Weakness in the muscles of the knee can cause a problem called knee instability. This is a particular problem in neuromuscular diseases where the muscles or the nerves which control the muscles are affected. The knee can give way which can lead to falls. This can cause people with neuromuscular diseases problems in walking and generally getting about.
Orthotic devices or orthoses (also called braces or callipers) are used to hold the leg in position and to provide strength and support to the knee. There are different types that can be used. Some are fixed below the knee supporting the ankle and foot. Others are longer and cover the knee, ankle and foot. For severe weakness they can also include a hip band. Traditionally they were made of metal and leather but lighter materials are now available. Some are custom-made for the patient. There are also new types that allow a more natural walking pattern, but these are more expensive.
There is no agreement about which is the best orthosis for knee instability because the research has not been pulled together and looked at closely. Also, no one has pulled together information on what types of devices are most commonly used in the NHS and how much they cost. There is some research that shows that people often do not use their orthosis so it is important to find out more about the opinions of patients. The National Institute for Health Research (NIHR) recognised the value of this work and are funding this project through an NIHR HTA programme grant. Our planned research is in four parts.
(i) We will do a systematic review. This will bring together the results of all the previous research on the benefits and any harms from using orthotic devices for knee instability in adults with neuromuscular disease. This will tell us what is currently known about the usefulness of the devices.
(ii) We will do a survey of health care professionals who fit people with orthotic devices for knee instability to find out about what is currently happening in the NHS. We will ask about what types of devices they use most often and how they decide which one to use. We will also find out how much they cost.
(iii) We will gather together the views of people with neuromuscular disease who have been fitted with an orthotic device for knee instability. We will carry out interviews with people in their home and also meet with some groups of patients. We will find out about their experience of wearing an orthosis, what their treatment goals are and what influences whether they wear the orthosis. We will do this in an ethical way.
(iv) We will pull together the information from the three studies to find out what the important issues are for future research.
The project will be carried out over 12 months from 1st April 2014. For details of the team members please go to the Research Team and Steering Group pages.