Therapeutic effect of a flexible and non-heeled footwear on the clinical, functional feature and gait biomechanics in elderly women with knee osteoarthritis: a randomized clinical trial

Abstract

Osteoarthritis (OA), classified as a chronic degenerative rheumatic disease is, undoubtedly, the most common disorder of the musculoskeletal system, which contributes to an incapacity to work of about 15% of adults worldwide. This disease has the mechanical stress as a major cause of onset and progression of disease, especially in joints with constant movement and overloading as the knee. Given this, one of the main treatment aims at reducing intra-articular load. Recent studies have demonstrated an acute, that the use of footwear that mimic gait barefoot can minimize joint overload, however, not yet aware of any study that evaluated the effect of using this type of footwear for in patients with chronic knee OA. Then, the objective of this study is to evaluate the chronic therapeutic effect of an inexpensive and flexible footwear without heels on the clinical, functional and gait biomechanical of elderly women with knee OA. The disease clinical and functional aspects will be evaluated using a visual analogue scale (VAS) for pain, WOMAC and Lequesne questionnaires of quality of life in patients with OA and six-minute walk test (6MWT). Biomechanical analysis of the gait will be performed by infra-red cameras and a force platform. From the data of kinematics and kinetics, will be calculated moments of the knee joint by inverse dynamics solutions. Participants will be 56 elderly women with knee OA grades 2 and 3 (Kellgren and Lawrence). Participants will be randomized (in blocks) and placed in the group that will use a flexible and shoes without heels, called the intervention group (IG) or in a group will not use these shoes (CG). Both groups will be followed for 6 months. The process will be divided as follows: Step 1, where there will be screening and initial assessment of prospective participants, step 2, where they will be evaluated through VAS pain, function and quality of life by means of questionnaires, WOMAC and Lequesne and the 6MWT, and by evaluating the biomechanics of gait. In step three (3 month follow-up), the OAG will be evaluated again by the VAS and WOMAC questionnaires and Lequene. In step 4, after 6 months of starting the monitoring process, both groups will be reevaluated through the VAS, WOMAC, Lequesne, 6MWT and biomechanical analysis of the gait. This step is the final evaluation, characterizing the end of intervention. Comparisons between groups will be conducted by independent t tests and cross-moments by testing analysis of variance (ANOVA) for repeated measures followed by post hoc Newman-Keuls. This procedure will be performed for each variable. Comparisons of the variables of WOMAC and Lequesne be compared using the Mann-Whitney.