Japanese Knee Osteoarthritis Measure Score Research Articles

Mobile application for home exercise adherence in patients with knee osteoarthritis: A pilot study.

Background:The adherence to home exercise is generally low despite its well-known effect on knee osteoarthritis. Therefore, we developed a home exercise application, LongLifeSupport, to provide patients with daily basic exercise videos and an automatic recording calendar. We hypothesized that this application would encourage patients to exercise and help maintain their motivation; this pilot study aimed to determine their exercise adherence rates. Using outcome measures, we also aimed to determine the effect of home exercise using this application and the factors for its continuation.Methods:Twenty patients with knee osteoarthritis were included. The participants exercised for 12 weeks. Using pre- and post-tests, we examined their satisfaction with continuation (only in the post-test), Japanese knee osteoarthritis measure score, short physical performance battery score, bilateral knee extension muscle strength, and short test battery for locomotive syndrome. Furthermore, we investigated correlations between adherence rates and pretest scores of Japanese knee osteoarthritis measure and short test battery and between pretest scores and variations in Japanese knee osteoarthritis measure and short test battery.Results:The mean adherence rate was 82.4%. The participants showed ease of continuation (100%) and significant improvements in the degree of knee pain, pain, and stiffness, and daily life conditions using the Japanese knee osteoarthritis measure score, total score, walk seconds, and chair stand seconds of the short physical performance battery, as well as the extension muscle strength of the right- and pain-side knee. No significant correlations were identified between the adherence rate and the pretest or variation.Conclusion:The adherence rate to the application was over 80%. Participants with knee osteoarthritis showed almost full satisfaction, reduced pain, and improved physical ability. Therefore, the use of this application provided a safe exercise program and maintained the exercise motivation of participants. Thus, it may be useful for unsupervised home exercise.

Comparison of the Efficacy of Two High-Molecular-Weight Hyaluronic Acid Products for Patients With Knee Osteoarthritis.

In Japan, hyaluronic acid (HA) is often used to treat patients with relatively mild knee osteoarthritis (OA). The use of HA in and the physique and lifestyle of the Japanese population differ from those of other populations. Therefore, clinical reports of HA from around the world must be interpreted with caution for application in Japan. We compared the clinical efficacy of two HA products, with average molecular weights of 900,000 (HA90) and 1.9 million (HA190), for Japanese patients with knee OA. There were 49 patients and 54 knees (27 patients received both HA90 and HA190 injections). We used a disease-specific/patient standing-type knee OA function evaluation scale that was developed earlier and later improved considering the uniqueness of the Japanese lifestyle. The assigned HA product was injected into the joints of patients with knee OA with Kellgren-Lawrence classification system grades I to III once a week, for 5 consecutive weeks. Effects were subjectively self-evaluated using the Japanese Knee Osteoarthritis Measure (JKOM) and a visual analog scale. The average age of the patients was 65.4 years (range, 42-88 years). Both HA products alleviated walking pain and improved JKOM scores, and symptoms continued to improve with continued injections for 6 months. The continued administration of HA90 improved general activity more than that of HA190. In contrast, HA190 improved initial pain more, but its continued administration did not contribute to improving general activity. These results suggest that it may be effective to use different HA products depending on the symptoms and conditions of patients with knee OA. [Orthopedics. 2022;45(1):13-18.].

Differential Contribution of the Medial and the Lateral Side of the Joint to Symptoms in Knee Osteoarthritis: A Radiographic and Laboratory Analysis in the Nagahama Study.

