THE EFFECTIVENESS OF CUSTOM FOOT ORTHOSIS VERSUS PLACEBO ORTHOSIS ON CHRONIC LOW BACK PAIN AMONG PATIENTS WITH FLATFEET: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Introduction: The purpose of this study was to determine the effectiveness of foot orthosis in treating chronic low back pain among patients with flatfeet. Methods: This systematic review followed the JBI methodology for systematic reviews and was registered with PROSPERO. The search strategy involved a three-step process to identify both published and unpublished studies from various databases without language or date restrictions. After title & abstract screening then full-text screening, selected studies were assessed for bias using the Cochrane Risk of Bias Assessment Tool, with domains such as attrition, reporting, detection, selection, and performance bias considered. The data extraction was done using a standardized JBI tool, and statistical analysis utilized RevMan 5.4 software. The GRADE approach was employed to evaluate the certainty of evidence and outcomes included information on risk, relative risk, quality of evidence, and various factors influencing it. Results: Out of 3,102 papers, only 2 were included in the study. With a total of 152 participants, 80 were assigned to the experimental group while 70 in the control group. Statistical analysis reveals a reduction in pain with a mean difference of 3.50 (95% CI, 95% CI, 4.04, 2.97) & improvement in disability with a mean difference of 13.87 (95% CI, 16.37, 11.37). No significant heterogeneity were calculated as indicated by an I² of 0%. Discussion: Findings suggest that both CFO is more effective than placebo orthosis in treating back pain and disability. However, statistical analysis reveals that CFO is clinically significant in treating only back-pain related disability and not back pain per se. The review acknowledges a scarcity of compelling evidence from prior research, underscoring the necessity for additional research to confirm the broader effectiveness of foot orthotics in managing low back pain.