Neha Dewan

Efficacy of knee braces and foot orthoses in conservative management of knee osteoarthritis: a systematic review.

A systematic analysis was conducted on the effectiveness of knee braces and foot orthoses in conservative management of knee osteoarthritis. The methodologic quality of the randomized clinical trials, controlled clinical trials, and observational studies were systematically reviewed using the Structured Effectiveness Quality Evaluation Scale. Twenty-five studies met the inclusion criteria. The orthoses used in the studies included Generation II osteoarthritis knee brace, valgus knee braces, functional off-loading knee braces, knee sleeves, lateral-wedged insoles with subtalar strapping, medial-wedged insoles, and specialized footwear. Results suggest that knee braces and foot orthoses are effective in decreasing pain, joint stiffness, and drug dosage. They also improve proprioception, balance, Kellgren/Lawrence grading, and physical function scores in subjects with varus and valgus knee osteoarthritis. Knee braces and foot orthoses could be cautiously considered as conservative management for relief of pain and stiffness and improving physical function for persons with knee osteoarthritis. The conclusions of this review are limited by methodologic considerations like poor quality of trials and heterogeneity of interventions.

Epidemiology of distal radius fractures and factors predicting risk and prognosis.

STUDY DESIGN Literature Review. INTRODUCTION For optimal Distal Radius Fracture (DRF) rehabilitation and fracture prevention, it is important to understand the epidemiology and factors predictive of injury, chronic pain, chronic disability, and subsequent fracture. PURPOSE To summarize the literature reporting on DRF epidemiology, risk factors, and prognostic factors. METHODS Literature synthesis. RESULTS Although incidence varies globally, DRFs are common across the lifespan and appear to be on the rise. Risk of DRF is determined by personal factors (age, sex/gender, lifestyle, health condition) and environmental factors (population density, climate). For example, age and sex influence risk such that DRF is most common in boys/young men and older women. The most common causes of DRF in the pediatric and young adult age groups include playing/sporting activities and motor vehicle accidents. In contrast, the most common mechanism of injury in older adults is a low-energy trauma because of a fall from a standing height. Poorer health outcomes are associated with older age, being female, poor bone healing (or having an associated fracture of the ulnar styloid), having a compensated injury, and a lower socioeconomic status. CONCLUSIONS Risk stratification according to predictors of chronic pain and disability enable therapists to identify those patients who will benefit from advocacy for more comprehensive assessment, targeted interventions, and tailored educational strategies. The unique opportunity for secondary prevention of osteoporotic fracture after DRF has yet to be realized by treating therapists in the orthopedic community. LEVEL OF EVIDENCE V.

Recovery patterns over 4 years after distal radius fracture: Descriptive changes in fracture-specific pain/disability, fall risk factors, bone mineral density, and general health status

Study Design: Descriptive/Longitudinal cohort. Introduction: Distal radius fracture (DRF) is a common fall related fragility fracture that is known to be an early and independent predictor of secondary osteoporotic (OP) fractures. Changes in falls risk status, bone status and general health has not been evaluated prospectively in a population that has sustained a DRF. Purpose of the Study: The purpose of our study was to describe the status of fracture‐specific pain/disability, fall risk factors such as physical activity (PA) and fear of falling (FOF), bone mineral density (BMD) and general health status (HS) in people with a DRF and how these variables change over four years with respect to sex, age, incidence of secondary falls and secondary OP fractures. Methods: Patients (n = 94) self‐reported their fracture‐specific pain and disability (Patient‐Rated Wrist Evaluation), PA (Rapid Assessment of Physical Activity), FOF (Modified Fall Efficacy Scale), HS (12‐item Short Form Health Survey) and completed dual‐energy X‐ray absorptiometry scan based BMD assessment (lumbar spine and total hip) at baseline (1–2 weeks post‐fracture), six months and four years after DRF. Descriptive statistics and general linear models were used to describe changes in recovery patterns over four years. Results: There was significant (p<0.001) improvement in fracture‐specific pain/disability (60 points), FOF (1 point) and physical HS (11 points) between baseline and 4 year follow‐up. There were no significant changes in PA and BMD. When stratified with respect to age, sex, presence of subsequent falls and OP fractures, there were no significant differences in fracture‐specific pain/disability, PA, FOF, and BMD at baseline, six months or four years after DRF. The physical HS was significantly (p<0.05) less/poorer among those with secondary falls (lower by 2–6 points) and fractures (lower by 5–6 points) compared to those without. Similarly, mental HS was significantly (p<0.05) poorer among people with secondary falls (lower by 2–6 points) and in 50–64 year age group (lower by 3–5 points) than those without secondary falls and in 65–80 year age group, respectively. Conclusion: Post DRF, the majority of the improvement in fracture‐specific pain/disability, FOF and HS was completed at six months and very small changes were observed between the six month and four year follow‐up. Level of Evidence: NA.