This cross-sectional study aimed to explore the differences of the medial and lateral sides of the knee joint and precise radiographic abnormalities in contribution to the knee pain and clinical outcomes. Participants 60 years or older who underwent radiographic evaluation were included. Knee radiography was assessed using grading systems of the Osteoarthritis Research Society International (OARSI) atlas. The Japanese Knee Osteoarthritis Measure (JKOM) was evaluated as clinical outcomes. Serum high-sensitivity C-reactive protein (hsCRP) was used to evaluate systemic inflammation. We divided the participants into normal, medial-, lateral-, and medial & lateral-OA types and compared their JKOM using an analysis of covariance. Furthermore, we analyzed the relationship between the knee pain and stiffness of JKOM and the grading of each radiographic feature using a multiple regression model. Lateral- and medial & lateral-OA groups had a significantly worse symptoms in the total and the pain score, especially in movement subscales, in JKOM score. Lateral-OA groups had higher hsCRP than medial-OA group. Multivariate analysis showed that medial joint space narrowing (JSN), and lateral femoral and tibial osteophytes significantly affected knee pain (adjusted odds ratios: 1.73, 1.28, and 1.55, respectively). The radiographic changes are associated with pain more in JSN in the medial side and osteophytes in the lateral side. Lateral- and medial & lateral-OA groups showed worth symptom. In addition, medial JSN and lateral osteophytes have potent effects on the knee pain.

Difference in patient-reported outcomes of various patellar component designs in total knee arthroplasty: A randomized clinical study.

This study investigated the clinical effects of different patellar components without being affected by the femoral component design in total knee arthritis (TKA) for patients with knee osteoarthritis (OA). In total, 48 patients with OA who met the criteria of the American College of Rheumatology for OA were enrolled and randomly assigned in a 1:1 ratio to two groups according to the usage of patellar component design for TKA (medialized dome type [dome group] or medialized anatomic type [anatomic group]). To evaluate the clinical outcomes for TKA, knee range of motion (ROM), pain intensity of 0-100 mm visual analog scale (pain VAS), and the Japanese Knee Osteoarthritis Measure (JKOM) score were obtained at baseline and year 1. The difference in knee ROM, pain VAS, or total JKOM score at year 1 was not significant between the dome and anatomic groups (p = 0.398, 0.733 and 0.536, respectively). Moreover, similar results were obtained for changes in knee ROM, pain VAS, or total JKOM scores from baseline. In both groups, the pain VAS and total JKOM scores were significantly improved at year 1. Both dome and anatomic groups in TKA are significantly effective for pain and function using the JKOM score. However, their efficacy did not differ, according to the JKOM score. Results of this study are rare information focusing on the patellar component design and provide one of the insights into the TKA clinical management.

Relationships between early postoperative gait biomechanical factors and patient-reported outcome measures 6 months after total knee arthroplasty

BackgroundThis study was focused on the gait parameters of the knee extensor and hip abductor muscle groups, which are believed to contribute to knee joint function improvement in early postoperative TKA. The associations between patient-reported outcome measures (PROMs) 6 months after total knee arthroplasty (TKA) and the early postoperative internal knee extension moment, knee extension negative joint power, and internal hip abduction moment while walking were investigated. MethodsTwenty-one patients who underwent primary TKA for knee osteoarthritis were included. Three weeks after TKA, gait at a comfortable speed was measured by three-dimensional motion analysis. The lower limb joint angle, internal joint moment, and joint power parameters on the operated side while standing were calculated. The PROMs 6 months after TKA were assessed using the Japanese Knee Osteoarthritis Measure (JKOM). The relationship between each gait biomechanical parameter and the JKOM was determined. ResultsThe maximum internal knee extension moment and maximum knee extension negative joint power during the early stance showed moderate negative correlations with the JKOM scores. The maximum internal hip abduction moment was not correlated with the JKOM scores. The maximum internal hip extension moment during the early stance and internal hip flexion moment during the late stance showed moderate negative correlations with the total JKOM scores. ConclusionThe early postoperative internal knee extension moment, maximum knee extension negative joint power, and internal hip extension and flexion moment are associated with patient PROMs 6 months after TKA.

