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Foot Orthoses in the Prevention of Injury in Initial Military Training: A Randomized Controlled Tria

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Nov 2, 2010.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Foot Orthoses in the Prevention of Injury in Initial Military Training: A Randomized Controlled Trial
    Andrew Franklyn-Miller, Cassie Wilson, James Bilzon, Paul McCrory
    American Journal of Sports Medicine (in press)
  2. One word for this study.....HUGE!!
  3. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Thank God. Not read the full article, but on the surface this appears to be a long overdue quality study that looks at "outcomes" and avoids the perennial distraction of "but how do they work". Who cares? We don't understand how half of the most common drugs in the world truly work.

    Please, academic podiatry researchers,...follow this lead.:D

  4. Funny thing if the outcomes had of been negative I would guess we would be complaining about the type of device used or how the device was choosen.

    While a step forward how many people make their clinicial orthotic design decisions from pressure plate recordings?

    So while again positive not really ready to start the old orthotic prevent injury discussions with patients. But maybe it´s just me
  5. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    I didn't think it would take long...

    If we collectively pulled our heads out of out proverbials and stopped worrying so much out how/which type/which theory/ etc, and put our energies into more meaningful clinical outcomes studies, the profession would be enternally grateful.

    Clearly there are multiple approaches/theories etc. Same goes for our medical colleagues who approach renal failure, diabetes control etc all from slightly varying philosophies. You don't see the drug companies and research labs worrying endlessly about they why. They get to the point to clear regulatory hurdles, then just get on with proving in population studies wether new drug B is better than old drug A or placebo.

    I'm sorry, but the endless debates on this website arguing in circles about my theory is better than yours is tiresome, redundant and now about 30 years old.

    Time to spin it around.


    ps I couldnt care less if this research concluded a negative response to orthoses. I just personally want to see much, much more research of this nature from our research colleagues. Only this kind of stuff can guide clinicians such as myself.
  6. CraigT

    CraigT Well-Known Member

    People who have one of these systems... and foot pressure measurement is VERY popular in Europe, although I am not sure many people interpret the foot pressure readings the same way as this system does.
    Nonetheless this study demonstrates that it may be a reasonable tool to base orthotic protocols on... although you cannot say that the result would have been any different to using a standard OTC device. That would have been an interesting sub group.
    The study clearly shows less injuries- particularly MTSS and ITB syndrome- in the group that used orthoses. Now... why?;)
  7. Craig it looks like you can get your hands on a copy- what were the design features of the device ?
  8. I have not read the full paper so perhaps some one can tell me how they "risk assessed" the subjects?

    I find these kind of trials interesting, can someone explain to me how we "know" that the reduced injury rate in the study group was a result of the foot orthoses and not to some other factor?
  9. Craig Payne

    Craig Payne Moderator

    They were the devices being marketed by RS Scan
    I have done one of these studies (not published yet) and the injury rate was not lower in the orthotics group. To answer your question, you have to control every thing, so that the only differences between the two groups are the intervention (ie the orthotic).
  10. But the subjects in the two groups are not clones of one another. So it is possible that the difference in injury rate is due to factors inherent to the individuals assigned to the two groups.
  11. Craig Payne

    Craig Payne Moderator

    Thats the purpose of randomisation - to end up with two groups that are equal on everything, so then they will only differ on the intervention. Usually stats tests are done on a whole range of variables to compare the two groups at baseline to show they are not different in any of them ... there is however, that there may be some differences, but the whole process of the randomisation is to make sure it does not happen.
  12. Yes I understand statistical theory. In reality though while you may age match, gender match etc. the propensity for injury will be due to a combination of genetic and environmental components which may not been taken into account, thus you may still have mismatched samples. For example there is evidence to suggest that those with blood group O have a greater propensity for tendonosis, specifically of the Achilles, so where the subjects in the study matched for blood type? What causes injury?
  13. Griff

    Griff Moderator

    Good point. More blood type refs:

    Jozsa, L., Balint, J. B., Kannus, P., et al. (1989). Distribution of blood groups in patients with tendon rupture. An analysis of 832 cases. The Journal of Bone & Joint Surgery Br, 71(2), 272-274.

