Why use a soft brace?
Soft braces are elastic and non-adhesive orthoses often used to reduce activity limitations. 1 They are commonly used due to their low cost and ease of use 2 . Additionally, they are recommended as appropriate treatment for non- surgical management of knee OA. 2,3 • Ease of use: With mechanical bracing, despite improvements in patient reported outcomes, there is an unwillingness amongst patients to wear these braces for prolonged periods. 5,6 • Low cost: Soft bracing is mostly designed for compression and is usually elasticated. Due to the lack of hinges and metallic material, they are usually significantly cheaper than mechanical alternatives. • Improve patient adherence: Mechanical bracing is often associated with poor adherence due to factors such as skin irritation, discomfort, bad fit, bulkiness, practicality and social stigma. 7
Underlying mechanisms of soft bracing
Potential underlying mechanisms of soft bracing to reduce activity limitations are: • Improved joint proprioception: Soft braces supposedly act on cutaneous mechanoreceptors that contribute to improvements in proprioception 1,4 • Pain reduction: Tactile stimulation provided by a soft brace can cause neural inhibition leading to the reduction of pain signals 1,4 • Improved joint stability: Mechanical effects are usually associated with soft bracing. However, it has been suggested that a reduction in joint instability may be the result of additional sensory input from the brace, leading to improvements in proprioception 1,4
Medical grade compression classes and standards
Compression classes relate to the amount of compression, measured in mmHg, provided by a support. This is defined by the pressure applied to the limb by the compression support.
STANDARDS
COMPRESSION LEVELS
GERMAN RAL-GZ 387:2000
BRITISH BS 6612:1985
FRENCH ASQUAL
Class I
Light
14-17 mmHg
18-21 mmHg
10-15 mmHg
Class II
Medium
18-24 mmHg
23-32 mmHg
15-20 mmHg
20-36 mmHg*
Class III
Strong
25-35 mmHg
34-46 mmHg
Class IV
Very strong
N/A
>49 mmHg
>36 mmHg
*The ankle and knee supports (except DonJoy GenuLax™) in this range adhere to French ASQUAL Class III standards.
References 1. Cudejko T, van der Esch M, van den Noort JC, Rijnhart JJ, van der Leeden M, Roorda LD, Lems W, Waddington G, Harlaar J, Dekker J, 2019. Decreased pain and improved dynamic knee instability mediate the beneficial effect of wearing a soft knee brace on activity limitations in patients with knee osteoarthritis. Arthritis care & research 71 (8), pp.1036 1043. 2. Cudejko, T., van der Esch, M., van der Leeden, M., Roorda, L.D., Pallari, J., Bennell, K.L., Lund, H. and Dekker, J., 2018. Effect of soft braces on pain and physical function in patients with knee osteoarthritis: systematic review with meta-analyses. Archives of physical medicine and rehabilitation, 99(1), pp.153-163. 3. McAlindon, T.E., Bannuru, R., Sullivan, M.C., Arden, N.K., Berenbaum, F., Bierma-Zeinstra, S.M., Hawker, G.A., Henrotin, Y., Hunter, D.J., Kawaguchi, H. and Kwoh, K., 2014. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and cartilage, 22(3), pp.363-388. 4. Hassan BS, Mockett S, Doherty M. Influence of elastic bandage on knee pain, proprioception, and postural sway in subjects with knee osteoarthritis. Ann Rheum Dis 2002;61:24 8. 5. Cudejko T, van der Esch M, van der Leeden M, van den Noort JC, Roorda LD, Lems W, Twisk J, Steultjens M, Woodburn J, Harlaar J, Dekker J. The immediate effect of a soft knee brace on pain, activity limitations, self-reported knee instability, and self-reported knee confidence in patients with knee osteoarthritis. Arthritis Res Ther. 2017 Dec 1;19(1):260. 6. Beaudreuil J, Bendaya S, Faucher M, Coudeyre E, Ribinik P, Revel M, Rannou F. Clinical practice guidelines for rest orthosis, knee sleeves, and unloading knee braces in knee osteoarthritis. Joint Bone Spine. 2009 Dec;76(6):629-36. 7. Kwaees, T.A., Richards, J., Rawlinson, G., Charalambous, C.P. and Chohan, A., 2019. Can the use of proprioceptive knee braces have implications in the management of osteoarthritic knees: An exploratory study. Prosthetics and orthotics international, 43(2), pp.140-147.
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