ʟ-Serine and EPA Relieve Chronic Low-Back and Knee Pain in Adults: A Randomized, Double-Blind, Placebo-Controlled Trial

ABSTRACTBackgroundMultisite pain, including low-back and knee pain, is a major health issue that greatly decreases quality of life.ObjectivesThis study analyzed the effects of l-serine, which provides necessary components for nerve function, and EPA, which exerts anti-inflammatory properties, on pain scores of adults with pain in at least the low back and knee for ≥3 mo.MethodsThis was a randomized, double-blind, placebo-controlled, parallel-group study. The Japan Low Back Pain Evaluation Questionnaire (JLEQ) and Japanese Knee Osteoarthritis Measure (JKOM) were applied as primary outcomes. The Brief Pain Inventory (BPI) and safety evaluation were secondary outcomes. We enrolled 120 participants aged ≥20 y (36 men and 84 women: mean ± SD age = 40.8 ± 10.9 y). The participants were randomly allocated to either the active group (daily ingestion of 594 mg l-serine and 149 mg EPA) or placebo group. The study period consisted of 8-wk dosing and 4-wk posttreatment observation. ANCOVA between groups for each time point was conducted using the baseline scores as covariates.ResultsThe JLEQ scores (active compared with placebo: 14.2 ± 11.2 compared with 19.0 ± 10.2) at week 8 were lower in the active group (P < 0.001). The JKOM scores at week 4 (11.7 ± 9.0 compared with 13.9 ± 7.9), week 8 (10.4 ± 7.9 compared with 13.1 ± 7.1), and week 12 (10.3 ± 7.4 compared with 13.8 ± 7.5) were lower in the active group (P ≤ 0.04). Additionally, the active group had 11–27% better scores compared with the placebo group for BPI1 (worst pain), BPI3 (average pain), and BPI5D (pain during moving) at week 4 (P ≤ 0.028) and week 8 (P ≤ 0.019), respectively, and BPI5D was 23% better in the active group at week 12 (P = 0.007). No adverse events were observed.Conclusions l-Serine and EPA were effective for pain relief in adults with low-back and knee pain after multiplicity adjustment.This trial was registered at the University Hospital Medical Information Network Clinical Trials Registry as UMIN000035056.

Effect and usability of anti-inflammatory drug plasters for knee osteoarthritis: A crossover, double-blind, repeated measures, randomized controlled trial

BackgroundThe use of plasters is a well-accepted treatment with high adherence. However, the characteristics such as its cool feeling or extensibility favored by elderly have a possibility to contribute to clinical utility.The purpose is to examine the effect of anti-inflammatory drug plasters for knee osteoarthritis and the clinical preference of the patients for using plasters. We conducted a crossover, double-blind, randomized controlled trial (RCT) recruited 168 patients with knee osteoarthritis. MethodsWe included a “run-in-period” to evaluate the patients’ preference among A (first-generation; methyl salicylate), B (second-generation; indomethacin), and N (base substrate for B) before the crossover sequence of two treatment periods with A and B plasters; four arms (N-A-B, A-A-B, N-B-A, and B-B-A) were made to compare the assessment of A, B, and N plasters.We used two measures: The Japanese Knee Osteoarthritis Measure (JKOM), for clinical functions, and the usability questionnaire to evaluate the clinical value of plasters. ResultsAt baseline, there were no significant differences in characteristics. The subjects in groups A and B showed improved overall JKOM scores at the end of each intervention. Comparison of the change of the mean difference showed that A and B were statistically significant improvement over N (−2.40, (95%CI = −3.58 to −1.21), −2.52, (−3.65 to −1.40)) but no significant difference between A and B – 0.13, (−1.14 to 0.89)).In network analysis for usability, twelve items were independent of JKOM's network structure and consisted of two domains. The analysis of usability showed that N and B were preferred over A significantly. ConclusionBoth the first- and second-generation plasters were statistically superior to the base only, but no significant difference between two generations. The patient is surely aware of the effect of the drug itself, but the two feelings are important in the preference.

