{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:19:32Z","timestamp":1789823972341,"version":"4.0.1"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":303,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003130","name":"Research Foundation Flanders","doi-asserted-by":"publisher","award":["G013318N"],"award-info":[{"award-number":["G013318N"]}],"id":[{"id":"10.13039\/501100003130","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>This randomized controlled trial (RCT) investigated whether adding daily use of flat flexible footwear (FFF) to a strengthening and aerobic exercise program improved short- and longer-term outcomes compared with adding stable supportive shoes (SSS) in people with medial tibiofemoral OA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Participants (n\u2009=\u200997) with medial tibiofemoral OA were randomly assigned (1:1) to the FFF (n\u2009=\u200950) or SSS (n\u2009=\u200947) group. Participants in both groups received a 9-month intervention (3\u2009months supervised followed by 6\u2009months unsupervised exercise). The primary outcome was the change in knee pain on walking at 3\u2009months measured using an 11-point numeric rating scale (NRS). Secondary outcomes included the change from baseline to 3 and 9\u2009months in the severity of knee pain overall (NRS), physical function (WOMAC subscale), habitual physical activity level (Physical Activity Scale for the Elderly), quality of life (QoL) (European Quality of Life 5-Dimensions 5-Levels questionnaire) and markers of inflammation (effusion and Hoffa synovitis) and structural disease progression (bone marrow lesions).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were no significant differences between the groups in the change in pain on walking [between-group difference \u22120.67 (95% CI \u22121.62, 0.29)] at 3\u2009months. Knee pain on walking and overall knee pain significantly decreased in both groups at 3 and 9\u2009months. Physical function and QoL improved in both groups at 3 and 9\u2009months. We found no between-group differences in any secondary outcome at any time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>FFF added to exercise therapy did not provide additional better symptom nor structure-modification benefit compared with conventional SSS and exercise in people with medial tibiofemoral OA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration<\/jats:title>\n                  <jats:p>ClinicalTrials.gov (http:\/\/clinicaltrials.gov), NCT03796832.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/rap\/rkae133","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T19:17:05Z","timestamp":1730315825000},"source":"Crossref","is-referenced-by-count":2,"title":["Exercise and footwear in medial knee osteoarthritis: a randomized controlled trial comparing flat flexible footwear to stable supportive shoes"],"prefix":"10.1093","volume":"8","author":[{"given":"Paolo","family":"Dainese","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Stautemas","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"De Mits","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Ghent University Hospital , Ghent,","place":["Belgium"]},{"name":"Smart Space, Ghent University Hospital , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Wittoek","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Ghent University Hospital , Ghent,","place":["Belgium"]},{"name":"Department of Internal Medicine and Pediatrics, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ans","family":"Van Ginckel","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"Huysse","sequence":"additional","affiliation":[{"name":"Department of Radiology, Ghent University Hospital , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heleen","family":"Demeyer","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Ghent University , Ghent,","place":["Belgium"]},{"name":"Department of Rehabilitation Sciences, KU Leuven , Leuven,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanne","family":"Mahieu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-8155","authenticated-orcid":false,"given":"Patrick","family":"Calders","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences and Physiotherapy, Ghent University , Ghent,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"2024121301365083300_rkae133-B1","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1136\/annrheumdis-2012-202745","article-title":"EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis","volume":"72","author":"Fernandes","year":"2013","journal-title":"Ann Rheum Dis"},{"key":"2024121301365083300_rkae133-B2","author":"National Institute for Health and Clinical Excellence","year":"2014"},{"key":"2024121301365083300_rkae133-B3","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.gaitpost.2011.03.026","article-title":"Inexpensive footwear decreases joint loading in elderly women with knee osteoarthritis","volume":"34","author":"Trombini-Souza","year":"2011","journal-title":"Gait Posture"},{"key":"2024121301365083300_rkae133-B4","doi-asserted-by":"crossref","first-page":"2923","DOI":"10.1002\/art.22123","article-title":"Walking barefoot decreases loading on the lower extremity joints in knee osteoarthritis","volume":"54","author":"Shakoor","year":"2006","journal-title":"Arthritis