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.
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BACKGROUND: Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population.OBJECTIVE: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness.METHODS: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g).RESULTS: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57).CONCLUSIONS: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale.
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This study is part of the WHeelchair ExercisE and Lifestyle Study (WHEELS) project and aims to identify determinants of dietary behaviour in wheelchair users with spinal cord injury or lower limb amputation, from the perspectives of both wheelchair users and rehabilitation professionals. Results of focus groups with wheelchair users (n = 25) and rehabilitation professionals (n = 11) are presented using an integrated International Classification of Functioning, Disability and Health and Attitude, Social influence and self-Efficacy model as theoretical framework.
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