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Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders

McDaid, Catriona, Fayter, Deborah, Booth, Alison, O'Connor, Joanne, Rodriguez-Lopez, Roccio, McCaughan, Dorothy, Bowers, Roy, Iglesias, Cynthia, Lalor, Simon, O'Connor, Rory, Phillips, Margaret and Ramdharry, Gita (2017) Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders. BMJ Open, 7, e015927. ISSN (online) 2044-6055

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Abstract

Objectives To assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder. Design A systematic review of primary studies. Setting Community. Participants Adults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee. Interventions Orthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material. Primary and secondary outcome measures Conditionspecific or generic patient-reported outcome measures assessing function, disability, independence, activities of daily living, quality of life or psychosocial outcomes; pain; walking ability; functional assessments; biomechanical analysis; adverse effects; usage; patient satisfaction and the acceptability of a device; and resource utilisation data. Results Twenty-one studies including 478 patients were included. Orthotic devices were evaluated in patients with postpolio syndrome, poststroke syndrome, inclusion body myositis and spinal cord injury. The review included 2 randomised controlled trials (RCTs), 3 non-randomised controlled studies and 16 case series. Most were small, single-centre studies with only 6 of 21 following patients for 1 year or longer. They met between one and five of nine quality criteria and reported methods and results poorly. They mainly assessed outcomes related to gait analysis and energy consumption with limited use of standardised, validated, patient-reported outcome measures. There was an absence of evidence on outcomes of direct importance to patients such as reduction in pain and falls. Conclusions There is a need for high-quality research, particularly RCTs, of orthotic devices for knee instability related to neuromuscular and central nervous system conditions. This research should address outcomes important to patients. There may also be value in developing a national registry

Item Type: Article
Additional Information: This work was supported by the National Institute for Health Research (NIHR) HTA Programme (project number 13/30/02) and has been published in full in Health Technol Assess 2016;20(55).
Research Area: Allied health professions and studies
Faculty, School or Research Centre: Faculty of Health, Social Care and Education
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Depositing User: Gita Ramdharry
Date Deposited: 15 Sep 2017 14:25
Last Modified: 15 Sep 2017 14:25
URI: http://eprints.kingston.ac.uk/id/eprint/39167

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