A clinical prediction rule for predicting a delay in quality of life recovery at 1 month after total knee arthroplasty: A decision tree model

BackgroundThere is no clinical prediction rule for predicting the prognosis of quality of life after total knee arthroplasty and for assessing its accuracy. The study aimed to develop and assess a clinical prediction rule to predict decline in quality of life at 1 month after total knee arthroplasty. MethodsThis study included 116 patients with total knee arthroplasty in Japan. Potential predictors such as sociodemographic factors, medical information, and motor functions were measured. Quality of life was measured using the Japanese Knee Osteoarthritis Measure at 1 day before surgery and 1 month after total knee arthroplasty. The classification and regression tree methodology was used for developing a clinical prediction rule. ResultsThe Japanese Knee Osteoarthritis Measure score pre-total knee arthroplasty (≦34.0 or >34.0) was the best single discriminator. Among those with the Japanese Knee Osteoarthritis Measure score pre-total knee arthroplasty ≦34.0, the next best predictor was knee flexor muscle strength on the affected side (≦0.45 or >0.45 N m/kg). Among those with knee flexor muscle strength on the affected side >0.45, the next predictor was knee flexion range of motion on the affected side (≦132.5°or >132.5°). The area under the receiver operating characteristic curves of the model was 0.805 (95% confidence interval, 0.701–0.909). ConclusionsIn this study, 4 variables were selected as the significant predictor. However, the results of knee flexor muscle strength and knee flexion range of motion were paradoxical. This result suggests that it should be careful to perform surgery to the patients with good preoperative knee function. The clinical prediction rule was developed for predicting quality of life decline 1 month after total knee arthroplasty, and the accuracy was moderate. This clinical prediction rule can be used for screening of patients with total knee arthroplasty.

Comparison of patient-reported outcomes of treatment with low- and intermediate molecular weight hyaluronic acid in Japanese patients with symptomatic knee osteoarthritis: A prospective, randomized, single-blind trial

ObjectivesThe objective of this study was to compare the clinical outcomes of treatment with low- or intermediate-molecular-weight hyaluronic acid (HA) in patients with knee osteoarthritis (OA). MethodsIn total, 59 patients with OA who fulfilled the criteria of the American College of Rheumatology for OA were enrolled. Patients were randomly assigned in a 1:1 ratio to the low- or intermediate-molecular-weight HA group. An intraarticular injection of HA into the knee joint was performed five times per week. The visual analog scale for pain (pain VAS) and Japanese Knee Osteoarthritis Measure (JKOM) score were analyzed at baseline and week 6 to assess the outcomes. ResultsPain VAS and JKOM score were significantly improved in both groups. At follow-up, there were no significant between-group differences in pain VAS or total JKOM score. Moreover, reduction in pain VAS and JKOM score was not significantly different between the two groups. ConclusionsBoth low- and intermediate-molecular-weight HA have significant efficacy in the first-line treatment of patients with knee OA as indicated by patient-reported outcomes. However, there does not appear to be any difference between the efficacy of low- and intermediate-molecular-weight HA as indicated by the JKOM score. We believe that the results of this study provide important insights into the clinical management of Japanese patients with knee OA.

Effect of Shoes Reducing Varus Instability of the Knee on Gait Parameters, Knee Pain, and Health-Related Quality of Life in Females With Medial Knee Osteoarthritis

Observations: The effects of shoes reducing varus instability of the knee on gait parameters, knee pain, and health-related quality of life (HRQOL) in patients with medial knee osteoarthritis were investigated. Methods: Twelve patients with medial knee osteoarthritis wore shoes reducing varus instability of the knee. Results and Conclusions: Gait velocity, stride length, step length, knee pain, and Japanese Knee Osteoarthritis Measure scores significantly improved in the postintervention period compared with the pre- and postcontrol periods. Therefore, shoes reducing varus instability of the knee can effectively improve gait parameters, knee pain, and HRQOL in patients with medial knee osteoarthritis.

