Background: Osteoarthritis (OA) is the most common rheumatic disease of the musculoskeletal system, with the knee as the most affected joint. The number of people with OA of the knee is likely to increase due to the ageing society and the obesity epidemic. The predominant clinical symptom of knee OA is pain, which is described as worsening by activity and relieving by rest. Knee instability has been recognized as an important clinical feature in persons with knee OA. Pain and knee instability are associated with limitations in performing daily activities. Non-pharmacological options in the management of knee OA consist of education, weight loss, exercise, braces and physical therapy. Knee bracing has been recommended by the Osteoarthritis Research Society International (OARSI). Valgus knee braces designed to decrease loads on the medial compartment of the knee for patients with varus alignment are the most common. It has been shown however, that valgus bracing may have little or no effect on pain and physical functioning, and adherence to this treatment in patients with knee OA is low.Because of ease of use and access, lack of complications and low cost, soft knee braces are commonly used in persons with knee OA. However, the evidence for efficacy of soft knee bracing on pain and activity limitations in knee OA is limited. Therefore, it is important to strengthen the evidence of using a soft brace to reduce pain and activity limitations as well as to evaluate the efficacy of soft knee bracing on knee instability in persons with knee OA. There is also debate about the effectiveness of soft braces in other affected joints of the lower extremity and in conditions other than OA such as rheumatoid arthritis.Objectives: The aim of the study will be to evaluate the effect of wearing a soft brace on dynamic knee instability in patients with OA of the knee.Methods: Persons with knee OA and self-reported knee instability from the Amsterdam Osteoarthritis cohort participated in a single-session lab-experimental study. A within-subject design was used, comparing no brace versus brace, and comparing a non-tight versus a tight brace (standard fit). The primary outcome measure was dynamic knee instability, expressed by the Perturbation Response (PR), i.e., a biomechanics based measure reflecting deviation in the mean knee varus-valgus angle after a controlled mechanical perturbation, standardized to the mean (SD) varus-valgus angle during level walking. Linear mixed-effect model analysis was used to evaluate the effect of a brace on dynamic knee instability.Results: The wearing of a soft brace reduced the knee instability significantly during perturbed walking. Results will also be presented from the literature search and from the lab-experimental study.Conclusion: Wearing a soft brace reduces dynamic knee instability in patients with knee OA. However, longitudinal studies are needed to evaluate the clinical implications of wearing a soft brace.
BACKGROUND: Generalized Joint Hypermobility (GJH) has been found to be associated with musculoskeletal complaints and disability. For others GJH is seen as a prerequisite in order to excel in certain sports like dance. However, it remains unclear what the role is of GJH in human performance. Therefore, the purpose of the study was to establish the association between GJH and functional status and to explore the contribution of physical fitness and musculoskeletal complaints to this association.METHODS: A total of 72 female participants (mean age (SD; range): 19.6 (2.2; 17-24)) were recruited among students from the Amsterdam School of Health Professions (ASHP) (n = 36) and the Amsterdam School of Arts (ASA), Academy for dance and theater (n = 36) in Amsterdam, The Netherlands. From each participant the following data was collected: Functional status performance (self-reported Physical activity level) and capacity (walking distance and jumping capacity: side hop (SH) and square hop (SQH)), presence of GJH (Beighton score ≥4), muscle strength, musculoskeletal complaints (pain and fatigue) and demographic characteristics (age and BMI).RESULTS: GJH was negatively associated with all capacity measures of functional status. Subjects with GJH had a reduced walking distance (B(SE):-75.5(10.5), p = <.0001) and jumping capacity (SH: B(SE):-10.10(5.0), p = .048, and SQH: B(SE):-11.2(5.1), p = .024) in comparison to subjects without GJH, when controlling for confounding: age, BMI and musculoskeletal complaints. In participants with GJH, functional status was not associated with performance measures.CONCLUSION: GJH was independently associated with lower walking and jumping capacity, potentially due to the compromised structural integrity of connective tissue. However, pain, fatigue and muscle strength were also important contributors to functional status.
Study Type – Aetiology (individual cohort)Level of Evidence 2bWhat's known on the subject? and What does the study add?Recent studies have already shown associations between generalized joint hypermobility (GJH) and voiding and defecation dysfunction and/or slow transit constipation. Changes in extracellular matrix composition in vesico‐ureteric junction of vesico‐ureteral reflux (VUR) patients were also observed previously.This study is the first to assess joint mobility as a parameter for connective tissue composition in vesico‐ureteral reflux. We convincingly demonstrate that VUR patients have significantly more hypermobile joints compared to controls and this provides a new angle to the intriguing subjects of development of VUR and susceptibility to VUR.OBJECTIVE•To assess whether there is an increased prevalence of joint hypermobility in patients with vesico‐ureteric reflux (VUR).MATERIALS AND METHODS•We studied 50 patients with primary VUR and matched controls drawn from a reference population.•Joint mobility was assessed using the Bulbena hypermobility score.RESULTS•We identified significantly more patients with VUR with generalized joint hypermobility than controls (24% vs 6.7%, P= 0.007).CONCLUSION•Our findings confirm our clinical observation of an increased rate of joint hypermobility in patients with VUR. We speculate that an altered composition of the connective tissue may contribute to the severity of the (pre‐existing) VUR phenotype.
