EFFECTIVENESS OF KNEE BRACES IN THE

TREATMENT OF KNEE OSTEOARTHRITIS

AN EVIDENCE BASED CASE REPORT
Introduction
OSTEOARTHRITIS
• Osteoasthritis is a degenerative joint disease characterized by boney inflammation
of one or more joints
• 2017  9,6 % Males, 18 % female. Risk > 60 years old
• 80 %  limitations of movement
• 25 %  functional limitations of daily activities
• Strongest risk factor  > 50 years old in males
> 40 years old in females
Risk factors: gender, joint trauma, non- traumatic biomechanical factors, and
weaker strength of knee extensor muscles
Management: weight management, physical exercises, biomechanical
interventions, and pharmacological management (topical NSAIDs or
corticosteroids)
PREVALENS
• In Asia, > 65 years old is estimated to increase from 6.8% in 2008 to
16.2% in 2040.
Female, 57 years old, arrived with complaints of pain in both knees
since one month prior to hospital admission, especially when patient
was doing standing up after squatting or kneeling. Crepitating sensation
was also felt on her knees.
History
• uncontrolled diabetes mellitus type-2
• uncontrolled hypertension
Physical findings
• blood pressure 180/100 mmHg
• pulse rate 100x/minutes
• respiratory rate 22x/minute
• temperature 36.3 0C
• body weight 71.6 kg
• body height 155.4 cm (IMT 29.6 kg/m2)
• crepitate in the right knee and ankle-brachial index suggestive of
peripheral arterial disease
Clinical question
For patients with knee osteoarthritis, is treatment with knee braces more
effective in improving the quality of life compared to no treatment or
other conservative treatment?
METHODS
 Database Keywords Findings Selected
Chocrane "Knee osteorthritis 1 1

Embase "Knee brace" or "Valgus knee brace" or "Neutral brace" or 30 1

"Neoprene sleeves"

OVIDMedli "Quality of life" 29 0

ne

EBM 11 1
Reviews
RESULT
Parameter Duivenvoord T, et al (2015) Raja K, et al (2011) Mine K, et al (2011)
PICO + + needed further improvement
acceptable results acceptable results

Article search + + addressed similar PICO as the

strategy performed assessment of risk of bias;
thus, ensuring validity of study. High
risk of performance bias due to lack of
blinding of study participants and
medical personnels; as well as detection
bias was observed from the assessment.
Therefore this review is still considered
as not sufficiently valid to answer the
clinical question. The results were
presented well through forest plot for
each comparison and outcome
measures.
Inclution criteria + +
the possibility of imprecision
was small in the latter article
based on the breakdown
results of SEQES scoring
which also concluded the
studies included in the review
as moderate-to-high quality
studies.
PICO in this report, however,
limitations of language and
dates from literature
searching might make the
possibility of missed
important and relevant
studies became very likely
various interventions and
comparators in inclusion
criteria and the absence of
exclusion criteria might
Parameter Duivenvoord T, et al (2015)
Study validity - +
addressed the possible imprecision
issue due to small number of studies
Homogeneity - -
showed high heterogeneity
Raja K, et al (2011) Mine K, et al (2015)
the possibility of imprecision was
small in the latter article based on
the breakdown results of SEQES
scoring which also concluded the
studies included in the review as
moderate-to-high quality studies.
Aside from small number of
studies, another possible reason
was addressed is such as wide
variety of interventions,
comparators, outcome measures,
and follow-up duration.
owever; did not perform any
heterogeneity test or establish any
meta-analysis; thus, making the
statistical heterogeneity could not
be determined.
• Intervention from all three reviews (knee braces) is considered as
applicable based on the appraisal
• Mine K, et al: did not recommend the use of knee braces for patients
without any doctor-patient discussion or without any pain during
specific activities because the results of their review did not show that
the benefits of intervention can outweigh harm and cost
DISCUSSION
• Raja K, et al. This might be caused by minimal skin irritation, which
often appeared as side effects of knee braces use.
Raja K, et al
Showed that valgus bracing is the best option for treating tibiofemoral
osteoarthritis, which mainly involves medial compartment, through
reduction of medial compartment loading external valgus moment
applied by force on the knee joint.
Mine K, et al
Also showed different effects of different types of knee braces; such as:
improvement in pain on squatting position with knee braces with pads;
improvement in pain on walking on uneven grounds with short lever
elastic braces.
Duivenvoorden, et al
Had more superior importance compared to the other reviews by
showing detailed comparisons between each intervention with many
outcome measures provided along with meta-analysis; small number of
studies with high risk of bias and absence of number of loss-to-follow-
up degraded the level of validity in this review
• the review by Raja K, et al is deemed as the most superior evidence in
this report.
• all studies provided risk of bias and quality assessment (Cochrane
Collaboration tools, PEDro scale, SEQES) to ensure that the
conclusions were obtained from moderate-to-high quality studies with
minimal risk of bias.
For the patient in this case report
• Education about advantages and side effects of the knee braces can be
performed.
• Patient can also be educated about the impact on healthcare costs
(patient does not need to buy pain relief medications continuously)
and economic productivity (due to improved clinical manifestation).
CONCLUSION
• In patients with knee osteoarthritis, the use of knee braces can improve
the quality of life.
• It is inconclusive whether knee braces are more effective to improve
the quality of life of patients with knee osteoarthritis compared to
other conservative treatment.
Recommendations
• It is recommended to perform studies about comparison between knee
braces and other conservative treatment with better methodological
quality; specifically related to randomization, blinding mechanism,
more sufficient number of subjects based on sample size calculation,
improvement of reporting style, and ensuring homogeneity of
intervention and outcome measures.
• It is also recommended to assess long-term and short-term benefit
through at least 5-years duration of study since osteoarthritis is a
chronic disease.
REFERENCES