Defining thresholds for the Kellgren-Lawrence grading between 2 and 3 for the Japanese knee osteoarthritis measure questionnaire for urban inhabitants more than 65-year old

Purpose: According to the population-based cohort study in Japan, over 80 percent of 80-year old and above Japanese women have had a prevalence rate of knee osteoarthritis (OA). Knee OA is one of the most prevalent conditions resulting in disability particularly in the elder population, and it also leads to high economic costs and death further. To assess knee OA, Kellgren-Lawrence (KL) grading has been commonly used in many epidemiological studies, and the KL grade 2 is usually used as the disease threshold. Prevent knee joint degeneration progressing from KL grade 2 to KL grade 3 in healthy individuals may reduce high economic costs by receiving knee replacement surgery or interventional therapy, ensure elder inhabitant’s quality of life further. In addition, patient-reported outcome measures (PROMs) of the Japanese Knee Osteoarthritis Measure (JKOM) with its high reliability and validity, has been widely used to evaluate OA-related health domain. Physicians can assess knee OA with the KL grading and JKOM objectively. However, what JKOM scores indicating the process of knee OA were unclear. The purpose of this present study was to determine the KL grading thresholds between KL grade 2 and KL grade 3 for the JKOM for urban inhabitants more than 65-year old. Methods: Participants who completed the JKOM questionnaire, received X-ray and diagnosed as KL grade 2 or KL grade 3 of knee OA by the expert physician were included in this study. To determine the score that best distinguished those who were in KL grade 2 and who were in KL grade 3, the sensitivities and specificities for each of the potential scores were plotted as a receiver operating characteristic (ROC) curve. The maximal product of specificity and sensitivity was taken to be the KL grade 2-3 threshold. Results: A total of 754 out of 795 participants (mean age, SD= 73.0, 5.5; male vs female = 321 vs 433) were included in this study. Of these, 645 participants (85.5%, male vs female = 299 vs 346) were in KL grade 2 with the mean JKOM score (SD) of 5.6 (6.8) points, which was significantly lower than KL grade 3 group (mean score, SD= 11.9, 11.5, P value < 0.0001). In addition, mean score of the subscale of JKOM between KL grade 2 and KL grade 3 were also statistically significant (P value < 0.05). The KL 2-3 threshold (sensitivity, specificity) was 8 (0.54, 0.78) for the JKOM total score, 8 (0.57, 0.75) for the degree of knee pain (JKOM I), 1 (0.73, 0.62) for the pain and stiffness in knees (JKOM II), 4 (0.19, 0.89) for the condition in daily life (JKOM III), 1 (0.70, 0.62) for the general activities (JKOM IV), and 2 (0.50, 0.70) for the health conditions (JKOM V). Conclusions: Our results should provide additional information to interpretation what score indicates the progressing of knee joint degeneration in the healthy population.

Correlation between ultrasonographic findings and symptoms of knee osteoarthritis.

Knee osteoarthritis (OA) is mainly diagnosed by clinical and radiographic findings. The aim of this study was to evaluate the correlation between ultrasonography (US) findings during flexion and knee loading and symptoms of knee OA. We studied 33 knees with OA in 21 patients. Using US, the medial meniscal protrusion was measured at the midpoint of the medial joint space with the patient standing and the knee in maximum extension and flexion. With the knee in extension, the thickness of the synovial membrane at the suprapatellar area and the size of the osteophytes at the medial joint space were measured. Radiography was performed to determine the Kellgren-Lawrence (K-L) scores. The correlations between US findings and the visual analog scale (VAS) score, Japanese Knee Osteoarthritis Measure (JKOM) score, K-L score, and range of motion (ROM) were analyzed. Medial meniscal protrusion was significantly correlated with K-L score and ROM limitation. Synovial membrane thickness was also significantly correlated with the total JKOM and usual activity scores. There was no correlation between the VAS scores and US findings. Multigroup comparisons of the patients' positions during US did not reveal significant intergroup differences. US was able to detect a change in medial meniscal protrusion during knee flexion and loading. Although medial meniscal protrusion was not correlated with pain, it was related to structural changes of the knee, similar to radiographic findings. Synovial membrane thickness detected by US correlated with pain and a disturbance in the usual activity of patients with OA.

