Knee osteoarthritis (OA) is commonly treated using laterally wedged insoles. Although these insoles typically reduce knee abduction moments (KAM) - a variable associated with knee osteoarthritis - and thus are believed to be beneficial for OA management, recent research has indicated that in some cases lateral wedge insoles actually increase knee joint loads. In such cases, a medial wedge may be more appropriate. The purpose of this study is to evaluate the influence of reduced KAMs on pain over 3-months for patients with knee OA. It is hypothesized that pain reduction will be directly related to KAM reduction. Forty-six participants with knee OA will be recruited to participate. Each will undergo biomechanical gait analysis to determine the wedge type that most greatly reduces knee adduction moments. In addition, each participant will undergo a Dual Energy X-Ray Absorptiometry (DXA) scan to quantify adiposity. Finally, participants will complete a series of questionnaires to evaluate pain, function, physical activity, footwear comfort and injury history. Participants will be randomized into either a wait list control group (no insole) or experimental group (medial or lateral wedged insole), and monitored for 3 months. Changes to pain, function, comfort and physical activity from baseline to 3 months will be assessed within the control and experimental groups. Regression analyses will be conducted on the experimental group to determine if a relationship exists between reduced KAMs and reduced pain over 3 months. Comparisons will also be made between the control and experimental groups.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
48
Wedged insoles are designed to reduce frontal plane knee joint mechanical loads during gait. Specifically, they can alter the knee adduction moment during gait - a variable associated with progression of knee osteoarthritis. In the experimental arm of this study, participants will undergo biomechanical gait analysis to identify the wedged insole that reduces the moments the most. The two options are medial wedge, where the medial aspect of the foot is elevated relative to the lateral aspect, and the lateral wedge, where the lateral wedge is elevated relative to the medial aspect.
Human Performance Laboratory, University of Calgary
Calgary, Alberta, Canada
KOOS pain score
Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subsection
Time frame: baseline, 1-month, 2-months, 3-months
Adiposity
Measured using Dual Energy X-Ray Absorptiometry (DXA) scan
Time frame: baseline
Knee biomechanics
Other knee joint mechanical variables assessed using motion analysis (ex. varus thrust, knee adduction impulse).
Time frame: baseline
PASE score
Physical Activity Scale for the Elderly (PASE)
Time frame: baseline, 1-month, 2-months, 3-months
UCLA Physical Activity Score
Scale evaluating physical activity levels
Time frame: baseline, 1-month, 2-months, 3-months
Knee Adduction Moment
Calculated using inverse dynamics
Time frame: baseline
Footwear Comfort
Evaluated using 100mm visual analog scale
Time frame: baseline
KOOS subsection and aggregate scores
All other KOOS sections (excluding pain, which is primary outcome)
Time frame: baseline, 1-month, 2-months, 3-months
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