***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: Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : OBJECTIVE To assess the effect of an insole with subtalar strapping on patients with medial compartment osteoarthritis ( OA ) of the knee . METHODS Novel lateral wedged insoles with elastic subtalar strapping ( the subtalar strapping support group ) and ankle supporters with a lateral wedged heel insert ( the sock-type ankle support group ) were prepared . Eighty-eight female out patients with knee OA were treated with 1 of the 2 insoles for 8 weeks . Femorotibial angle was assessed by st and ing radiographs with and without unilateral insole use for each subject . Symptoms of knee OA were evaluated according to the severity index of Lequesne et al at baseline and at the final assessment . RESULTS Participants wearing the insole with subtalar strapping ( n = 42 ) demonstrated significantly decreased femorotibial angle ( an average of change : -3.1 degrees + /- 2.5 degrees , P < 0.0001 ) , but a significant difference was not found in the sock-type ankle support group ( n = 46 ; -0.4 degrees + /- 1.1 degrees , P > 0.05 ) . In the subtalar strapping support group , pain during bed rest with full extension of the knee ( P < 0.0001 ) , pain after getting up ( P = 0.04 ) , pain on getting up from a seated position ( P = 0.021 ) , maximum distance walked ( P = 0.009 ) , and aggregate severity score ( P < 0.0001 ) were significantly improved compared with baseline . In contrast , significant symptomatic improvement was detected only in the aggregate score ( P = 0.016 ) in the sock-type ankle support group , but not in any of the 10 specific categories . CONCLUSION The lateral wedged insole with subtalar strapping induces correction of the femorotibial angle and symptomatic relief in patients with varus-deformity knee OA R and omized controlled trials often suffer from two major complications , i.e. , noncompliance and missing outcomes . One potential solution to this problem is a statistical concept called intention-to-treat ( ITT ) analysis . ITT analysis includes every subject who is r and omized according to r and omized treatment assignment . It ignores noncompliance , protocol deviations , withdrawal , and anything that happens after r and omization . ITT analysis maintains prognostic balance generated from the original r and om treatment allocation . In ITT analysis , estimate of treatment effect is generally conservative . A better application of the ITT approach is possible if complete outcome data are available for all r and omized subjects . Per- protocol population is defined as a subset of the ITT population who completed the study without any major protocol violations Lateral wedges were originally proposed to manage medial compartment osteoarthritis of the knee but recent review s suggest that lateral wedges do not affect disease progression . We performed a systematic review to analyse the recent literature and define how effective , if at all , lateral wedges are in the management of medial compartment osteoarthritis of the knee . The inclusion criteria were defined as any study published within the last decade , using a sample size of at least twenty patients , and investigating the effect of insoles or wedges on either unilateral or bilateral knee varus osteoarthritis . The st and ardised keyword term ‘ lateral*wedge*OR insole*OR orthotic * OR medial compartment OR varus OR osteoarthri * OR knee * ’ was used . We identified 10 studies that fitted our inclusion criteria . Although there is not enough evidence in the literature to prove that lateral wedge orthotics are an effective treatment for varus osteoarthritis of the knee  , there is some evidence to suggest that they do have some symptomatic effect .  Patients with early osteoarthritis and higher BMI may benefit to a greater extent than those with a greater extent of degenerative changes and lower BMI . The literature is unclear as to what the optimal duration for the use of lateral wedges is , but does support the prolonged use of the wedges as the benefits at one month are maintained at one year . Future studies should be r and omised controlled trials with a large sample size with long follow-up , and use objective clinical , biomechanical and radiological outcome measures The index for hip disease ( ISH ) was established , vali date d and appraised as a new assessment test for the trial of new drugs as well as for long-term follow-up of patients , and to help with future indications for surgery . The ISH deals with pain , maximum walking distance , and some activities of daily living . Inter-observer reproducibility is good ( mean deviation 0.55 points ; p less than 0.05 ) . In a short-term , double-blind crossover trial , the ISH , judged according to its power to distinguish between the active drug period and the placebo period , appears as one of the best assessment tests . In the long term , total hip prosthesis is most often justified when the ISH score reaches 10 - 12 points . The index of severity for knee disease ( ISK ) was vali date d and appraised by the same statistical methods . Its value in non-steroidal anti-inflammatory drug ( NSAID ) or analgesic trials is lower than the value of the ISH . However , its use is still justified for that purpose , and for long-term follow-up of osteoarthritis of the knee OBJECTIVES To identify factors that predicted incident use of assistive walking devices ( AWDs ) and to explore whether AWD use was associated with changes in osteoarthritis of the knee . DESIGN Prospect i ve cohort study . SETTING Community . PARTICIPANTS Older adults ( N=2639 ) in the Health , Aging and Body Composition ( Health ABC ) Study including a subset of 874 patients with prevalent knee pain . