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All,

The results of the meta-analysis posted here:
http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=25265&postcount=73

Got me thinking about the last one of these I read on foot orthoses:
A critical review of the literature on foot orthoses
Pratt J Am Podiatr Med Assoc.2000; 90: 339-341

How do the scoring systems that were applied in the these two studies differ?

Do any of the reviewed studies that appear in both papers get widely differing "ratings" by the authors when the different criteria are applied?

If we took the more recent papers that were reviewed (post 2000) by Collins et al. and applied Pratt's criteria how would they score?

P.S. What was the "modification" to the Pedro system, i.e. could you list the the 14 criteria applied by Collins et al. please?

 

Nor I. As I recall it was something along the lines of: they were all very poor to poor with the exception of the Kilmartin study.

I still think that RCT's on custom foot orthoses are at best a test of the prescription/ manufacture protocol and not of the orthoses per se and the trouble with this kind of meta-analysis is that it uses RCT's as gold standards. :bash:

 

Systematic review (SR) of Rome K, Handoll H, and Ashford R, (2007) covered preventative intervention (mostly orthotics) and treatment (aircast braces) for lower-limb stress fractures.

 

I guess that is a dilemma the researchers have to face...ie doing research that stacks up well on the scoring systems (eg Sackets; PEDro; etc) so its methodologically sound and then on the other hand satisfying the demands of clinicians which may lower the score in the quality ratings.

Bottom line is that RCT's on foot orthoses generally rank poorly on the research quality scales (Pratt only found the Kilmartin et al study was ranked high enough to have some quality, yet the Collins et al analysis only gave it a 7/14 where as the more recent Landorf et al study got a 11/14).

 

I would also imagine that RCT's on customized braces/orthoses made for any part of the body would also rank poorly on research quality scales. Could this simply be an inherent problem with any customized brace/orthosis in that they are, by their very nature, "customized" and, as a result, need expert adjustment to achieve their therapeutic potential?? In other words, RCTs of customized foot orthoses, if the researchers do not allow for adjustment of the foot orthoses after dispensing in their study, will never show the therapeutic potential that a talented foot orthosis clinician may achieve in a normal situation with a patient.