Asics Gel Melbourne for Medial Knee Osteoarthritis

NewsBot · Jul 12, 2016

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Press Release:
Walking shoes provide relief from knee osteoarthritis
Unloading shoes and conventional walking shoes both provide relief from knee osteoarthritis symptoms

Researchers from the Centre for Health Exercise and Sports Medicine (CHESM) at the University of Melbourne have this week had the results of a footwear trial published in the highly regarded journal, Annals of Internal Medicine.
Lead author on the research paper, Professor Rana Hinman said Our trial was a clinical trial comparing two types of shoes for managing knee osteoarthritis symptoms.
As most people know, there is no cure for osteoarthritis, and there are very few effective treatments because most drugs have quite small short lasting effects and there is increasing concern about the harmful side effects of drugs.
There has been the increasing recognition about the role of abnormal biomechanics in osteoarthritis and because of this there is a widely held belief that wearing appropriate footwear can help the symptoms of osteoarthritis.
A number of footwear companies have now developed shoes specifically designed to reduce the forces across the knee joint in order to help people with osteoarthritis. But up until now there have been no clinical trials looking to see if different types of shoes can influence the symptoms of knee osteoarthritis" said Professor Hinman
The trial compared two different kinds of shoe, both manufactured by ASICS. The first shoe was the Gel Melbourne OA, a shoe developed by the same research team a number of years ago for people with knee osteoarthritis.
It contains a couple of design features specially aimed at trying to reduce the load across the knee joint. said Professor Hinman. These design features encourage the foot to pronate more than usual to help reduce the load across the medial knee joint."
The second shoe was the ASICS Gel Odyssey, which is a walking shoe that doesn?t contain the specific features of the Gel Melbourne OA.
One hundred and sixty four participants with knee osteoarthritis took part in the study. Each person was provided with either the unloading Gel Melbourne OA shoe, or the conventional Gel Odyssey, and asked to wear that shoe every day for 6 months.
What we found at the end of the trial was that both shoes were effective at reducing pain and dysfunction. On average, pain was reduced by about 25% and function was improved by about 22%, so both shoes were effective at helping to self-manage symptoms and there was no differences between the two shoes, showing either shoe option could be helpful for knee osteoarthritis patients. said Professor Hinman.
Speaking on the topic of footwear for self management of knee osteoarthritis, Professor Hinman said "I think footwear is appealing because it is such a simple and straightforward management strategy. We know that people with osteoarthritis prefer to use non-drug, non-surgical management strategies if possible, and I think that is one of the reasons why footwear is appealing. All people need to do is remember to put the footwear on in the morning and wear them as much as possible.
We hope this trial is going to get clinicians talking more about footwear with their patients and the role they can play in the management of their symptoms.
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NewsBot · Jul 12, 2016

Re: Asics Gel Melbourne for Medial Knee Ossteoarthritis

Unloading Shoes for Self-Management of Knee Osteoarthritis: A Randomized Trial
Rana S. Hinman, BPhysio(Hons), PhD; Tim V. Wrigley, BSc(Hons), MSc; Ben R. Metcalf, BSc(Hons); Penny K. Campbell, BAppSci(FoodSci&Nutr); Kade L. Paterson, BAppSci(Hons), BPod, PhD; David J. Hunter, MBBS, PhD; Jessica Kasza, BSc(Hons), PhD; Andrew Forbes, BSc(Hons), MS, PhD; and Kim L. Bennell, BAppSci(Physio), PhD
Ann Intern Med. Published online 12 July 2016 doi:10.7326/M16-0453

Background: Appropriate footwear is recommended for self-management of knee osteoarthritis. Shoes that reduce harmful knee loads are available, but symptomatic effects are uncertain.

Objective: To evaluate the efficacy of unloading shoes in alleviating knee osteoarthritis symptoms.

Design: Participant- and assessor-blinded comparative effectiveness randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12613000851763)

Setting: Community.

Participants: 164 persons with medial knee osteoarthritis.

Intervention: Walking shoes with triple-density, variable-stiffness midsoles and mild lateral-wedge insoles designed to unload the medial knee and worn daily (intervention) versus conventional walking shoes (comparator).

Measurements: Primary outcomes were pain with walking (assessed on a numerical rating scale [NRS]) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) at 6 months. Secondary outcomes were knee pain and stiffness (WOMAC), average pain (NRS), intermittent and constant knee pain (Intermittent and Constant Osteoarthritis Pain questionnaire), quality of life (Assessment of Quality of Life instrument), physical activity (Physical Activity Scale for the Elderly), and global change in pain and function (Likert scales).

