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Objective
To determine the effect of custom-fitted orthoses on postural sway over a 6-week acclimation period.
Design
Repeated-measures analysis of variance on postural sway measures with factors being group (control, malaligned), time (initial, 2wk, 4wk, 6wk postintervention), and condition (with orthoses, without orthoses). For single-limb stance, side (right, left) was analyzed to determine bilateral differences.
Setting
Biodynamics laboratory.
Participants
Twenty-one subjects, 11 asymptomatic with rearfoot malalignment and 10 asymptomatic with normal rearfoot alignment.
Interventions
Orthoses were prescribed and worn for 6 weeks. Balance testing was performed on 4 different dates with each subject tested in both orthotic conditions. Postural control was measured with three 10-second eyes-closed trials for single-limb stance, one 20-second eyes-closed bilateral stance with the platform moving, and one 20-second eyes-open bilateral stance with the platform and surroundings moving.
Main Outcome Measures
Sway velocity (in deg/s) for single-limb stance and equilibrium score for bilateral stance.
Results
Postural sway measures were significantly decreased during single-limb testing with orthoses versus without orthoses, regardless of group. The orthotic intervention significantly improved bilateral stance equilibrium score in the malaligned group at weeks 2, 4, and 6 when compared with measures at the initial week. Equilibrium score of the malaligned group with orthoses at initial week was significantly lower (worse) than the control group with orthoses at initial week; however, these results were not repeated during measurements taken at weeks 2, 4, or 6.
Conclusions
The application of orthoses decreased sway velocity for single-limb stance, improving postural stability regardless of group when visual feedback was removed. During bilateral stance, postural stability was initially worse for the malaligned group with and without orthoses when compared with the control group; however, improvements were seen by week 2 and continued throughout the remainder of testing. Clinically, the application of orthoses appears to improve postural control in people with rearfoot malalignment, particularly when vision is removed.
Arch support use for improving balance and reducing pain in older adults.
Mulford D, Taggart HM, Nivens A, Payrie C. Appl Nurs Res. 2008 Aug;21(3):153-8
Quote:
PURPOSE: The purpose of this study was to examine the effects of arch supports on balance, functional mobility, and pain in the back and lower extremity joints among older adults.
DESIGN: A single-factor within-subjects design was used. METHOD: A convenience sample of older adults formed a single group for fitting with arch supports. Balance, functional mobility, and self-reported pain in the back and lower extremities were measured without the arch supports, immediately after the insertion of the supports in the subjects' shoes, and after 6 weeks of arch support use.
FINDINGS: Sixty-seven older adults completed the study. The measures used indicated statistically significant improvements in scores for the Berg Balance Scale [Berg, K., Williams-Dauphinee, S., & Williams, J. I., (1995). The Balance Scale: Reliability assessment for elderly residents and patients with an acute stroke. Scandinavian Journal of Rehabilitation Medicine, 27, 27-31] and functional mobility [Timed Up and Go test; Podsiadlo, D., & Richardson, S. (1991). The Timed "Up and Go": A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142-148] as well as reduced back, foot, knee, and hip pain (p < .05). There was no statistically significant change in ankle pain (p > .05).
IMPLICATIONS: Knowledge of interventions that enhance health and well-being is essential for nurses. Arch supports may provide improved balance and functional mobility while reducing back and lower extremity joint pains. Further research is needed to support evidence-based practice.
Postural stability and foot orthoses
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