Effectiveness of single and combined treatments on biomechanical and clinical outcomes during walking in healthy individuals and individuals with knee osteoarthritis

Knee osteoarthritis (OA) is considered a common chronic musculoskeletal disease affecting the medial compartment more than the lateral compartment and leading to disability and a reduction in activity level. Lateral wedge insoles (LWI) are a conservative treatment that aims to reduce the knee loading (External knee adduction moment (EKAM), which is increased in individuals with knee OA compared to healthy individuals. Although, LWI reduce EKAM in individuals with knee OA, no significant difference was seen in pain when compared to the control treatment (neutral insole). Patients and healthcare practitioners are driven by pain more than by mechanics. Therefore, reductions in pain and loading could be achieved with LWI if combined with other conservative treatments, such as a simple knee sleeve.The overall aim of the thesis was to investigate the biomechanical and clinical effects of combining LWI with a knee sleeve, compared to each treatment used on its own. To accomplish this research, four studies were conducted. Firstly, a reliability study amongst healthy individuals was conducted. Secondly, a reliability study of individuals affected by knee OA was conducted. Both studies showed that most biomechanical and clinical outcomes have excellent reliability and low measurement error, which supports using them. Thirdly, a randomised crossover study was conducted among healthy individuals to investigate the immediate effects of the combined treatment and the single treatments. The results showed that a knee sleeve significantly reduced the knee joint frontal plane range of motion (ROM) but not the EKAM or muscle co-contraction. Furthermore, a significant reduction in the EKAM with use of LWI was noticed. The combined treatment showed both a reduction in the EKAM from LWI use and a reduction in frontal plane ROM, which supports the use of these treatments in individuals with knee OA. In the fourth and main study, thirty-four participants with medial knee OA were enrolled and randomised into 3 groups (LWI, simple knee sleeve, LWI and simple knee sleeve). The immediate and six-week effect on biomechanical and clinical outcomes were measured and compared between and within groups. At baseline there was no significant difference between the groups. The results showed a significant reduction in the magnitude of change in EKAM for the combined group and the LWI group compared with the sleeve group. The magnitude of change in muscle co-contraction was higher in the sleeve group and the combined group compared to the LWI group. The combined group (31.88%) showed greater reduction in pain than the LWI group (21.1%) and the sleeve group (11.16%); however, this was not statistically significant. Only the combined group and the LWI group showed improvement in balance and functional tests compared to their baseline. Finally, the pain pressure threshold did not change after treatment in all groups. Overall, the findings of this thesis support combined treatment. A larger trial to investigate combined treatment and single treatments in a larger sample size is needed to make the findings more conclusive