1. 111 Custom orthotics in knee osteoarthritis ESR4 Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center, Amsterdam, Netherlands

2. 2 Participants Supervisor –Dekker Co-supervisors –Pallari, Woodburn Project members –NN –Harlaar –Lems –Roorda –Steultjens –van den Noort –van der Esch –van der Leeden

3. 3 Instability of the joint in knee OA Inability to maintain a position or to control movements under external load Highly prevalent in knee OA –63 % –65 % Strong impact on limitations in activity van der Esch, 2007; Dekker, 2014; Knoop, 2014 Fitzgerald et al, 2004 van der Esch et al, 2012

4. 4 Neuromuscular control

5. 5 Soft brace Source of proprioceptive input Positive effect on proprioceptive acuity and postural sway –Not explained by reduction of pain No information on: –Impact on instability –Functioning during daily life Hassan et al, 2002 a, b

6. 6 Purpose To evaluate the impact of a soft brace on (i)Neuromuscular control –Instability (observed) –Sway (ii) Functioning during daily life –Instability (self reported) –Limitations in activity (observed, self reported)

7. 7 Methods Design oA – B – A – B  A = no brace  B = brace in lab, followed by daily life  A, B – several days duration (tbd) Patients –Knee OA (ACR clinical criteria) –Self reported instability –20 < BMI < 30 –Pain < 7 (1- 10 NRS) –N = 30

8. 8 Methods Intervention –Brace in the lab –Brace in daily life Neoprene sleeve –Customized size

9. 9 Methods Measures –Instability, observed –Sway, force platform –Instability, self reported (Felson, adapted) –Limitations in activity, self reported (WOMAC) –Limitations in activity, observed (6 MWT, GUG) –Muscle strength (isokinetic) –Pain –Proprioception –Compliance Knoop et al, 2012

10. 10 Perturbations during walking Instrumented Treadmill

11. Gait Sensitivity Norm