Question: Does daily use of a cane for two months produce clinical benefits in patients with knee osteoarthritis (OA)?
Design: A randomised, controlled trial where group allocation was carried out by computer-generated randomisation in a 1:1 ratio.
Setting: An outpatient rheumatology clinic in Sao Paulo, Brazil.
Participants: Men and women with the diagnosis of knee OA according to the American College of Rheumatology criteria, knee pain score between 3 and 7 (on a 0-10 Visual Analogue Scale), stable doses of non-steroidal anti-inflammatory drugs (NSAIDs), and no regular physical exercise or use of canes in the months prior to the study. Additional exclusion criteria were: symptomatic heart disease, symptomatic disease of the lower limbs (other than knee osteoarthritis) or of the upper limb that would hold the cane, symptomatic lung disease, severe systemic disease, and severe psychiatric illness.
Interventions: Each participant in the intervention group received an individually height adjusted wooden cane with a T-shaped handle and instruction in how to use it on the contralateral side at the start of the intervention and after one month. They were instructed to use the cane daily. The participants in the control group were instructed not use any gait device for two months, but otherwise to maintain their normal lives including treatment as usual.
Outcome measures: The primary outcome was pain measured on a 0-10 Visual Analogue Scale at one and two months. Secondary outcomes were function measured with the Lequesne knee questionnaire and the Western Ontario and McMaster Universities (WOMAC) questionnaire), health related quality of life (SF-36), energy expenditure during a 6-minute walk test, and consumption of NSAIDs.
Results: In total 64 patients were assigned to the intervention (n=32) and control groups (n=32), and 59 completed the two month follow-up. Mean differences in pain were 0.8 (95% CI 0.3 to 1.3) at one month follow up and 2.1 (95% CI 1.4 to 2.8) at two months, both in the favour of the intervention group. There were significant differences in favour of the intervention group in Lequesne knee questionnaire, SF-36 Bodily Pain and Role Physical scores, and consumption of NSAIDs.
Conclusion: Use of a cane can diminish pain and improve physical functioning in patients with knee osteoarthritis. [95% CIs calculated by the CAP Editors.].
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