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AB0978 Decreased pain and improved dynamic knee instability mediate the beneficial effect of wearing a soft knee brace on activity limitations in persons with knee osteoarthritis
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  1. T. Cudejko1,
  2. M. van der Esch2,
  3. J. van den Noort1,
  4. J. Rijnhart1,
  5. M. van der Leeden1,
  6. L.D. Roorda3,
  7. W. Lems1,
  8. J. Harlaar1,
  9. G. Waddington4,
  10. J. Dekker1
  1. 1VU University Medical Center
  2. 2De Boelelaan 1117, Afdeling revalidatiegeneeskunde
  3. 3Amsterdam Rehabilitation Research Center Reade, Amsterdam, Netherlands
  4. 4University of Canberra, Canberra, Australia

Abstract

Background We have previously shown that wearing a soft knee brace reduced activity limitations in persons with knee osteoarthritis (OA).1 Several underlying mechanisms have been proposed via which a soft knee brace reduces activity limitations in persons with knee OA.2 However, to our knowledge, no study has identified mechanisms explaining this effect.

Objectives The aim of the study was to identify mechanisms explaining the beneficial effect of wearing a soft knee brace on activity limitations in persons with knee OA.

Methods This was an exploratory analysis of data from 44 participants with knee OA from Amsterdam Osteoarthritis cohort, who enrolled in a single-session within-subject cross-over design study, comparing a soft brace with no soft brace, and comparing a non-tight soft brace with a tight soft brace (GENUTEX A2, Human I). A mediation analysis was performed and the mediation effect was calculated based on the product of coefficients approach. Confidence intervals were calculated with a bootstrap procedure. The outcome measures were activity limitations assessed with the 10-metre walk test and the Get up and Go test. The studied mediators were the changes in: knee joint proprioception, pain, pressure pain threshold (PPT) and objective dynamic knee instability. Knee joint proprioception was assessed by the active movement extent discrimination assessment; pain with the Numeric Rating Scale (NRS); PPT with a hand-held pressure algometer, and dynamic knee instability with the Perturbation Response i.e. a measure reflecting deviation in the mean knee varus-valgus angle after a controlled mechanical perturbation on the treadmill, in respect to level walking.

Results Both a decrease in pain during walking and a decrease in dynamic knee instability mediated the association between wearing a soft knee brace and reduction in time to complete both 10 m walk test and the GUG test (p<0.05). Changes in proprioception and PPT did not mediate these associations (p>0.05). Magnitudes of the mediation effects were similar for a non-tight and a tight soft knee brace.

Conclusions The decrease in activity limitations in persons with knee OA who wear a soft knee brace might be explained by a decrease in self-reported pain and a reduction in dynamic knee instability.

References [1] Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J: The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther2017;19:260.

[2] Cudejko T, van der Esch M, van der Leeden M, Roorda LD, Pallari J, Bennell KL, Lund H, Dekker J: Effect of Soft Braces on Pain and Physical Function in Patients With Knee Osteoarthritis: Systematic Review With Meta-Analyses. Arch Phys Med Rehabil2018;99:153–163.

Disclosure of Interest None declared

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