Rheum"},{"key":"2024121301365083300_rkae133-B5","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.joca.2016.10.001","article-title":"Effects of footwear on the knee adduction moment in medial knee osteoarthritis: classification criteria for flat flexible vs stable supportive shoes","volume":"25","author":"Paterson","year":"2017","journal-title":"Osteoarthritis Cartilage"},{"key":"2024121301365083300_rkae133-B6","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1002\/acr.20165","article-title":"Effects of common footwear on joint loading in osteoarthritis of the knee","volume":"62","author":"Shakoor","year":"2010","journal-title":"Arthritis Care Res"},{"key":"2024121301365083300_rkae133-B7","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13047-014-0043-8","article-title":"A survey of footwear advice, beliefs and wear habits in people with knee osteoarthritis","volume":"7","author":"Paterson","year":"2014","journal-title":"J Foot Ankle Res"},{"key":"2024121301365083300_rkae133-B8","doi-asserted-by":"crossref","first-page":"e0269331","DOI":"10.1371\/journal.pone.0269331","article-title":"Tibiofemoral contact force differences between flat flexible and stable supportive walking shoes in people with varus-malaligned medial knee osteoarthritis: a randomized cross-over study","volume":"17","author":"Starkey","year":"2022","journal-title":"PLoS One"},{"key":"2024121301365083300_rkae133-B9","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1016\/j.clinbiomech.2015.08.004","article-title":"Long-term use of minimal footwear on pain, self-reported function, analgesic intake, and joint loading in elderly women with knee osteoarthritis: a randomized controlled trial","volume":"30","author":"Trombini-Souza","year":"2015","journal-title":"Clin Biomech (Bristol)"},{"key":"2024121301365083300_rkae133-B10","doi-asserted-by":"crossref","first-page":"663","DOI":"10.7326\/0003-4819-134-8-200104170-00012","article-title":"The revised CONSORT statement for reporting randomized trials: explanation and elaboration","volume":"134","author":"Altman","year":"2001","journal-title":"Ann Intern Med"},{"key":"2024121301365083300_rkae133-B11","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/0976-500X.72352","article-title":"CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials","volume":"1","author":"Schulz","year":"2010","journal-title":"J Pharmacol Pharmacother"},{"key":"2024121301365083300_rkae133-B12","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1002\/acr.22375","article-title":"Association of exercise therapy and reduction of pain sensitivity in patients with knee osteoarthritis: a randomized controlled trial","volume":"66","author":"Henriksen","year":"2014","journal-title":"Arthritis Care Res"},{"key":"2024121301365083300_rkae133-B13","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/j.joca.2015.04.001","article-title":"The maximum tolerated dose of walking for people with severe osteoarthritis of the knee: a phase I trial","volume":"23","author":"Wallis","year":"2015","journal-title":"Osteoarthritis Cartilage"},{"key":"2024121301365083300_rkae133-B14","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br J Sports Med"},{"key":"2024121301365083300_rkae133-B15","first-page":"451","article-title":"Osteoarthritis antirheumatic drug trials. III. Setting the delta for clinical trials\u2014results of a consensus development (Delphi) exercise","volume":"19","author":"Bellamy","year":"1992","journal-title":"J Rheumatol"},{"key":"2024121301365083300_rkae133-B16","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1136\/ard.2004.022905","article-title":"Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement","volume":"64","author":"Tubach","year":"2005","journal-title":"Ann Rheum Dis"},{"key":"2024121301365083300_rkae133-B17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/0895-4356(93)90053-4","article-title":"The Physical Activity Scale for the Elderly (PASE): development and evaluation","volume":"46","author":"Washburn","year":"1993","journal-title":"J Clin Epidemiol"},{"key":"2024121301365083300_rkae133-B18","doi-asserted-by":"crossref","first-page":"2897","DOI":"10.1007\/s11136-018-1929-x","article-title":"Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness","volume":"27","author":"Bilbao","year":"2018","journal-title":"Qual Life Res"},{"key":"2024121301365083300_rkae133-B19","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s41669-022-00353-3","article-title":"An EQ-5D-5L value set for Belgium","volume":"6","author":"Bouckaert","year":"2022","journal-title":"Pharmacoecon Open"},{"key":"2024121301365083300_rkae133-B20","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"2024121301365083300_rkae133-B21","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.joca.2011.05.004","article-title":"Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score)","volume":"19","author":"Hunter","year":"2011","journal-title":"Osteoarthritis Cartilage"},{"key":"2024121301365083300_rkae133-B22","doi-asserted-by":"crossref","first-page":"62","DOI":"10.23736\/S1973-9087.23.07877-2","article-title":"Neuropathic-like pain in knee osteoarthritis: exploring differences in knee loading and inflammation. A cross-sectional study","volume":"60","author":"Dainese","year":"2024","journal-title":"Eur J Phys Rehabil Med"},{"key":"2024121301365083300_rkae133-B23","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1186\/s12891-022-05926-1","article-title":"Structural