Symptoms and physical findings of early knee osteoarthritis

Background: There is an increasing need on identifying symptoms and physical findings of the early knee osteoarthritis (KOA). The purpose of this study was to clarify clinical manifestation of early KOA detected by ultrasonography (US) and standard radiographs, and to characterize them for early detection of KOA. Methods: A total of 1,090 participants (2,180 knees) recruited at residential health examinations were evaluated by visual analogue scale of pain, the Japanese Knee Osteoarthritis Measure (JKOM) score as a health-related score, knee extension muscle strength, and images (US and radiographs). Among them, 663 knees with Kellgren-Lawrence Grade (KLG) 0 and 1 were divided into four groups; Group A (with no pain and echo-negative OA findings, n=192), Group B (with no pain and echo-positive OA findings, n=284), Group C (with pain and echo-negative OA findings, n=84), and Group D (with pain and echo-positive OA findings, n=103). Results: Group C and D indicated a significant higher JKOM score than Group A and B, especially in terms of disturbance of activities of daily living (ADLs) such as ascending upstairs or descending downstairs, standing up, and squatting. Group B showed significant higher subscales in disturbance of these ADLs than Group A, although Group B has no pain. Maximum knee extension muscle strength in Group C and D were weaker than Group A and B. Group D indicated the weakest knee extension muscle strength among the groups. In women, weak knee extension muscle strength was significantly correlated with pain and echo-positive OA findings. The risk factors of early KOA were woman, high BMI, and weak extension muscle strength. Conclusions: This study showed that symptoms of early KOA might be not only pain but also the disturbance of ADLs such as ascending upstairs or descending downstairs, standing up, and squatting with weak knee extension muscle strength. Pain-free knees with positive US findings, when disturbing these ADLs, might be the pre-stage of early KOA, namely super-early KOA. For not only treatment of the established KOA, but also prevention of proceeding to early KOA, strengthening of the knee extension muscle to maintain these ADLs might be recommended.

Daily Oral Chondroitin Sulfate Oligosaccharides for Knee Joint Pain in Healthy Subjects: A Randomized, Blinded, Placebo-Controlled Study

Background: The increased rate of population aging in Japan has led to an increase in the incidence of osteoarthritis (OA). Chondroitin sulfate has been reported to reduce the pain and swelling associated with OA and to improve knee function. Objective: We evaluated the safety and effects of oral chondroitin sulfate oligosaccharides on knee function in a randomized, double-blinded, placebo-controlled parallel group comparison study of healthy Japanese subjects with knee joint pain. Methods: Subjects were randomly divided into test and placebo groups and given either active-test capsules containing 100 mg of chondroitin sulfate oligosaccharides or placebo capsules daily for 8 weeks. The Japanese Knee Osteoarthritis Measure (JKOM), Visual Analog Scale (VAS), blood and physical examinations, and medical interviews were performed at weeks 0, 4, and 8, and the locomotive syndrome risk test was performed at weeks 0 and 8 during the test intake period. Results: The JKOM scores did not significantly differ between the test groups. However, among subjects with worse VAS scores, those in the active test group had significantly lower JKOM scores at 8 weeks, compared to those in the placebo group. Moreover, chondroitin sulfate oligosaccharide treatment tended to improve the subjects' scores on the stand-up test, which evaluates the risk of locomotive syndrome. Furthermore, no abnormal changes or severe adverse events were observed during physical or blood examinations or medical interviews. Conclusion: Our results suggest that chondroitin sulfate oligosaccharides improve knee pain and are safe for 8-week intake.

Effects of Psidium guajava Linn. leaf extract in Japanese subjects with knee pain: a randomized, double-blind, placebo-controlled, parallel pilot study.

