devices tested in this study decreased pressure and soft tissue strain at the second ray of the foot, and these two variables were strongly related. A better understanding of the role tissue strain plays in distributing plantar forces may lead to improvements in the design of orthotic devices.
Topics: Diabetic Foot; Female; Foot; Humans; Male; Metatarsal Bones; Middle Aged; Orthotic Devices; Pressure; Protective Clothing; Shoes; Stress, Mechanical
PubMed: 17182156
DOI: 10.1016/j.clinbiomech.2006.10.010 -
Journal of Foot and Ankle Research 2019Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the... (Review)
Review
BACKGROUND
Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children's gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children's footwear and to establish the range of studies that considered therapeutic footwear.
METHODS
A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children's footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies.
RESULTS
The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional).
CONCLUSION
Children's footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children's therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children's therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role.
Topics: Biomechanical Phenomena; Child; Developmental Disabilities; Disabled Children; Equipment Design; Foot Orthoses; Gait; Gait Disorders, Neurologic; Humans; Mobility Limitation; Shoes
PubMed: 31061678
DOI: 10.1186/s13047-019-0336-z -
Developmental Medicine and Child... Feb 1998
Topics: Cerebral Palsy; Child; Child, Preschool; Humans; Orthotic Devices; Treatment Outcome
PubMed: 9489493
DOI: 10.1111/j.1469-8749.1998.tb15364.x -
BMJ (Clinical Research Ed.) Feb 2008
Review
Topics: Chronic Disease; Hernia, Inguinal; Humans; Infertility; Orthotic Devices; Pain, Postoperative; Postoperative Complications; Recurrence; Surgical Mesh
PubMed: 18244999
DOI: 10.1136/bmj.39450.428275.AD