***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The purpose s of this study were to assess a ) the effectiveness of Masai Barefoot Technology ( MBT ) shoe in reducing  knee pain in persons with knee osteoarthritis ( OA ) and ( b ) changes in balance , ankle and knee ROM , and ankle strength compared with a high-end walking shoe for 12 wk . METHODS The research design was a r and omized controlled trial ( 123 subjects , knee OA ) . Subjects were r and omized to a MBT ( N = 57 ) or a control shoe ( N = 66 ) . A Western Ontario and McMaster Universities ( WOMAC ) OA index , BMI , balance , active ROM , and ankle torque were quantified at week 0 , 3 , 6 , 9 , and 12 . Two- sample t-tests were done for between-group comparisons . RESULTS There was no significant difference between groups in total pain score . A significant reduction over the 12-wk period was found for both shoe conditions ( -42/500 or 25.6 % MBT , -46.2 or 27.1 % control ) . There was no significant group difference in pain during walking ( t = -1.09 , P = 0.28 ) . Pain during walking was significantly reduced by 5.2/100 mm in the MBT and 9.7/100 mm in the control group . Total pain showed a significant reduction for the MBT -27.4/500 ( -16.6 % ) and the control group -28.9/500 ( -17.0 % ) between baseline and week 3 . Between week 3 and 6 , there was a significant reduction for the MBT group only ( -27.2/500 or -20.0 % ) . There was a significant increase in the static balance between baseline and 12 wk in the MBT group only , although the difference between groups was not significant . DISCUSSION The results indicate that special shoe interventions can reduce pain in subjects with moderate knee OA BACKGROUND To compare kinematics , kinetics and muscle activity during  st and ing and walking for healthy subjects using an  unstable test shoe  ( Masai Barefoot Technology , MBT ) and a stable control shoe . METHODS Eight subjects volunteered for this study . During quiet st and ing , center of pressure excursion and muscle activity were determined . During walking , lower extremity kinematics , kinetics , and muscle electromyographic ( EMG ) signals were determined . Data were collected for the two shoe conditions after a 2week accommodation period . Statistics included repeated measures ANOVAs ( alpha = 0.05 ) and post hoc tests where appropriate . FINDINGS During quiet st and ing , the center of pressure excursion was significantly and substantially greater in the unstable compared to the control shoe . Electromyographic intensity increased in the unstable test shoe for all tested muscles , but only significantly for the tibialis anterior . During locomotion , kinematics were similar in the two shoe conditions except for the initial plantar-dorsiflexion , which showed a significant more dorsiflexed position during the first half of stance in the unstable test shoe compared to the stable control shoe . The angular impulses did not show any significant differences between the two shoe conditions for all three joints but some trends towards a reduction for the knee and hip joint . There were no significant differences in electromyographic activities between the control and the unstable shoe . However , several muscles showed some trends . INTERPRETATION The unstable shoe produced changes and trends in kinematic , kinetic and electromyographic characteristics that seemed to be advantageous for the locomotor system . Further studies should investigate muscle strength , dynamic stability , pain reduction for arthritic knees and injury prevention for high performance athletes when using the unstable shoes OBJECTIVES There is some evidence of an improvement in falls risk in the elderly after completing a wobble-board training program . This study examined the effects of wobble-board training on ability to discriminate between different extents of ankle inversion movements in a group of older subjects , tested wearing shoes and barefoot . DESIGN A r and omized , controlled , crossover pilot study . SETTING Canberra region , Australia . PARTICIPANTS Twenty community-dwelling subjects aged 65 to 85 participated in this study ; all were in good health with no known disorder of the musculoskeletal system . MEASUREMENTS The accuracy with which subjects could identify a set of ankle inversion movements of different extents was measured , with testing conducted in an upright , weightbearing stance . INTERVENTION The effects of a 5-week training program using a wobble board modified for data logging or a period of normal activity only were assessed . Subjects underwent an ankle movement discrimination test pre- and posttraining , with shoes on and off . RESULTS Greater improvement in