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

BMJ Open, 2017 · DOI: 10.1136/bmjopen-2017-015927 · Published: January 10, 2017

Simple Explanation

This study reviews existing research on using orthotic devices (like braces) to help adults with knee instability caused by neuromuscular or central nervous system disorders. The review looks at how well these devices work to improve walking, reduce pain, and enhance quality of life for people with conditions like post-polio syndrome, stroke, or spinal cord injury. The review found that there is not enough high-quality research to fully understand how well these devices work and more studies are needed that focus on what matters most to patients.

Study Duration

Not specified

Participants

478 adults with a neuromuscular disorder or central nervous system disorder

Evidence Level

Systematic Review of primary studies

Key Findings

1
The review identified a paucity of high-quality evidence assessing the effectiveness of orthotic devices for knee instability experienced by people with NMD and CNS conditions.
2
Most studies were small, single-center, and had short follow-up periods, with limited use of standardized, validated, patient-reported outcome measures.
3
There was an absence of evidence on outcomes of direct importance to patients such as reduction in pain and falls.

Research Summary

This systematic review assessed the effectiveness of orthotic devices for managing knee instability in adults with neuromuscular disorders (NMD) or central nervous system (CNS) disorders. The review included 21 studies with 478 patients, focusing on conditions like postpolio syndrome, poststroke syndrome, inclusion body myositis, and spinal cord injury. The authors concluded that there is a need for more high-quality research, particularly RCTs, that address outcomes important to patients and suggest developing a national registry to collect relevant data.

Practical Implications

Need for High-Quality Research

There is a critical need for well-designed studies, especially RCTs, to assess the effectiveness of orthotic devices for knee instability in NMD and CNS conditions.

Focus on Patient-Centered Outcomes

Future research should prioritize outcomes that are important to patients, such as pain reduction, fall prevention, improved balance, and enhanced participation in daily activities.

Development of a National Registry

Establishing a national registry could systematically collect data on orthotic device usage, patient characteristics, and outcomes, facilitating future research and improving clinical practice.

Study Limitations

1
It was difficult to be certain that knee instability was the main problem being treated in some of the studies.
2
Due to poor reporting of the primary studies, it was not possible to extract outcome data in the standardised way planned in the protocol.
3
The evidence base consists of small, single-centre studies with outcome assessments that did not appear to have been undertaken independently of treating clinicians.

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