THE BACK PAGE RESEARCH REVIEW Putting shoe orthotics to the test REVIEWED BY SHAWN THISTLE STUDY TITLE: Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial AUTHORS: Cambron J, Dexheimer J, Duarte M, Freels S. Author’s Affiliations: Department of Research, National University of Health Sciences, Lombard, IL, USA; School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois, Chicago, IL, USA. PUBLICATION INFORMATION: Archives of Physical Medicine and Rehabilitation 2017; 98(9): 1752-62. R Results esearch done in the podiatric field has shown the use of foot orthoses is effective for the relief of low-back pain and that back pain may be related to a disruption in the kinetic chain. The authors suggest that foot dysfunction, therefore, should be con-sidered as a potential contributing factor when treating patients with LBP and dysfunction. The objective of this study was to in-vestigate the effectiveness of Foot Leve-lers shoe orthotics with and without chiropractic treatment for chronic low back pain, compared with no treatment. Six hundred eighty-two people were screened by telephone, with 416 of them found to be eligible. Of those, 290 ap-peared for the baseline visit and 225 were randomized to a group. Compliance with the interventions was as follows: • 86.7 per cent of the shoe orthotic plus chiropractic group participants were compliant with chiropractic care and 96.8 per cent were com-pliant with orthotic use. 92.5 per cent of the shoe orthotic subjects • • • • were compliant with orthotic use. Average LBP was significantly de-creased after six weeks in all three groups, as follows: less than one-point improvement in the waitlist group, 1.9-point improvement in the shoe orthotic only group, and 2.3-point improvement in the shoe orthotic plus chiropractic group. These decreases in pain from baseline continued to be significant in all three groups for all time points up to 12 months. However, the differences be-tween groups at week 12 and later were not significant. ODI disability scores improved signif-icantly in both intervention groups: • less than 1-point improvement (not significant) in the waitlist group, • 2.3-point improvement in the shoe orthotic only group, and • 4.3-point improvement in the shoe orthotic plus chiropractic group. After adjusting for baseline values, the shoe orthotic group showed significantly higher improvement than the waitlist group for both average pain (P < 0.0001) and for ODI (P = 0.0068). When chiropractic care was added to the orthotic treatment, outcomes were better than with orthotic care alone, being statistically significant for ODI (P = 0.0278) but not for average pain (P = 0.3431). Changes between groups that were observed early in the study were not significantly different at later time points for either outcome. Minimal clinically important differ-ence scores in this study were set at a minimum 30 per cent change from baseline. While the three groups were significantly different at six weeks, the greatest changes were in the shoe or-thotic plus chiropractic group where 70 per cent of the subjects experienced a decrease in pain and 56 per cent a de-crease in disability from baseline. For comparison, subjects in the shoe or-thotic only group experienced 58 per cent and 38 per cent decreases, respec-tively, and only 22 per cent and 20 per cent in the waitlist group. Applications, conclusions DR. SHAWN THISTLE is the founder and CEO of RRS Education, providing weekly research reviews, online courses and seminars to help busy clinicians integrate current research evidence rationally into practice. For more information, visit: www.rrseducation.com. Shawn can be reached by email at [email protected] 38 Canadian Chiropractor December 2017 Prescription shoe orthotics resulted in significantly improved back pain and function compared with no treatment at six weeks and the addition of chiro-practic care resulted in higher improve-ments in function. However, the differ-ences between groups at 12 weeks and beyond were not significant. This study provides practitioners with preliminary evidence that pre-scription shoe orthotics may be effec-tive in the treatment of patients with CLBP. These results should be confirmed by additional studies that attempt to control for some limitations that were present; for instance, blinding of the researchers and/or including a sham orthotic group. www.canadianchiropractor.ca
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