ankle movement discrimination capability was made in subjects who underwent wobble-board training than in subjects who did not train ( F(1,18)=11.2 , P=.003 ) . Active movements at the ankle were also significantly better discriminated throughout when subjects were wearing shoes than when barefoot ( F(1,18)=40.6 , P=.001 ) . CONCLUSION Training with a wobble board provides a simple in-home intervention that improves ability to differentiate between extent of movements into ankle inversion in subjects aged 65 and older . Research on trip and fall frequency after wobble-board use is needed before such training could be widely used BACKGROUND The Masai barefoot technology is used as a treatment option within the field of physical therapy to treat leg , back or foot problems . No information , however , is available on how Masai barefoot technology changes gait or muscle activity . METHODS Twelve healthy subjects underwent 3D gait analysis with simultaneously collecting surface electromyography data of the leg muscles when walking with regular shoes and with Masai barefoot technology-shoes .  Before data collection , subjects were trained in Masai barefoot technology .  A within-subjects study - design compared walking with regular shoes and Masai barefoot technology . FINDINGS With Masai barefoot technology , subjects walked slower with smaller steps . Movement pattern at the ankle showed major changes with increased dorsiflexion angle at initial contact followed by a continuous plantarflexion movement until terminal stance phase . With changed kinematics , alterations in the activity of tibialis anterior and gastrocnemius muscles could be observed . Smaller differences in movement and muscle activity were seen at knee and hip level . INTERPRETATION Masai barefoot technology has never been documented in detail concerning changes in movement pattern or muscle activity . This study showed that Masai barefoot technology changes movement patterns , especially at the ankle , and increases muscle activity . It may therefore be a useful training method for strengthening the muscle groups of the lower leg . Knee flexion and electromyographic characteristics around the knee joint are slightly increased and need to be considered in patients with knee problems . Our findings provide critical detailed information on changes compared to walking in regular shoes , but the clinical relevance of those changes remains to be determined Full body gait analysis was used to determine if differences exist in kinematic , kinetic , and temporal-spatial data with and without shoes in able-bodied children . The greatest difference noted between conditions was an increase in stride length with shoes . Minimal changes were seen in kinematics and kinetics with the addition of shoes . Due to the very tight st and ard deviations of the data , these minimal changes in the magnitude of the curves result ed in statistically significant differences , yet these changes do not appear to be clinical ly significant . It is believed that this study establishes that barefoot gait analysis is sufficient for most clinical studies , and an additional assessment undertaken while wearing shoes is not necessary OBJECTIVE Elevated dynamic joint loads have been associated with the severity and progression of osteoarthritis ( OA ) of the knee . This study compared the effects of a specialized shoe ( the mobility shoe ) design ed to lower dynamic loads at the knee with self-chosen conventional walking shoes and with a commercially available walking shoe as a control . METHODS Subjects with knee OA were evaluated in 2 groups . Group A ( n = 28 ) underwent gait analyses with both their self-chosen walking shoes and the mobility shoes .  Group B ( n = 20 ) underwent gait analyses with a control shoe and the mobility shoe .  Frontal plane knee loads were compared between the different footwear conditions . RESULTS Group A demonstrated an 8 % reduction in the peak external knee adduction moment with the mobility shoe compared with self-chosen walking shoes ( mean + /- SD 49 + /- 0.80 versus 2.71 + /- 0.84 % BW x H ; P < 0.05 ) . Group B demonstrated a 12 % reduction in the peak external knee adduction moment with the mobility shoe compared with the control shoe ( mean + /- SD 2.66 + /- 0.69 versus 3.07 + /- 0.75 % BW x H ; P < 0.05 ) . CONCLUSION Specialized footwear can effectively reduce joint loads in subjects with knee OA , compared with self-chosen shoes and control walking shoes . Footwear may represent a therapeutic target for the treatment of knee OA . The types of shoes worn by subjects with knee OA should be evaluated more closely in terms of their effects on the disease The effects of