The extract of Psidium guajava Linn. (guava) leaf was recently revealed to suppress the advance of osteoarthritis (OA) in rat anterior cruciate ligament-transection models. To investigate the efficacy of guava leaf extract in improving knee pain, which is a common symptom of OA, we conducted a double-blind parallel pilot clinical study in Japanese subjects with knee pain. The subjects, who had no medical history of knee treatment, were randomly assigned to two groups with similar total Japanese Knee Osteoarthritis Measure (JKOM) scores. During the 12-week intake period, the subjects in each group ingested 1g of guava leaf extract (the guava group) or placebo (the placebo group) daily. At week 12, pain and stiffness in knees (one subcategory of JKOM score) in the guava group was significantly lower than that in the placebo group. Using the visual analogue scale (VAS) for knee pain, a significant association between treatment effect and test period was shown, and the guava group had a lower VAS score at week 12 than the placebo group. In conclusion, continuous intake of guava leaf extract might relieve knee pain, suggesting a potential preventive effect against OA symptoms.

Efficacy and safety of a compound supplement containing glucosamine, chondroitin, and five bioactive ingredients in volunteers with knee joint pain

Abstract Purpose This study was designed to evaluate the efficacy and safety of a compound supplement containing glucosamine (GS), chondroitin sulfate (CS), and five bioactive ingredients for improvement of knee osteoarthritis (OA). Methods Sixteen volunteers aged ≥40 years with knee pain and without ambulant treatment participated in a 6-week randomized, double-blind, placebo-controlled study. They were assigned to the dietary supplement or placebo groups (n = 8, respectively) and ingested six capsules twice daily. The OA symptoms of each subject were determined in pre- and post-treatment periods using a visual analog scale for pain (VAS pain) and four Japanese Knee Osteoarthritis Measure (JKOM) subscales (joint stiffness, daily living, social activities, and general health condition). For safety and biomarker assessments, blood and urine samples were tested. Results In the treatment group, the subjective symptoms of VAS pain and three JKOM subscale scores except for social activities were significantly improved compared to pre-treatment. Among them, the pattern of change in joint stiffness and total JKOM scores showed a significant difference between groups (p = 0.008 and 0.041, respectively). The serum level of interleukin-6, a systemic inflammation biomarker, was significantly decreased in the treatment group after 6 weeks (p = 0.019), whereas the level remained stable in the placebo group (p = 0.690). Diagnostic urine and hematological parameters revealed no serious adverse differences following dietary supplementation over the 6-week study. Conclusion These findings suggest that the compound supplementation of functional food ingredients has potential as an adjunctive and safe therapy for knee OA.

Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series

ObjectiveThe purpose of this case series was to describe the short-term and long-term clinical effects of a manual technique for treating osteoarthritis (OA) knee pain. MethodsThis study measured of the immediate effect and long-term effect by using a case series of different groups of subjects. Knee OA and activity restriction in patients were evaluated by using the Kellgren-Lawrence (K/L) Grading Scale and the Japanese Knee Osteoarthritis Measure (JKOM) index. In the intervention, lower limb muscles were squeezed by hand for 20 seconds. Each squeeze was performed for both lower limbs. Passive range-of-motion (ROM) exercise was performed on the knee joint. In one set of cases, immediate effects were measured after a one-time treatment with pretreatment and posttreatment outcome measures. Eleven people with knee OA participated in the study. On a visual analogue scale (VAS) for pain, muscle stiffness, and muscular hemodynamics for estimation of muscle blood flow were recorded before and after the squeeze-hold treatment. In another set of cases, the treatment was given to all patients once a week for 6 months, and long-term effects were measured. Data on 5 subjects with knee OA were collected for 6 months after initial treatment. The VAS for pain and JKOM were recorded every month for 6 months. ResultsFor immediate effects, the VAS was 69 ± 21 mm before treatment and 26 ± 22 mm after treatment. Muscle stiffness was 8.8 ± 3.6 (absolute number) before treatment and 3.5 ± 2.1 after treatment. Tissue (muscle) oxygen saturation was 60.1 ± 5.7% before treatment and 65.3 ± 4.8% after treatment. Total hemoglobin was 24.3 ± 3.3 (absolute number) before treatment and 25 ± 2.3 after treatment. A tendency for reduction in OA knee pain and muscle stiffness was observed, and a tendency for increase was observed in the blood flow in the muscle. For long-term effects in all 5 participants (any K/L grade, any JKOM score), OA knee pain and JKOM score improved gradually through 6 months. ConclusionsThe participants in this case series showed improvement in pain and function. These findings indicate the feasibility of a larger study on the squeeze-hold intervention for OA knee pain.

