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Last Revised 4/1/09

On-line CEUs

NAOT members with an active OTC credential can earn CEU credits toward recertification just by reading the “Tip of the Month” contained in each issue of the Orthotech Professional and answering a few short questions at the conclusion of the article.  Members can either answer the questions in the print version of the newsletter and return them via fax or mail to the NAOT offices, or submit answers on-line by clicking on the link at the end of each article and completing the on-line questionnaire. To receive 1 CEU (Category 2) for each article read, you must include:

-Your full name
-NAOT member number
-Email address (if applicable)
-Answers to all questions
-OTC number 

NAOT will maintain a database with these CEU submissions and provide a record of total CEUs earned at the end of each calendar year to all participating members.  Members will still be responsible for logging these hours with NBCOT at the appropriate time for recertification.

TIP OF THE MONTH: March/April 2009
Knee Osteoarthritis
by Marjorie Albohm, MS, ATC



Arthritis is a health care epidemic, costing America over 81 billion dollars annually on treatment and management. More than one in every 5 adult Americans suffers from arthritis. The painful effects of arthritis limit everyday physical activity more than cancer, heart disease or diabetes. (1)

Osteoarthritis of the knee is one of the most disabling conditions of the musculoskeletal system. The primary treatment choices have been analgesic and anti-inflammatory prescription medications and total knee replacement, a costly and life changing surgery. Current research provides valid evidence, however, to support the use of unloading bracing in the management of knee OA.

Kirkley, et al, in 1999, validated the effectiveness of the Unloader® brace in a prospective, randomized controlled trial, comparing the Unloader to a knee sleeve and no brace. Results indicated a significant decrease in pain and improvement in function in subjects wearing the Unloader brace. (2)

A meta analysis by Pollo, et al, validates the Unloader brace and demonstrates that knee bracing for OA effectively relieves pain and improves function (3).  In addition, randomly controlled trials by Pollo, et al (4) and Hillstrom, et al (5) demonstrate that the Unloader brace reduces pain and improves function.

Preliminary data from the most compelling patient-outcomes study to-date, demonstrates a 24% reduction in pain medication in patients wearing an Unloader One™ brace (6). In addition, there was an improvement in function and decrease in symptoms.  Patient enrollment is ongoing and results remain consistent.

So, with this available scientific evidence, why are unloading braces selected only 0.5% as a treatment option, compared to 93.5% for pharmaceuticals or no treatment? (6) Previous versions of unloading braces were less than user friendly. Cumbersome braces, with frequent slippage and heat generating liners, made patients, understandably, non-compliant. Patient satisfaction was poor and physician prescribers could not appreciate the benefits because many patients didn’t give the braces a chance.

New technology has dramatically changed fit, comfort, and the effectiveness of unloading braces.  For example, specially designed liners and ventilated lightweight shells have made the Ossur Unloader One™ brace a 16 oz. low profile device that is extremely comfortable and achieves a high level of patient satisfaction. 

Prescriber education and consumer awareness is needed to demonstrate the value of the new Unloader brace, to give patients a viable, scientifically proven alternative to prescription medication and total knee replacement. Knee OA patients deserve to know ALL options available to them and it’s our obligation, as health care professionals, to provide that information to them.

Much still remains to be learned regarding the most effective treatment protocol for knee OA. Effective management does not involve only one treatment option. A combination of scientifically proven therapies and interventions will result in the best patient outcomes. These may include prescription exercise programs, weight loss/control programs, neutraceuticals, analgesics, anti-inflammatories, and, unloading braces. Research has yet to determine the exact protocol for the most effective combination therapy treatment for knee OA.

Knee osteoarthritis may inevitably result in total knee replacement surgery. But non-invasive treatment options, specifically unloading braces, have been proven to provide safe pain relief and improved function that prevent or delay the need for this major surgery. Every opportunity should be provided to patients to do just that.

REFERENCES

1. Doyt Conn, M.D., professor, medicine, and director, division of rheumatology, Emory University School of Medicine, Atlanta; Louise Murphy, Ph.D., epidemiologist on loan to CDC from Business Computer Applications Inc., Atlanta; Edward Yelin, Ph.D., professor, medicine and health, University of California, San Francisco; May 2007 Arthritis & Rheumatism

2. Kirkley A, Webster-Bogaert S, Litchfield R, Macdonald S, Amendola A, MaCalden R, Fowler P: The Effect of Bracing on Varus Gonarthrosis. Journal of Bone and Joint Surgery, 81(4): 539-547, 1999.

3. Meta analysis; Pollo FE et al; J of AAOS, 14:5-11, 2006.

4. Pollo FE, Otis JC, Backus SI, Warren RF, Wickiewicz TL: Reduction of Medical Compartment Loads with Valgus Bracing of the Osteoarthritic Knee. American Journal of Sports Medicine, 30 (3): 414-421, 2002.

5. Hillstrom HJ, Brower DJ, Whitney K, McGuire J, Schumacher HR: Lower Extremity Conservative Realignment Therapies for Knee Osteoarthritis. In: Physical Medicine & Rehabilitation: State of the Art Reviews. Philadelphia: Hanley & Belfus, Inc., 2002: 507 - 520.

6. Frost & Sullivan

7. Steadman Briggs: unpublished, presented at OA Roundtable, Orlando FL, 2008



CLICK HERE TO ANSWER QUESTIONS ABOUT THIS ARTICLE AND OBTAIN 1 CEU CREDIT

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