title: Do rocker-sole shoes influence postural stability in chronic low back pain? A randomised trial.
abstract: BACKGROUND
  People with chronic low back pain (CLBP) demonstrate greater postural instability compared with asymptomatic individuals. Rocker-sole shoes are inherently unstable and may serve as an effective balance training device. This study hypothesised that wearing rocker-sole shoes would result in long-term improvement in barefoot postural stability in people with CLBP.
  
  
  METHODS
  20 participants with CLBP were randomised to wear rocker-sole or flat-sole shoes for a minimum of 2 hours each day. Participants were assessed barefoot and shod, over three 40 s trials, under 4 posture challenging standing conditions. The primary outcome was postural stability assessed by root mean squared error of centre of pressure (CoP) displacement (CoPRMSE AP) and mean CoP velocity (CoPVELAP), both in the anteroposterior direction, using force plates. Participants' were assessed without knowledge of group allocation at baseline, 6 weeks and 6 months (main outcome point). Analyses were by intention-to-treat.
  
  
  RESULTS
  At 6 months, data from 11 of 13 (84.6%) of the rocker-sole and 5 of 7 (71.4%) of the flat-sole group were available for analysis. At baseline, there was a mean increase in CoPRMSE AP(6.41 (2.97) mm, p<0.01) and CoPVELAP(4.10 (2.97) mm, p<0.01) in the rocker-sole group when shod compared with barefoot; there was no difference in the flat-sole group. There were no within-group or between-group differences in change in CoP parameters at any time point compared with baseline (1) for any barefoot standing condition (2) when assessed shod eyes-open on firm ground.
  
  
  CONCLUSIONS
  Although wearing rocker-sole shoes results in greater postural instability than flat-sole shoes, long-term use of rocker-sole shoes did not appear to influence postural stability in people with CLBP.
authors.affiliation: College of Health and Life Sciences, Brunel University, Uxbridge, UK; Therapy Services, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
authors.forename: C Sian
authors.identifier: 0000-0002-2060-670X
authors.initials: CS
authors.lastname: MacRae
authors.affiliation: Academic Department of Physiotherapy and Division of Health and Social Care Research , King's College London , London , UK.
authors.forename: Duncan
authors.identifier: 0000-0003-3650-4852
authors.initials: D
authors.lastname: Critchley
authors.affiliation: Faculty of Health Sciences , University of Ljubljana , Ljubljana , Slovenia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Morrissey
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, One Small Step Gait Laboratory, London, UK; Biomedical Engineering, King's College London, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Shortland
authors.affiliation: Department of Allied Health Professions, University of Hertfordshire, Hatfield, UK; Musculoskeletal Services, Central London Community Healthcare NHS Foundation Trust, London, UK.
authors.forename: Jeremy S
authors.initials: JS
authors.lastname: Lewis
keywords: Biomechanics; Exercise rehabilitation; Lumbar spine; Randomised controlled trial