Results: A total of 160 participants (98%) completed primary outcome measures at 6 months. Changes in pain (mean difference, 0.0 units [95% CI, −0.9 to 0.8 unit]) and function (mean difference, 0.3 unit [CI, −3.2 to 3.7 units]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements in function and the intervention group showing clinically relevant improvements in pain. There were no differences in secondary outcomes. Pain was globally improved in 54% of participants, and function was globally improved in 44% to 48%. Unloading shoes were not associated with increased probability of improvement (odds ratios, 0.99 [CI, 0.53 to 1.86] for pain and 0.85 [CI, 0.45 to 1.61] for function).

Limitation: Effects on joint structure were not evaluated.

Conclusion: Shoes with modified midsoles to unload the medial knee conferred no additional benefit over conventional walking shoes. Both improved pain and function by clinically relevant amounts.
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Admin2 · Jul 12, 2016

Re: Asics Gel Melbourne for Medial Knee Ossteoarthritis

Related Topics:
Lateral foot wedging for medial knee OA
Can Foot Orthoses Have an Impact for Knee Osteoarthritis?
Patent granted for shoe outsole to decrease knee adduction moment
How do you do lateral wedging for medial knee osteoarthritis

Admin2 · Sep 22, 2016

Older video:

NewsBot · Jul 19, 2016

Editorial
A Cinderella Tale: Can New Shoes Change the Life of a Person With Knee Osteoarthritis?
Marian T. Hannan, DSc, MPH; Carol A. Oatis, PhD, PT; and Robert R. McLean, DSc, MPH
Ann Intern Med. Published online 12 July 2016 doi:10.7326/M16-1459

Guidelines recommend appropriate footwear for patients with knee osteoarthritis, but little evidence exists to inform shoe choice. Hinman and colleagues report a randomized trial that compared shoes designed to unload the knee versus new conventional shoes. The editorialists note that the fact that both groups improved similarly leads one to wonder whether readily available, new, supportive lace-up shoes should be the current evidence-based recommendation for appropriate footwear while we await future studies of knee biomechanics that might identify more effective interventions.
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markjohconley · Jul 19, 2016

So the reason for the apparent 'discrepancy' between the 2014 analysis and the 2016 RCT?

Craig Payne · Jul 19, 2016

markjohconley said: ↑

So the reason for the apparent 'discrepancy' between the 2014 analysis and the 2016 RCT?
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Pass.

I wrestling with the issue. Seems to be that the control groups often improve as well which mean the intervention did not work. Having said that there is an apparent subject specific response in both groups which could account to the lack of the systematic response! ... need to get to the bottom on this.

Funny you should post this when you did; just 2 minutes ago I emailed a couple of key people to invite them to a private webinar on this for me to video record the discussion --> edit and publish it! Watch this space.

NewsBot · Jul 19, 2016

Reuters Health are carrying the story:
Special footwear may not improve knee arthritis

NewsBot · Nov 14, 2017

Moderators and mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis: an exploratory analysis of the SHARK randomised controlled trial.
Paterson KL et al
Osteoarthritis Cartilage. 2017 Nov 8. pii: S1063-4584(17)31304-3. doi: 10.1016/j.joca.2017.11.002.

OBJECTIVE:
To investigate moderators and biomechanical mediators of effects of unloading shoes on knee pain in people with knee osteoarthritis (OA).
METHODS:
Exploratory analysis from 164 participants in a clinical trial comparing unloading (ASICS GEL-Melbourne OA) to conventional walking shoes. The primary outcome was 6-month change in knee pain (11-point numerical rating scale). Moderators included baseline peak knee adduction moment (KAM), radiographic severity (Kellgren & Lawrence (KL) scale), body mass, foot posture, neuropathic pain and diffuse knee pain. Mediators included change in peak KAM and KAM impulse.
RESULTS:
Radiographic severity was the only moderator to interact with footwear group (p=0.02). Participants with KL=2 experienced greater pain reductions with conventional compared to unloading shoes (mean difference in change in pain -1.64 units, 95%CI -3.07, -0.21), while unloading shoes tended to result in greater pain reductions than conventional shoes in KL=3 (0.98, 95%CI -0.44, 2.39) and KL=4 (0.64, 95%CI -0.64, 1.93). No variable showed any significant mediating effect in the entire cohort. However, there was some evidence that unloading shoes may reduce pain through reductions in peak KAM (indirect effect -0.31, 95%CIs -0.65, 0.03; p=0.07) in people with KL≥3, compared to conventional shoes.
CONCLUSION:
Unloading shoes conferred additional symptomatic benefits over conventional shoes in people with moderate to severe knee OA. There was some evidence effects may be mediated by a reduction in peak KAM. However, we were underpowered for subgroup analyses. These patients may represent a subgroup to which biomechanical interventions designed to reduce the KAM may be more effectively targeted.
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