Abstract：
OBJECTIVE: Immediate biomechanical and functional benefits of knee braces and lateral wedge foot orthoses (FO) are often reported on patients with medial knee osteoarthritis. However, the effectiveness of their combined use in a longer-term orthotic treatment remains unclear. The aim was to evaluate pain, function, comfort and knee adduction moment (KAM) during the stance phase of gait with three modalities of orthotic treatment.
METHODS: Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM.
RESULTS: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO.
CONCLUSIONS: The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes.
METHODS: Therapeutic study level I randomised crossover trial.
METHODS: Twenty-two patients with knee osteoarthritis were analysed in a randomised crossover trial including a knee brace with valgus and external rotation functions (VER), FO and their combined use (VER + FO). Western Ontario and McMaster Universities scale (WOMAC) and Knee injury and Osteoarthritis Outcome Scores and KAM during gait were obtained before and after each orthotic treatment of 3 months. Repeated measures analyses of variance contrasted the factors orthosis (VER, FO, VER + FO), treatment (pre and post) and wear (without and with) on pain, function, comfort and KAM.
RESULTS: An interaction between orthosis and treatment on the WOMAC pain (effect size [ES] = 0.17) and a main effect on the pain visual analogue score (ES = 0.24) indicated that VER and VER + FO were more alleviating than FO. The three modalities of orthotic treatment significantly improved functional scores (ES > 0.2) and reduced discomfort (ES = 0.25). A significant multivariate interaction between orthosis and wear (ES = 0.73) showed that the KAM reduction while wearing the orthoses was more pronounced with the VER and VER + FO than the FO.
CONCLUSIONS: The VER-brace obtained more effectiveness than FO on pain and KAM after 3 months for medial knee osteoarthritis and the combined treatment did not substantially improve biomechanical and functional outcomes.
METHODS: Therapeutic study level I randomised crossover trial.
摘要：
目的：经常报道膝关节内侧骨关节炎患者使用膝关节支具和外侧楔形足矫形器（FO）的直接生物力学和功能益处。然而,在长期矫形治疗中联合使用这两种药物的有效性尚不清楚.目的是评估疼痛，函数,步态站立阶段的舒适度和膝关节内收力矩（KAM），采用三种矫形治疗方式。
方法：在一项随机交叉试验中分析了22例膝骨关节炎患者，包括具有外翻和外旋功能（VER）的膝关节支架，FO及其组合使用(VER+FO)。西安大略和麦克马斯特大学量表（WOMAC）和膝关节损伤和骨关节炎的结果评分和步态期间的KAM均在每次矫形治疗前和后3个月获得。重复测量方差分析对比了矫形器的因素(VER，FO,VER+FO),治疗（前后）和磨损（无和有）疼痛，函数,舒适和KAM。
结果：矫形器和治疗对WOMAC疼痛（效应大小[ES]=0.17）以及对疼痛视觉模拟评分（ES=0.24）的主要影响之间的相互作用表明VER和VERFO比FO更缓解。三种矫形治疗方式显着改善了功能评分（ES>0.2）并减少了不适感（ES=0.25）。矫形器与磨损之间的显着多变量相互作用（ES=0.73）表明，与VER和VERFO相比，佩戴矫形器时的KAM降低更为明显。
结论：3个月后，VER支具在治疗内侧膝骨关节炎的疼痛和KAM方面比FO获得了更高的疗效，联合治疗并没有显著改善生物力学和功能结果。
方法：治疗研究I级随机交叉试验。
方法：在一项随机交叉试验中分析了22例膝骨关节炎患者，包括具有外翻和外旋功能（VER）的膝关节支架，FO及其组合使用(VER+FO)。西安大略和麦克马斯特大学量表（WOMAC）和膝关节损伤和骨关节炎的结果评分和步态期间的KAM均在每次矫形治疗前和后3个月获得。重复测量方差分析对比了矫形器的因素(VER，FO,VER+FO),治疗（前后）和磨损（无和有）疼痛，函数,舒适和KAM。
结果：矫形器和治疗对WOMAC疼痛（效应大小[ES]=0.17）以及对疼痛视觉模拟评分（ES=0.24）的主要影响之间的相互作用表明VER和VERFO比FO更缓解。三种矫形治疗方式显着改善了功能评分（ES>0.2）并减少了不适感（ES=0.25）。矫形器与磨损之间的显着多变量相互作用（ES=0.73）表明，与VER和VERFO相比，佩戴矫形器时的KAM降低更为明显。
结论：3个月后，VER支具在治疗内侧膝骨关节炎的疼痛和KAM方面比FO获得了更高的疗效，联合治疗并没有显著改善生物力学和功能结果。
方法：治疗研究I级随机交叉试验。
