LAUSR

Background: Rheumatoid patients(RA)have increased rate of falls and an impaired balance. Foot orthoses are commonly used in RA. Despite the evidence of pain relief with foot orthoses, it is not clear if their use can improve or even impair balance in RA. Objectives: The aim of this study was to evaluate the effect of foot orthoses on balance of RA patients. Methods: 94 RA patients in the outpatient clinic of the Rheumatology Division of Unicamp were randomly assigned to intervention group/IG(n=48)with foot orthoses or control group/CG(n=46)without orthoses. At initial visit, subjects were assessed regarding:sociodemographic and clinical data(number of falls in last year, fear of falling, disease duration, rheumatoid factor, lmedication, visual impairment, vertigo, physical activity, body mass index, comorbidity index, foot tactile sensitivity, number of lower limbs swollen and tender joints count, disease activity-CDAI and disability-HAQ). Subjects answered The Foot Function Index-FFI and were submitted to Berg Balance Scale-BBS, the Timed Up and Go-TUG and the 5-Time Sit Down-to-Stand up-SST5 tests.IG subjects received custom made insoles according to each foot needs. After four weeks, subjects were reassessed for FFI, BBS and TUG. To compare baseline values of groups, the chi-squared test, Fisher’s exact test and Mann-Whitney test were applied.ANOVA for repeated measures was used to compare differences between groups and times for BBSTUG and FFI. Effect size was analyzed using the Cohen's d test. All data were analyzed with a 5%level of significance. Results: 81 subjects completed the research protocol,40 in the IG and 41 in the CG. Groups were similar at baseline for most variables with exception of comorbidity index(worst index in IG) and race(p<0.05). After four weeks, FFI-total, FFI-Pain, FFI-activity limitation disclosed a significant improvement only in IG. Significant differences between times were noted for TUG and BBS only in IG. Interaction group versus time was significant for FFI and BBS. Subjects from IG reported a mean wearing time of 7.32hs/day. Adverse effects were noted in ten subjects(foot pain, hot foot). Comparison between IG and CG at baseline (t1) and after 4 weeks (t2) Variables IG vs CG, p* t1 vs t2, p* Interaction groups vs time, p-value* Effect Size** FFI-pain 0.0001 <0.0001 0.001a -0.60 FFI- disability 0.050 0.001 0.036b -0.28 FFI-activity limitation 0.007 0.004 0.011a -0.61 FFI-Total 0.002 <0.0001 0.001a -0.57 TUG 0.454 <0.0001 0.079c No interaction BBS 0.358 0.0001 0.011b 0.35 NCS 0.422 0.102 0.022 0.44 *ANOVA for repeated measures (variables converted into ranks) **d de Cohen Conclusions: Foot orthoses were well accepted and worn during long periods with FFI and balance tests (BBS, TUG)improvement. Prospective placebo controlled studies are recommended to assure the possibility to use insoles as adjuvant interventions to improve balance in RA. References 1. Hennessy K, Woodburn J, et al. Custom foot orthoses for rheumatoid arthritis: A systematic review2012Mar;64(3):311–20. 2. de P Magalhães E, Davitt M, et al. The effect of foot orthoses in rheumatoid arthritis.Rheumatology2006;45(4):449–53. 3. Clark H, Rome K, et al. A critical review of foot orthoses in the rheumatoid arthritic foot. Rheumatology2006;45(2):139–45. 4. Metli N, Kurtaran A, et al. Impaired Balance and Fall Risk in Rheumatoid Arthritis Patients. Annals of the Rheumatic Diseases2014;73:906. Disclosure of Interest: None declared