tissue damage and 24-month progression of semi-quantitative MRI biomarkers of knee osteoarthritis in the IMI-APPROACH cohort","volume":"23","author":"Roemer","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"2024121301365083300_rkae133-B24","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1002\/art.42105","article-title":"Five-year structural changes in the knee among patients with meniscal tear and osteoarthritis: data from a randomized controlled trial of arthroscopic partial meniscectomy versus physical therapy","volume":"74","author":"Collins","year":"2022","journal-title":"Arthritis Rheumatol"},{"key":"2024121301365083300_rkae133-B25","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.3389\/fnins.2019.01016","article-title":"Biomarkers in painful symptomatic knee OA demonstrate that MRI assessed joint damage and type II collagen degradation products are linked to disease progression","volume":"13","author":"Sofat","year":"2019","journal-title":"Front Neurosci"},{"key":"2024121301365083300_rkae133-B26","doi-asserted-by":"crossref","first-page":"381","DOI":"10.7326\/M16-0453","article-title":"Unloading shoes for self-management of knee osteoarthritis: a randomized trial","volume":"165","author":"Hinman","year":"2016","journal-title":"Ann Intern Med"},{"key":"2024121301365083300_rkae133-B27","doi-asserted-by":"crossref","first-page":"39","DOI":"10.3390\/informatics8020039","article-title":"Defining valid activity monitor data: a multimethod analysis of weight-loss intervention participants\u2019 barriers to wear and first 100 days of physical activity","volume":"8","author":"Orstad","year":"2021","journal-title":"Informatics"},{"key":"2024121301365083300_rkae133-B28","doi-asserted-by":"crossref","first-page":"S531","DOI":"10.1249\/01.mss.0000185657.86065.98","article-title":"Conducting accelerometer-based activity assessments in field-based research","volume":"37","author":"Trost","year":"2005","journal-title":"Med Sci Sports Exerc"},{"key":"2024121301365083300_rkae133-B29","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/j.ypmed.2004.06.003","article-title":"How many days of pedometer monitoring predict weekly physical activity in adults?","volume":"40","author":"Tudor-Locke","year":"2005","journal-title":"Prev Med"},{"key":"2024121301365083300_rkae133-B30","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological assessment of osteo-arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann Rheum Dis"},{"key":"2024121301365083300_rkae133-B31","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.clinbiomech.2005.08.002","article-title":"Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index","volume":"21","author":"Redmond","year":"2006","journal-title":"Clin Biomech (Bristol)"},{"key":"2024121301365083300_rkae133-B32","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1002\/art.24017","article-title":"Effects of specialized footwear on joint loads in osteoarthritis of the knee","volume":"59","author":"Shakoor","year":"2008","journal-title":"Arthritis Rheum"},{"key":"2024121301365083300_rkae133-B33","doi-asserted-by":"crossref","first-page":"462","DOI":"10.7326\/M20-6321","article-title":"The effect of flat flexible versus stable supportive shoes on knee osteoarthritis symptoms: a randomized trial","volume":"174","author":"Paterson","year":"2021","journal-title":"Ann Intern Med"},{"key":"2024121301365083300_rkae133-B34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/ar4405","article-title":"Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes","volume":"15","author":"Li","year":"2013","journal-title":"Arthritis Res Ther"},{"key":"2024121301365083300_rkae133-B35","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.semarthrit.2018.10.014","article-title":"Effects of long-term exercise therapy on knee joint structure in people with knee osteoarthritis: a systematic review and meta-analysis","volume":"48","author":"Van Ginckel","year":"2019","journal-title":"Semin Arthritis Rheum"},{"key":"2024121301365083300_rkae133-B36","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.knee.2020.12.022","article-title":"The effect of exercise therapy on inflammatory activity assessed by MRI in knee osteoarthritis: secondary outcomes from a randomized controlled trial","volume":"28","author":"Bandak","year":"2021","journal-title":"Knee"}],"container-title":["Rheumatology Advances in Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/rheumap\/advance-article-pdf\/doi\/10.1093\/rap\/rkae133\/60248827\/rkae133.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/8\/4\/rkae133\/61099662\/rkae133.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/rheumap\/article-pdf\/8\/4\/rkae133\/61099662\/rkae133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T01:37:16Z","timestamp":1734053836000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/rheumap\/article\/doi\/10.1093\/rap\/rkae133\/7852843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024]]},"references-count":36,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,9,14]]}},"URL":"https:\/\/doi.org\/10.1093\/rap\/rkae133","relation":{},"ISSN":["2514-1775"],"issn-type":[{"value":"2514-1775","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024]]},"published":{"date-parts":[[2024]]},"article-number":"rkae133"}}