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Title: Foot orthoses in individuals with knee osteoarthritis : biomechanical and clinical effects of a personalised intervention approach
Author: Allan, Richard
ISNI:       0000 0004 6422 1021
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2017
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Introduction: Epidemiological and Biomechanical research approaches were adopted in this thesis to investigate the application of foot orthotics (FOs) in the knee osteoarthritis (KOA) population. Long term influence of FO devices in relation to the incidence of KOA was investigated. Novel Computer-aided Design and Manufacturing (CAD/CAM) approaches were exploited to investigate response to alterations in design characteristics of FOs in an attempt to optimise reductions in pain and disability associated with the incidence and progression of KOA. Methods: Three studies were undertaken, (i) Retrospective matched case-control assessment of the role of prescribed orthopaedic footwear devices on incident rates of KOA in the Greater Glasgow & Clyde area of Scotland, (ii) Biomechanics study assessing the immediate biomechanical response to design variations in 3D-printed personalised FOs in medial compartment knee osteoarthritis (mKOA) and healthy subjects (iii) Biomechanics study involving a crossover design assessing the application of a novel 3D-printed participant-customised, modular FO against a market-leading prefabricated FO in subjects with mKOA Study one was a retrospective matched cohort study investigating incidence rates of KOA in a Scottish population to determine whether habitual orthotic use had a detrimental influence on the incidence of KOA. Computer-aided design and manufacturing (CAD-CAM) systems were developed and evaluated for the production of customised FOs via fused deposition modelling (FDM) for studies two and three. Study two applied commercially available CAD software dedicated to FO design. Eight FOs with variations in design characteristics relating to FO length and lateral wedging were created and evaluated. Study three advanced the design requirements by creating a modular personalised FO using commercial free-form CAD software. A crossover study evaluated the modular FO against a prefabricated FO relative to shod conditions in tasks representative of activities of daily living (ADL). Both biomechanics studies incorporated 3D gait analysis techniques to investigate the kinematic and kinetic outcomes related to knee function whilst patient-reported outcome measures (PROMs) were used to assess therapeutic effect. Results: Study one indicated that individuals predisposed to KOA development may accelerate the rate of disease progression when given the opportunity to be in habitual orthotic use for other non-KOA conditions. Study two demonstrated significant reductions in variables related to medial compartment loading with the FOs, with optimal reductions for participants occurring with varied device designs. No significant differences were found between FO conditions in relation to pain and PROMs. Study three targeted the heterogeneous response through a novel approach to self- evaluate the FO design required for optimal response. Differences were reported between all FOs across kinematic, kinetic and PROMs. Individual biomechanical and therapeutic benefit occurred with both, neither or inconsistently between conditions. Conclusion: Long term outcomes indicate inappropriate device use could lead to faster disease progression. Furthermore, the application of FOs is more complex than a one size fits all approach, even when tailored to individual preference. Variability in biomechanical responses indicates that greater care is required during FO prescription in order to improve short and subsequent long term outcomes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available