title: Systematic review and meta-analysis of effects of foot orthoses on pain and disability in rheumatoid arthritis patients.
abstract: OBJECTIVE
  This meta-analysis examined the effects of foot orthoses (FO) on pain and disability in rheumatoid arthritis (RA) patients.
  
  
  METHODS
  MEDLINE, Cochrane Controlled Trials Register, EMBASE, SPORT Scielo, and CINAHL were searched through July 2014 for randomized controlled trials (RCTs) examining the effects of orthoses on pain and disability in RA patients. Two reviewers selected studies independently. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated, and heterogeneity was assessed using the I(2) test.
  
  
  RESULTS
  Three studies, involving 110 patients who received FO and 108 control patients, met the study criteria. Relative to controls, FO had a positive impact on pain (WMD 0.40; 95% CI 0.04-0.57). Between group differences in disability were not statistically significant.
  
  
  CONCLUSIONS
  FO may improve pain in RA patients, but their impact on disability remains undetermined. Additional large RCTs are needed to investigate the effects of these devices in RA patients. Implications for Rehabilitation The use of foot orthoses (FO) often part of the conservative treatment of patients with rheumatoid arthritis (RA). However, the indication of these devices is usually empiric. Thus, the results of this meta-analysis can provide guidance to rehabilitation professionals to undertake these devices to therapeutic programs. There is no consensus among rehabilitation professionals regarding the efficacy of FO improved pain and disability in patients with RA. The results of this meta-analysis suggest that the use of the FO improves pain but has no impact on disability. Thus, rehabilitation professionals, from reading this article will make clear to their patients that benefit of the FO is exclusively in pain improvement. Healthcare professionals and organizations should take into account the costs of production of FO during the definition of the therapeutic program. In case of low cost, the effect on improvement of pain in the feet can justify the indication of these devices to a patient with RA.
authors.affiliation: Biofunction Department, Physical Therapy, Institute of Health Sciences, Federal University of Bahia - UFBA , Salvador, Bahia , Brazil .
authors.forename: Cristiano Sena da
authors.initials: CS
authors.lastname: Conceição
authors.forename: Mansueto
authors.initials: M
authors.lastname: Gomes Neto
authors.forename: Selena M D
authors.initials: SM
authors.lastname: Mendes
authors.forename: Kátia Nunes
authors.initials: KN
authors.lastname: Sá
authors.forename: Abrahão Fontes
authors.initials: AF
authors.lastname: Baptista
mesh_terms: D001172:Arthritis, Rheumatoid / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D061826:Foot Orthoses; D006801:Humans; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic
keywords: Disability; foot orthoses; pain; rehabilitation; rheumatoid arthritis