    Kujala, U. M., Jarvinen, M., Natri, A., Lehto, M., et al. (1992). ABO blood groups and musculoskeletal injuries. Injury, 23(2), 131-133.
  14. Craig Payne

    Craig Payne Moderator

    Matching by age, gender etc is a case control study, not a randomised controlled study. Because of randomisation, you assume that there are equal numbers of blood group O in each of the groups.
  15. Yeah, "assume" being key, since there will always be selection bias. And with pure randomisation we can end up with a group of females versus a group of males or a group of blood group O's versus the rest, or a group of individuals who are more likely to get injured during military training than another group... Crass at best. The word "controlled" and "randomised" are not happy bed fellows in this context.
  16. Craig Payne

    Craig Payne Moderator

  17. Craig, if I used pure randomisation I'd perhaps be suspicious if I ended up with equal numbers of males and females in both groups unless the sample size was tiny or huge. Regardless, I feel you have taken my example a little too literally. The point being that we don't understand all of the predictors of musculo-skeletal injury, we might assume that by sampling randomly and assigning randomly then we will have balanced populations in the study and control groups, but since we don't know what the predictors are, we have no idea. Lets assume that eating cheese is a predictor for injury in military recruits. We randomly assign military recruits to either a study or control group, we might assume that we have equal numbers of cheese eaters in each group, but we don't know that unless we ask them. We could ask how many eat cheese in each group, this would give us our answer. i.e. we can test the samples for differences in the values we consider to be important and find differences or not. We might test things like age, gender etc between the two groups (study and control) and conclude that the groups were well matched. Yet, we don't know all of the questions to ask when it comes to musculoskeletal injury, since we don't know what the predictors are. Lets say gene X is a predictor, we might assume that our randomisation results in equal numbers of individuals with gene X in each sample, but how do we know this unless we test for gene X? And test for differences in the study versus control groups for the gene X prevalence? Are the samples balanced or not with regard to gene X? Who knows?

    If I flip a coin ten times how may times will it turn up heads and how many times will it turn up tales? How many times do I need to flip it, until the number of heads equal the number of tails? Twice? Sometimes. Two hundred? Sometimes, A thousand? Sometimes.

    So lets say we recruit 400 subjects of which 200 have gene X (which we know causes injury in military recruits), for each subject we flip a coin to decide whether they go into the treatment or control groups (with pure randomisation we could end up with all of them in the control group BTW), what's the probability that the two groups will have an equal number of subjects with gene X within them when all subjects have been assigned?

    Back to the paper that is the point of this discussion, 400 subjects (I love round figures). Lets assume that the only cause of injury in military recruits is eating cheese. How do we know from the study whether 21 individuals in the intervention group and 61 individuals in the control group were cheese eaters, and the rest were not?

    To answer your question: no I haven't carried out this kind of study, for the reasons I'm outlining. Does the fact that I haven't performed one, preclude me from discussing them?
  18. p.S. Indeed, how do we know whether those that did get injured in the study group, got injured as a result of the orthotics? And if they hadn't been assigned the orthotics would they have got injured?
  19. Stratified randomisation can be employed to ensure the study and control groups are balanced. My choice of the word "matched" may not have been the best here, I meant that we can stratify for certain variables i.e. age, gender to ensure the study and control groups are balanced. Hence it is still a randomised controlled trial, yet with stratified randomisation.
  20. Gibby

    Gibby Active Member

    orthotics help soldiers avoid injury?
    As a podiatrist and a soldier, I already knew that.
    Perhaps I will do a study- "helmets help soldiers avoid head injuries..."
  21. Great maybe you can also do a study on the fact that " when you join the army you might get shot at " ........... so people can stop crying about being shot at when they are in the army.
  22. mr2pod

    mr2pod Active Member

    ROFL!! I have always been amused by this. Notice how it's never the ppl that join that are complaining.
  23. NewsBot

    NewsBot The Admin that posts the news.

    Lower limb injuries in soldiers: feasibility of reduction through implementation of a novel orthotic screening protocol.
    Baxter ML, Baycroft C, Baxter GD.
    Mil Med. 2011 Mar;176(3):291-6.
  24. Griff

    Griff Moderator

  25. brekin

    brekin Active Member


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