Orthosis Management in Knee Osteoarthritis: Evaluating Existing Recommendations and Achieving Consensus on Implementation Through the Delphi Method.

Abstract

Objective: The available evidence on orthosis management in the knee osteoarthritis (KOA) remains questionable. This study aims to evaluate existing recommendations and achieve consensus on their implementation through the modified Delphi method.

Methods: Experienced experts in orthosis management for KOA patients participated in three Delphi rounds. Each round involved addressing various questions related to recommended orthosis type such as insole, knee brace, footwear, indications and contraindications, dosage of orthosis usage, follow-up period, long-term side effects, fitting, and weaning procedure. Consensus was defined as  ≥ 70% agreement with a question.

Results: Consensus was achieved for all questions. Experts frequently recommended custom-made insoles, neoprene knee braces, and appropriate footwear. The recommended duration of insole and knee brace usage averaged 3-6 months. Insole usage was advised during all weight-bearing activities, while knee braces were suggested for 4-6 h per day. Experts recommended orthosis follow-up for an average of 4-6 months. Reduced compliance with orthoses was highlighted by experts as the most significant long-term side effect. The fitting of orthoses is typically evaluated through gait analyses, assessment of symptoms and comfort, and observation of the corrective effects on impaired biomechanics in the clinical setting. Besides, experts commonly recommend a gradual weaning process from orthoses.

Conclusions: This study addresses the existing lack of consensus on orthosis management in KOA and provides essential clinical practice recommendations from multidisciplinary experts.