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Abstract Number: 2155

Beneficial Effect Of Long-Term Use Of a Low-Cost Minimalist Footwear On Joint Load, Clinical, and Functional Aspects Of Elderly Women With Knee Osteoarthritis

Francis Trombini-Souza1, Alessandra Matias1, Mariane Yokota1, Marco Butugan1, Ivye Pereira1, Claudia Goldenstein-Schainberg2, Ricardo Fuller3 and Isabel C.N. Sacco1, 1Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil, 2Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil, 3Division of Rheumatology - Hospital das Clinicas - Medical School, University of Sao Paulo, São Paulo, Brazil

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: clinical trials and osteoarthritis, Knee

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Session Information

Session Title: Osteoarthritis - Clinical Aspects II: Symptoms and Therapeutics in Osteoarthritis.

Session Type: Abstract Submissions (ACR)

Background/Purpose: Positive outcomes of minimalist shoes on reduction of overload in patients with knee osteoarthritis (OA) have been highlighted. We have recently shown beneficial effects of acute use of a low-cost minimalist flat, flexible and non-heeled footwear in aged women with knee OA. Based on the chronic aspect of the disease, we now aim to investigate the long-term effects of this same footwear on gait biomechanics, clinical, and functional features of elderly women affected by knee OA.

Methods: Twenty-eight elderly women with grade 2 or 3 Kellgren and Lawrence knee OA were randomized and allocated to either intervention group (IG, n=16) which wore this minimalist shoe (Moleca) for 6 months for at least 6 hours daily, or to control group (CG, n=12) which did not wear these nor similar shoes. Physical therapy treatment was not allowed throughout the study. A diary was used to record the amount of daily use of the footwear intervention and paracetamol intake; every 2 weeks, adherence to treatment was verified through phone calls. All patients were assessed at baseline, 3th and 6thmonth by a physician and a physiotherapist, both blinded to group allocation. Primary outcome was pain WOMAC score and secondary ones were global WOMAC; joint stiffness and disability WOMAC scores; amount of paracetamol rescue medication intake over 6 months; knee adduction moment (KAM) during gait; knee edema and joint effusion. Multiple imputation methods and intention-to-treat analysis were performed. Treatment-time interactions were detected by general linear models of analysis of variance for repeated measure. Statistical significance is based at α = 5%.

Results: Interaction effect was observed for WOMAC pain (p=.007), function (p=.035) and WOMAC total score (p=.012). The percentage changes are in table 1. IG experienced a reduction by 18% (p=.043) in first peak KAM, 39% (p=.025) in KAM during midstance phase, and 29% (p=.041) in KAM impulse compared with CG at the end of intervention. Paracetamol intake was lower IG vs. CG at 4th (p=.004), 5th (p=.006) and 6thmonths (p=.012). Clinical aspects as knee edema and effusion did not present any difference in both IG and GC at the end of intervention.

Conclusion: Long-term use of this flat, flexible and non-heeled shoe proved to be beneficial in elderly women with knee OA and thus can be prescribed as a low-cost non-invasive treatment capable to decrease pain and knee overload, and to improve overall function.

Table 1 – Percentage of change in the 3rd and in the 6thmonth by both groups in the WOMAC scores.

Variable

Group

3rd month

6th month

WOMAC Pain (% reduction)

Intervention

47%

60%

Control

32%

16% (n. s.)

WOMAC Function (% improvement)

Intervention

45%

51%

Control

25%

14% (n. s.)

WOMAC Total (% improvement)

Intervention

46%

52%

Control

24%

15% (n. s.)


Disclosure:

F. Trombini-Souza,

State of Sao Paulo Research Foundation (FAPESP) ,

2;

A. Matias,

State of Sao Paulo Research Foundation (FAPESP) ,

2;

M. Yokota,

State of Sao Paulo Research Foundation (FAPESP) ,

2;

M. Butugan,
None;

I. Pereira,
None;

C. Goldenstein-Schainberg,
None;

R. Fuller,
None;

I. C. N. Sacco,

National Council for Scientific and Technological Development (CNPq),

2.

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