An algorithm to improve knee orthosis prescription for osteoarthritis patients.

Objective To develop an algorithm to help orthosis prescription for knee osteoarthritis patients. Material/Patients and methods Systematic review of the literature using a qualitative analysis on Pubmed databases, Cochrane Library and Pedro from 1966 to 2015, using the keywords “knee osteoarthritis”, “orthosis” with recommendations and highest quality trials. Development of a preliminary version of the algorithm using data from the literature and taking into account experience of different health professionals involved in the management of osteoarthritis patients. Validation of the algorithm by an international multidisciplinary expert college (PMR and sport medicine physician, rheumatologist, general practitioner, orthopaedic surgeon, physiotherapist, methodologist). New adaptations to obtain an acceptable final version. Results Elastic braces may be proposed in addition to the first-line non-pharmacological treatment (information/education, exercise and physical activity, weight reduction). Secondary a biomechanical analysis may be needed to provide a more rigid brace taking into account: the topography of pain, the lower limb static (varus/valgus), stability, any deformation reducibility. For unicompartimental OA, one can propose an unicompartmental discharge brace; a hinged stabilizing brace for bicompartmental OA with or without instability. For patellofemoral OA we can offer an orthotic with specific patellar device, Discussion/Conclusion Using an original methodology has produced an applicable algorithm in routine. A prospective validation in primary and secondary care to thirty patients is needed followed by an evaluation of the implementation of a wide range of health professionals in order to definitely validate the algorithm.