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Incident use of AWDs , mean Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain scores , and the frequency of joint space narrowing on knee radiographs over a 3-year time period . RESULTS AWD use was initiated by 9 % of the entire Health ABC cohort and 12 % of the knee pain subset . Factors that predicted use in both groups were age ≥73 ( entire cohort : odds ratio [OR]=2.07 ; 95 % confidence interval [ CI ] , 1.43 - 3.01 ; knee pain subset : OR=1.87 ; 95 % CI , 1.16 - 3.03 ) , black race ( entire cohort : OR=2.95 ; 95 % CI , 2.09 - 4.16 ; knee pain subset : OR=3.21 ; 95 % CI , 2.01 - 5.11 ) , and lower balance ratios ( entire cohort : OR=3.18 ; 95 % CI , 2.21 - 4.59 ; knee pain subset : OR=3.77 ; 95 % CI , 2.34 - 6.07 ) . Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users . Twenty percent of non-AWD users and 28 % of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least 1 knee . Fourteen percent of non-AWD users and 12 % of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least 1 knee . CONCLUSIONS AWDs are frequently used by older adults . Knee pain and balance problems are significant reasons why older adults initiate use of an AWD . In an exploratory analysis , there was no consistent relation between the use or nonuse of an  AWD and WOMAC pain scores or knee joint space narrowing progression . Further studies of the relation of use of AWDs to changes in knee osteoarthritis are needed OBJECTIVE To assess the contribution of radiological osteoarthritis of the hips and knees to disabilities in the activities of daily living related to lower limb function . METHODS During a home interview 1156 men and 1739 women , r and omly chosen from the source population of all independently living residents aged 55 years and over living in a district of Rotterdam ( the Rotterdam Study ) were asked about locomotor disability by six questions of the Health Assessment Question naire ( HAQ ) and about pain in the hips and knees in the past month . Radiographs of hips and knees were scored according to the Kellgren grading system for osteoarthritis . RESULTS The prevalence of locomotor disability , defined as at least some difficulty with three or more out of six lower limb functions , was 20.2 % for men and 31.9 % for women ;  hip pain was present in 8.3 % of the men and 16.6 % of the women ; knee pain in 12.6 % of the men and 22.3 % of the women . The prevalence of radiological osteoarthritis grade 2 + of the hip was 14.1 % for men and 15.9 % for women , and of the knee 16.3 % and 29.1 % respectively . The odds ratio ( OR ) ( 95 % confidence intervals ) of hip radiological osteoarthritis for locomotor disability adjusted for age and all other variables was for men : 1.4 ( 0.9 , 2.1 ) and for women : 2.2 ( 1.6 , 2.9 ) . The ORs of knee radiological osteoarthritis adjusted for age and all other variables were 1.1 ( 0.9 , 2.1 ) and 1.4 ( 1.1 , 1.8 ) respectively . Severe radiological osteoarthritis ( grade 3 + ) was stronger associated . The ORs of pain in the hips or knees and morning stiffness were much higher ( between 2.7 and 5.5 for men and between 2.1 and 5.1 for women ) . CONCLUSIONS Radiological osteoarthritis of the hip and knee are only weak independent predictors of  locomotor disability in women , and not at all independently associated with locomotor disability in men . Age , pain of the hips and knees , and morning stiffness seem to be the most important independent determinants of locomotor disability Overemphasis on hypothesis testing-- and the use of P values to dichotomise significant or non-significant results --has detracted from more useful approaches to interpreting study results , such as estimation and confidence intervals . In medical studies investigators are usually interested in determining the size of difference of a measured outcome between groups , rather than a simple indication of whether or not it is statistically significant . Confidence intervals present a range of values , on the basis of the sample data , in which the population value for such a difference may lie . Some methods of calculating confidence intervals for means and differences between means are given , with similar information for proportions . The paper also gives suggestions for graphical display . Confidence intervals , if appropriate to the type of study , should be used for major findings in both the main text of a paper and its abstract The prevalence of  osteoarthritis ( OA )  is greater in women then men . Weight , a factor strongly associated with osteoarthritis , is significantly increased over the menopausal transition . Despite the high prevalence of osteoarthritis , a disabling disease with limited treatment options , there is a paucity of studies in women . The longitudinal phase of the Melbourne Women ' 
    Output:
    
Limited evidence supported the positive effects of short-lever elastic knee braces to improve pain and functional disability in specific outcomes .
No evidence was found to support the use of foot orthoses , such as laterally wedged insoles , medial arch support and metatarsal arch pad .
Conclusion : Our systematic review found no conclusive evidence about the effectiveness of any braces and orthoses for patients with medial knee osteoarthritis .
Clinical relevance This is the first systematic review of Japanese- language r and omised controlled trials investigating orthoses for patients with knee osteoarthritis .
Clinicians can consider the use of short-lever elastic knee braces to improve specifically pain on squat or walking .
Evidence found in this review does not support the use of foot orthoses