two training programs on movement discrimination ability , at the ankle and knee , were assessed from the left and right lower limbs of forty-four football players . All players in three Under 18 Victorian Football League ( VFL ) squads were allocated to either wobble board training , jump l and ing training , or no-training conditions . Pre-tests to assess discrimination of extent for active movements made while st and ing were carried out on both ankles and knees of all subjects , using an automated device to accurately set the different movement stop points . Five distances were used , between 10.5 degrees and 14.5 degrees from horizontal for ankle inversion , and between 30.3 degrees and 31.7 degrees from vertical for knee flexion . From a series of 50 inversion movements and 50 knee flexion movements , matrices of absolute judgement by actual movement extent were produced . Non-parametric signal detection analysis was applied to the discrimination score . All subjects were retested after eight weeks . Improvement in discrimination of ankle movements into inversion from pre-test ( 0.65 ) to post test ( 0.70 ) for the wobble board trained group was significantly larger than the change in the jump-l and ing trained and the untrained groups ( Jump L and ing : Pretest : 0.64 to Post-test : 0.64 and Control ; Pretest : 0.63 to Post-test : 0.64 ) . Discrimination of knee flexion movements improved significantly from pre-test to post-test in all three groups . These data demonstrate that wobble board training can improve discrimination of discrete ankle inversion movements , an effect interpreted as enabling greater accuracy in the making of inversion movements in foot preparation prior to ground contact Study Design . Multicenter , assessor-blind , r and omized , clinical trial . Objective . To compare the effectiveness of rocker sole footwear to traditional flat sole footwear as part of the management for people with low back pain ( LBP ) . Summary of Background Data . During the past decade , persistent advertising has cl aim ed that footwear constructed with a rocker sole will reduce LBP . However , there is no robust evidence to support these cl aims . Methods . One hundred fifteen people with chronic LBP were r and omized to wear rocker sole shoes or flat sole shoes for a minimum of 2 hours each day while st and ing and walking . Primary outcome was the Rol and Morris Disability Question naire ( RMDQ ) . In addition , participants attended an exercise and education program once a week for 4 weeks and wore their assigned shoes during these sessions . Participants were assessed without their knowledge of group allocation prer and omization , and at 6 weeks , 6 months , and 1 year ( main outcome point ) . Analysis was by intention-to-treat method . Results . At 12 months , data from 44 of 58 ( 77.2 % ) of the rocker sole group and 49 of 57 ( 84.5 % ) of the flat sole group were available for analysis . In the rocker sole group , mean reduction in RMDQ was −3.1 ( 95 % CI [ confidence interval ] , −4.5 to −1.6 ) , and in the flat sole group , it was −4.4 ( 95 % CI , −5.8 to −3.1 ) ( a greater negative value represents a greater reduction in disability ) . At 6 months , more people wearing flat shoes compared with those wearing rocker shoes demonstrated a minimal clinical ly important improvement in disability ( 53.2 % and 31.1 % , respectively ; P = 0.03 ) . Between-group differences were not significant for RMDQ or any secondary outcomes ( e.g. , pain ) at any time . People reporting pain when st and ing and walking at baseline ( n = 59 ) reported a greater reduction in RMDQ at 12 months in the flat sole group ( −4.4 [ 95 % CI , −6.0 to −2.8 ] , n = 29 ) than the rocker sole group ( −2.0 [ 95 % CI , −3.6 to −0.4 ] , n = 30 ) ( P < 0.05 ) . Conclusion . Rocker sole shoes seem to be no more beneficial than flat sole shoes in affecting disability and pain outcomes in people with chronic LBP .  Flat shoes are more beneficial for LBP aggravated by st and ing or walking . Level of Evidence : BACKGROUND The Reebok Easy Tone shoe concept was developed to induce instability during walking and st and ing with the primary purpose of increasing muscle activity of the lower extremity muscles . To the authors ' knowledge , no scientific work has been published , which analyzed neuromuscular and biomechanical effects when walking and st and ing with Reebok Easy Tone shoes . Therefore , the purpose of this study was to investigate the immediate effects of 
    Output:
    
Considering kinetic and kinematic interaction of variables in the included studies revealed that confounding factors may have high impact on biomechanical findings of unstable footwear .