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Stable Supportive Footwear for Self-managing Hip Osteoarthritis Pain : A Randomized Clinical Trial
Kade L Paterson1, Kim L Bennell1, Ben R Metcalf1
1Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.P., K.L.B., B.R.M., J.P., S.J., R.S.H.).
Background:
Few effective nonsurgical treatments exist for hip osteoarthritis. Footwear influences hip forces and may be a promising novel approach.
Objective:
To evaluate whether stable supportive shoes are more effective than flat flexible shoes for hip pain.
Design:
2-group, pragmatic, comparative effectiveness, superiority randomized trial. (Australian New Zealand Clinical Trials Registry: ACTRN12621001532897).
Setting:
Community.
Participants:
120 people with hip osteoarthritis pain.
Intervention:
Off-the-shelf stable supportive (n = 60) or flat flexible (n = 60) shoes that met prespecified criteria. Participants chose from options in their randomly assigned shoe group and were instructed to wear selected shoes at least 6 hours per day for 6 months.
Measurements:
The primary outcome was 6-month change in average hip pain on walking in the previous week (11-point scale; range, 0 to 10, with higher scores indicating worse pain). Secondary outcomes included other measures of pain, symptoms, function in daily living, function in sport and recreation, quality of life, physical activity, global improvement, and adverse events.
Results:
A total of 120 participants were randomly assigned, and 116 (97%) completed 6-month primary outcomes. Stable supportive shoes did not differ from flat flexible shoes in improving hip pain (mean difference [MD], -0.5 point [95% CI, -1.3 to 0.2 point]; P = 0.163). Few secondary outcomes differed by shoe type, but flat flexible shoes showed greater improvement in the Hip Disability and Osteoarthritis Outcome Score symptom subscale (MD, 6.6 points [CI, 1.4 to 11.7 points]) and quality-of-life subscale (MD, 7.8 points [CI, 1.1 to 14.4 points]), whereas stable supportive shoes showed more improvement in contralateral foot or ankle pain (MD, 0.8 point [CI, 0.0 to 1.5 points]). There were fewer adverse events in the stable supportive shoe group (n = 7 [12%]) than the flat flexible shoe group (n = 18 [31%]; relative risk, 0.39 [CI, 0.18 to 0.86]).
Limitation:
Unblinded participants.
Conclusion:
Stable supportive shoes were not superior to flat flexible shoes for improving hip osteoarthritis pain while walking.
Primary Funding Source:
National Health and Medical Research Council.
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