Effect of Box Taping as an Adjunct to Stretching-Strengthening Exercise Program in Correction of Scapular Alignment in People with Forward Shoulder Posture: A Randomised Trial

Objective. The objective of this study was to provide preliminary estimates of effects of box taping as an adjunct to stretching-strengthening exercise program on scapular alignment in healthy subjects with forward shoulder posture (FSP). Methods. Sixty subjects were screened and 38 asymptomatic subjects with FSP were allocated into box taping and standard treatment group using block randomization. Both groups received a supervised stretching-strengthening exercise program and postural advice for 15 sessions over 3 weeks. In addition, box taping was applied to the intervention group. Static and dynamic scapular alignment was recorded at baseline, 7th and 15th sessions. Differences over time and between the treatment groups were determined using repeated measures of analysis of variance (ANOVA). Results. Twenty subjects completed the study. Both interventions were well tolerated and resulted in improvements in static and dynamic postural indicators over time in both groups () except for dynamic scapular alignment by the 15th session. We were under powered to detect differences between the groups (). Conclusions. This study suggests postural exercises improve scapular alignment; but a large RCT is required to determine whether the addition of box taping is indicated, and whether this preventative approach reduces the incidence of upper quarter musculoskeletal disorders. This trial is registered with CTRI/2013/10/004095.

Validity and Responsiveness of the Short Version of the Western Ontario Rotator Cuff Index (Short-WORC) in Patients With Rotator Cuff Repair

&NA; • STUDY DESIGN: Clinical measurement. • BACKGROUND: Recently, the Western Ontario Rotator Cuff Index (WORC) was shortened, but few studies have reported its measurement properties. • OBJECTIVE: To compare the validity and responsiveness of the short version of the Western Ontario Rotator Cuff Index (Short‐WORC) and the WORC (disease‐specific measures) with those of the Shoulder Pain and Disability Index (SPADI) and the simple shoulder test (SST) (joint‐specific measures); the Disabilities of the Arm, Shoulder and Hand (DASH) (a region‐specific measure); and the Medical Outcomes Study 12‐Item Short‐Form Health Survey version 2 (SF‐12v2) (a general health status measure) in patients undergoing rotator cuff repair (RCR). • METHODS: A cohort of patients (n = 223) completed the WORC, SPADI, SST, DASH, and SF‐12v2 preoperatively and at 3 and 6 months after RCR. Short‐WORC scores were extracted from the WORC questionnaire. The construct validity (Pearson correlations) and internal responsiveness (effect size [ES], standardized response mean [SRM], relative efficiency [RE]) of the Short‐WORC were calculated. • RESULTS: The Short‐WORC was strongly correlated with the WORC (r = 0.89‐0.96) and moderately to strongly correlated with non‐disease‐specific measures at preoperative and postoperative assessments (r = 0.51‐0.92). The Short‐WORC and WORC were equally responsive (REShort‐WORC/WORC = 1) at 0 to 6 months and highly responsive overall at 0 to 3 months (ESShort‐WORC, 0.72; ESWORC, 0.92; SRMShort‐WORC, 0.75; SRMWORC, 0.81) and 0 to 6 months (ESShort‐WORC, 1.05; ESWORC, 1.12; SRMShort‐WORC, 0.89; SRMWORC, 0.89). The responsiveness of the comparator measures (SPADI, SST, DASH, SF‐12v2) was poor to moderate at 0 to 3 months (ES, 0.07‐0.55; SRM, 0.09‐0.49) and 0 to 6 months (ES, 0.05‐0.78; SRM, 0.07‐0.78). • CONCLUSION: The Short‐WORC and WORC have similar responsiveness in patients undergoing RCR, and are more responsive than non‐diseasespecific measures. Future studies should focus on validation of the Short‐WORC in samples representing the spectrum of rotator cuff disorders.

Modifiable Determinants of Bone Health in Women With Distal Radius Fracture A Cross-sectional Study

Background: Distal radius fracture (DRF) is an early and independent predictor of future osteoporotic (OP) fractures. Currently, there are no studies evaluating the role of modifiable risk factors on OP fracture risk in postmenopausal women (PMW) with DRF. Purpose/Objectives: To determine the extent to which modifiable risk factors such as balance, muscle strength, and physical activity can explain variability in bone mineral density (BMD) among women with DRF. Materials and Methods: The study was designed as a cross-sectional investigation of baseline data. Women aged 50 to 80 years with DRF were assessed for balance, muscle strength (grip strength, plantar flexion), and physical activity using reliable and validated measures. Dual-energy x-ray absorptiometry was used to assess areal BMD at the femoral neck (BMD-FN) and total hip (BMD-TH). Analysis: Stepwise multiple regression analysis was used to determine the extent to which modifiable risk factors (predictors) could explain variability in the BMD (outcome). Results: Women (n = 67; mean age: 62.12 ± 7.45 years) were analyzed. Hand grip strength as an independent predictor explained 15% (F = 11.26, P = .001) and 6% (F = 4.18, P = .04) of total variability in BMD-FN and BMD-TH, respectively. Balance (R2 = .10, F = 4.35, P = .04) and hand grip strength (R2 = .32, F = 10.78, P = .003) explained significant variability in BMD-FN among 50- to 64-year-old (n = 41) and among 65- to 80-year-old (n = 25) PMW with DRF, respectively. Conclusions: Hand grip strength is the independent predictor of femoral neck and total hip BMD in PMW with DRF. Because hand grip strength and balance are modifiable factors that are related to bone health, they may represent useful prevention targets for hand therapists. We recommend evaluation of hand grip strength and balance as a component of OP risk factor assessment among women with DRF.