1. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORA L JOINT PAIN Isaac Knott Student ID: u3068884

2. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN  Prevalence = approximately 26% active population [1].  Pain in retro-patellar (behind) or peri-patella (around) [1].  Pain brought on through an increased load through the patellofemoral joint [1-3].  Prolonged walking, ascending/descending stairs, running, kneeling, squatting, prolonged sitting… Image 1: Moveforwardpt.com. Patellofemoral Pain - MoveForwardPT.com [Internet]. 2014 [cited 14 September 2014]. Available from: http://www.moveforwardpt.com/symptomsconditionsdetail

3. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Image 2: My Trainer Chris. Knee Strengthening for Females [Internet]. 2013 [cited 14 September 2014]. Available from: http://mytrainerchris.wordpress.com/2013/12/21/knee-strengthening-for-females/

4. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN “Conservative management is currently considered the principle treatment, with foot orthoses often prescribed in combination or as an alternative to other management strategies including taping, exercise prescription and analgesics (2) ”.

5. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN  Foot orthoses are specially moulded devices designed to fit inside footwear (1).  Many different variations and styles  Custom vs prefabricated  Hard, medium or soft  Corrects foot posture and improves lower limb biomechanics thereby decreasing PFJ pain? (1,3) Image 3 & 4: Soleplatinum.blogspot.com.au. Sole Solutions: Custom Foot Orthotics Laboratory in Cayman! [Internet]. 2011 [cited 14 September 2014]. Available from: http://soleplatinum.blogspot.com.au/2011/06/custom-foot-orthotics-laboratory-in.html

6. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Why is it important?  High prevalence  Decreases functional performance  Potential to contribute to additional chronic conditions (e.g osteoarthritis)  Physiotherapists on the “frontline” in terms of treating such conditions  Orthotics widely available

7. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN

10. Evaluation Strengths  Clearly defined research question.  Extensive search for relevant papers using strict inclusion and exclusion criteria.  Methods for each of the included trials were evaluated for bias.  Results interpreted with appropriate applications for clinical practice.  Protocols implemented to reduce the risk of bias through the selection and review process. Weaknesses  Only two articles were examined  Prevented assessments of heterogeneity and sensitivity  Neither of the reviewed trials had a clearly defined control group.

11. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN

13. Evaluation Strengths  Systematic review – did include some RCT’s  Larger number of studies and participants Weaknesses  Broad and multifaceted research question  Included case series and other lower quality study designs  Poor study design, poorly defined outcome measures and a lack of quantifiable data from the included studies.  Little to no comparison between studies  High risk of bias in included studies  No clear conclusions drawn

14. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN

16. Evaluation Strengths  Clearly defined control  Clear conclusion drawn  Well-designed methods that attempted to limit possible sources of bias (e.g. Blinding) Weaknesses  Low participant numbers  Shorter duration (6wks)  Orthoses supplied by prominent international manufacturer. Bias?

17. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Summary  Evidence around this topic seems to be conflicting  Higher levels of evidence seem to indicate that orthoses have little impact on PFJ pain over the long-term but there is a potentially a positive impact over the short term. Clear that there is a lack of high quality, well designed trials addressing this topic.

18. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN What did I learn?  Patience.  How to better recognise good quality evidence.  A better ability to recognise potential sources of bias.  The ability to recognise the clinical significance and potential impact of a good quality article.

19. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN Thank you! Any Questions ? Email: Zacknott@gmail.com

20. FOOT ORTHOSES FOR THE TREATMENT OF PATELLOFEMORAL JOINT PAIN References 1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database Syst Rev. 2011;1. 2.Barton MCJ, Munteanu SE, Menz HB, Crossley KM. The efficacy of foot orthoses in the treatment of individuals with patellofemoral pain syndrome. Sports Medicine. 2010;40(5):377-95. 3.Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised control trial of short term efficacy of in-shoe foot orthoses compared with a wait and see policy for anterior knee pain and the role of foot mobility. British Journal of Sports Medicine. 2011:bjsports-2011-090204. 4.Nhmrc.gov.au. Resources for guideline developers | National Health and Medical Research Council [Internet]. 2014 [cited 14 September 2014]. Available from: https://www.nhmrc.gov.au/guidelines/resources- guideline-developers