Wedged Insoles for Management of Knee Osteoarthritis

NCT ID: NCT02067208

Last Updated: 2015-12-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

48 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-10-31

Study Completion Date

2015-11-30

Brief Summary

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Knee osteoarthritis (OA) is commonly treated using laterally wedged insoles. Although these insoles typically reduce knee abduction moments (KAM) - a variable associated with knee osteoarthritis - and thus are believed to be beneficial for OA management, recent research has indicated that in some cases lateral wedge insoles actually increase knee joint loads. In such cases, a medial wedge may be more appropriate.

The purpose of this study is to evaluate the influence of reduced KAMs on pain over 3-months for patients with knee OA. It is hypothesized that pain reduction will be directly related to KAM reduction.

Forty-six participants with knee OA will be recruited to participate. Each will undergo biomechanical gait analysis to determine the wedge type that most greatly reduces knee adduction moments. In addition, each participant will undergo a Dual Energy X-Ray Absorptiometry (DXA) scan to quantify adiposity. Finally, participants will complete a series of questionnaires to evaluate pain, function, physical activity, footwear comfort and injury history. Participants will be randomized into either a wait list control group (no insole) or experimental group (medial or lateral wedged insole), and monitored for 3 months.

Changes to pain, function, comfort and physical activity from baseline to 3 months will be assessed within the control and experimental groups. Regression analyses will be conducted on the experimental group to determine if a relationship exists between reduced KAMs and reduced pain over 3 months. Comparisons will also be made between the control and experimental groups.

Detailed Description

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Conditions

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Knee Osteoarthritis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Caregivers Outcome Assessors

Study Groups

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Waitlist Control

A waitlist control condition, where the participant receives no insole for 3 months. During this 3 month period, the participant will continue to be monitored for outcome variables.

Group Type NO_INTERVENTION

No interventions assigned to this group

Experimental wedged insole

Either a medially wedged or laterally wedged footwear insole (whichever reduces knee joint mechanical loading more, as determined from subject-specific biomechanical tests), constructed using a 3D printer will be inserted into each participant's shoe. The participant will be asked to utilize this insole as much as possible throughout the day over the course of 3 months.

Group Type EXPERIMENTAL

wedged insole

Intervention Type DEVICE

Wedged insoles are designed to reduce frontal plane knee joint mechanical loads during gait. Specifically, they can alter the knee adduction moment during gait - a variable associated with progression of knee osteoarthritis. In the experimental arm of this study, participants will undergo biomechanical gait analysis to identify the wedged insole that reduces the moments the most. The two options are medial wedge, where the medial aspect of the foot is elevated relative to the lateral aspect, and the lateral wedge, where the lateral wedge is elevated relative to the medial aspect.

Interventions

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wedged insole

Wedged insoles are designed to reduce frontal plane knee joint mechanical loads during gait. Specifically, they can alter the knee adduction moment during gait - a variable associated with progression of knee osteoarthritis. In the experimental arm of this study, participants will undergo biomechanical gait analysis to identify the wedged insole that reduces the moments the most. The two options are medial wedge, where the medial aspect of the foot is elevated relative to the lateral aspect, and the lateral wedge, where the lateral wedge is elevated relative to the medial aspect.

Intervention Type DEVICE

Other Intervention Names

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orthotic

Eligibility Criteria

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Inclusion Criteria

* Physician-diagnosed knee osteoarthritis (using American College of Rheumatology clinical and radiographic criteria)
* Kellgren-Lawrence grade 1, 2, 3 or 4
* Primary symptoms and disease location must be attributed to medial tibiofemoral compartment
* KOOS pain of 75 points or lower (where 0 is worst pain and 100 is no pain)

Exclusion Criteria

* X-ray older than 2 years
* Viscosupplementation within past 6 months
* Cortisone injection in past 3 months
* Narcotic pain medication within past 3 months
* Use of knee unloading brace interventions in past 2 months
* Recent (past 6 months) knee or neuromuscular injury that could bias pain assessments or gait analysis results
* No KAM reduction with either lateral or medial wedge insole
Minimum Eligible Age

40 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Natural Sciences and Engineering Research Council, Canada

OTHER

Sponsor Role collaborator

Alberta Innovates Health Solutions

OTHER

Sponsor Role collaborator

Killam Trusts

UNKNOWN

Sponsor Role collaborator

New Balance Athletic Shoe, Inc.

INDUSTRY

Sponsor Role collaborator

University of Calgary

OTHER

Sponsor Role lead

Responsible Party

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Ryan Lewinson

MD/PhD Candidate

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ryan T Lewinson, BSc

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Kelsey HM Collins, BS

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Isabelle A Vallerand, BSc

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

J Preston Wiley, MD, MPE

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Linda J Woodhouse, PhD, PT

Role: PRINCIPAL_INVESTIGATOR

University of Alberta

Raylene A Reimer, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Jay T Worobets, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Walter Herzog, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Darren J Stefanyshyn, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Calgary

Locations

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Human Performance Laboratory, University of Calgary

Calgary, Alberta, Canada

Site Status

Countries

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Canada

References

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Lewinson RT, Vallerand IA, Collins KH, Wiley JP, Lun VMY, Patel C, Woodhouse LJ, Reimer RA, Worobets JT, Herzog W, Stefanyshyn DJ. Reduced knee adduction moments for management of knee osteoarthritis:: A three month phase I/II randomized controlled trial. Gait Posture. 2016 Oct;50:60-68. doi: 10.1016/j.gaitpost.2016.08.027. Epub 2016 Aug 26.

Reference Type DERIVED
PMID: 27580080 (View on PubMed)

Lewinson RT, Collins KH, Vallerand IA, Wiley JP, Woodhouse LJ, Reimer RA, Worobets JT, Herzog W, Stefanyshyn DJ. Reduced knee joint loading with lateral and medial wedge insoles for management of knee osteoarthritis: a protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2014 Dec 3;15:405. doi: 10.1186/1471-2474-15-405.

Reference Type DERIVED
PMID: 25467955 (View on PubMed)

Other Identifiers

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23731-01

Identifier Type: -

Identifier Source: org_study_id