Decreased pain and improved dynamic knee instability mediate the beneficial effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis
Tomasz Cudejko (Amsterdam UMC)
Martin van der Esch (Amsterdam Rehabilitation Research Center Reade)
Josien C. van den Noort (Amsterdam UMC)
Judith J.M. Rijnhart (Amsterdam UMC)
Marike van der Leeden (Amsterdam UMC)
Leo D. Roorda (Amsterdam Rehabilitation Research Center Reade)
Willem Lems (Reade and Amsterdam Rheumatology and Immunology Centre)
Gordon Waddington (University of Canberra)
Jaap Harlaar (TU Delft - Biomechatronics & Human-Machine Control, Amsterdam UMC)
Joost Dekker (Amsterdam UMC)
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Abstract
Objective: To evaluate whether improvement of proprioception, pain, or dynamic knee instability mediates the effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis (OA). Methods: We conducted an analysis of data for 44 patients with knee OA who were enrolled in a laboratory-based trial evaluating the effect of wearing a commercially available soft knee brace. Activity limitations were assessed with the 10-meter walk test and the Get Up and Go test. Knee joint proprioception was assessed by an active joint position sense test; pain was assessed on a numeric rating scale (NRS) (range 0–10); pressure pain threshold (PPT) was assessed with a hand-held pressure algometer; dynamic knee instability was expressed by the perturbation response, i.e., a measure reflecting a deviation in mean knee varus–valgus angle after a controlled mechanical perturbation on a treadmill, with respect to level walking. Mediation analysis was conducted using the product of coefficients approach. Confidence intervals were calculated with a bootstrap procedure. Results: A decrease in pain (scored on an NRS) and a decrease in dynamic knee instability mediated the effect of wearing a soft knee brace on the reduction of activity limitations (P < 0.05), while changes in proprioception and PPT did not mediate this effect (P > 0.05). Conclusion: This study shows that decreased pain and reduced dynamic knee instability are pathways by which wearing a soft knee brace decreases activity limitations in patients with knee OA.
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