Article

Hallux abducto valgus (HAV) is a frequent cause of great toe pain and disability, yet common treatments are only supported by mixed or equivocal
research findings.
Surgery often only provides modest improvement and
post-surgery complications may significantly hamper outcomes, implying the need
for trials testing conservative treatment, such as manual and manipulative
therapy, particularly in cases where surgery may be contraindicated or premature.
The purpose of this exploratory trial was to test an innovative protocol of
manual and manipulative therapy (MMT) and compare it to standard care of a night
splint(s) for symptomatic mild to moderate HAV, with a view gather insight into
the effectiveness of MMT and inform the design of a definitive trial. DESIGN:
Parallel-group randomised trial set in an out-patient teaching clinic.
PARTICIPANTS: A convenience sample of 75 patients was assessed for eligibility,
with 30 participants (15 per group) being consented and randomly allocated to
either the control group (standard care with a night splint) or the experimental
group (MMT). INTERVENTION: Participants in the control group used a night
splint(s) and those in the experimental group (MMT) received a structured
protocol of MMT, with the participants in the experimental group receiving 4
treatments over a 2-week period. OUTCOME MEASURES: Visual analogue scale
(HAV-related pain), foot function index (HAV-related disability) and hallux
dorsiflexion (goniometry). RESULTS: There were no participant dropouts and no
data was missing. There were no statistical (p<0.05) or clinically meaningful
differences (MCID<20%) between the two groups based on outcome measure scores.
However, the outcome measure scores in the control group (night splint) regressed
between the 1-week follow-up and 1-month follow-up, while the scores in the
experimental group (MMT) were sustained up to the 1-month follow-up. The
within-group data analysis produced statistically and clinically significant
changes from baseline to the 1-week flow-up across all outcome measures. Post hoc
power analysis and sample size calculations suggest that the average between
group power of this trial was approximately 60% (ES=0.33) and that a definitive
trial would require a minimum of 102 participants per group (N=204) to achieve
satisfactory power of >/=80%. CONCLUSIONS: The trend in results of this trial
suggest that an innovative structured protocol of manual and manipulative therapy
(experimental group) is equivalent to standard care of a night splint(s) (control
group) for symptomatic mild to moderate HAV in the short term. The protocol of
MMT maintains its treatment effect from 1-week to 1-month follow-up without
further treatment, while patients receiving standard care seem to regress when
not using the night splint. Insights from this study support further testing of
MMT for symptomatic mild to moderate HAV, particularly where surgery is premature
or where surgical outcomes may be equivocal, and serve to inform the design of a future definitive trial.
CI - Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Langue : ANGLAIS