A multidisciplinary conservative approach is effective in improving symptoms and function in patients with knee osteoarthritis but bracing appears to add little to the mix, a Sydney study suggests.
Dr Shirley Yu and colleagues at Royal North Shore Hospital in Sydney offered bracing with the Ossur Unloader One device to patients with tibiofemoral OA and the Tru-Pull Lite to those with patellofemoral OA within a 52-week chronic care program.
The program included activities to increase functional capacity and manage risk factors, including weight loss through nutrition and physical activities, with input from a dietician, physiotherapist, orthotist, occupational therapist, social worker and doctor, tailored to the individual’s clinical need.
About two-thirds of patients were assigned to bracing, based on their clinical presentation and suitability.
All patients had less pain and better activities of daily living at 52 weeks, but those with bracing did no better than those without bracing.
“There is evidence supporting an emphasis on a conservative approach to managing OA before extending it to include involve pharmacological and surgical interventions,” Dr Yu told the limbic.
“Our study shows that a multidisciplinary, non-operative program does improve pain and function in patients with both patellofemoral and tibiofemoral osteoarthritis.
“The utility of bracing is complex, and it depends on an individual’s tolerability and usage.
Bracing aims to redistribute mechanical loads through a malaligned osteoarthritic knee, increasing mobility and acting as an adjunct to other interventions including physiotherapy and weight loss management, she said.
“The type of brace and fitting should be supervised by an appropriate health professional.”
In the report of the study, published in the International Journal of Rheumatic Diseases, Dr Yu and colleagues said randomised trials had demonstrated benefits of bracing but there had been very few ‘real world’ studies evaluating it as part of comprehensive care in unselected patients.
Participants in the Sydney study most commonly used their braces for two to four hours a day, usually when they were planning to be active, and about 60% claimed to use them daily throughout the year.
However, increased use was not associated with any greater improvement in outcomes.
Benefits of multidisciplinary non-operative treatments identified in the study were consistent with a recent paradigm shift toward a conservative, preventative approach as first-line management, Dr Yu and her colleagues wrote.
The approach was based on good quality evidence supporting education, exercise, weight control and passive non-pharmacological and non-surgical treatments for hip and knee OA.