Relationship between biological factors and catastrophizing and clinical outcomes for female patients with knee osteoarthritis.

AIMTo investigate the correlations between clinical outcomes and biopsychological variables in female patients with knee osteoarthritis (OA).METHODSSeventy-seven patients with symptomatic knee OA were enrolled in this study. We investigated the age, body mass index (BMI), pain catastrophizing scale (PCS) and radiographic severity of bilateral knees using a Kellgren-Lawrence (K-L) grading system of the subjects. Subsequently, a multiple linear regression was conducted to determine which variables best correlated with main outcomes of knee OA, which were pain severity, moving capacity by measuring timed-up-and-go test and Japanese Knee Osteoarthritis Measure (JKOM).RESULTSWe found that the significant contributor to pain severity was PCS (β = 0.555) and BMI (β = 0.239), to moving capacity was K-L grade (β = 0.520) and to PCS (β = 0.313), and to a JKOM score was PCS (β = 0.485) and K-L grade (β = 0.421), respectively.CONCLUSIONThe results suggest that pain catastrophizing as well as biological factors were associated with clinical outcomes in female patients with knee OA, irrespective of radiographic severity.

The effects of licorice flavonoid oil with respect to increasing muscle mass: a randomized, double‐blind, placebo‐controlled trial

The present study evaluated the effects of licorice flavonoid oil (LFO) with respect to increasing the muscle mass of elderly populations using a randomized, double-blind, placebo-controlled study. Fifty participants aged 54-90 years (seven men, 43 women), who underwent rehabilitation treatment for osteoarthritis of the knee, were examined and assigned to either the LFO group (n = 26) or the placebo group (n = 24). The LFO group consumed 300 mg LFO day-1 , whereas the placebo group consumed one placebo capsule every day for 16 weeks. We measured muscle mass, body fat percentage and the Japanese Knee Osteoarthritis Measure score at baseline and every 4 weeks thereafter. In the LFO group, muscle mass in the body trunk increased significantly after 16 weeks of LFO intake (+0.38 kg, P = 0.02). The trunk muscle mass weight of the LFO group increased significantly compared to that of the placebo group (P < 0.01). Furthermore, the body fat percentage and body trunk fat percentage of the LFO group were significantly suppressed compared to that of the placebo group (P = 0.03 and P < 0.01, respectively). The results of the present trial indicate that LFO supplementation has effects with respect to increasing muscle mass and suppressing the body fat percentage of elderly populations, especially in the body trunk. © 2016 Society of Chemical Industry.

Relation between the stand-up test and gait speed, knee osteoarthritis, and osteoporosis using calcaneal quantitative ultrasound – Cross-sectional study

ObjectiveThe aim of the present study was to clarify the relationship between the stand-up test and gait speed, knee osteoarthritis (OA), and osteoporosis using calcaneal quantitative ultrasound. Study designCross-sectional study. MethodsA total of 185 subjects (55 men, 130 women) aged ≥40 years (mean age, 63.7 years; range, 40–79 years) were evaluated using the stand-up test to screen for locomotive syndrome. We also assessed OA of the knee using X-rays and a subjective questionnaire, physical characteristics, 6-m gait speed (m/s), and bone density. If results on the stand-up test were worse than benchmarks by age group (i.e., the height at which 50% of each age group could stand-up), the subject was defined as having a risk for locomotive syndrome (L group). We analyzed the relationship between the stand-up test and other variables. ResultsOf 185 subjects, 50 (27.0%) were classified into the L group. In univariate analysis, there were significant differences between the L group and non-L group in bone density (p < 0.001), gait speed (p < 0.001), osteoporosis (p < 0.001), slow gait speed group (SGSG) (cut off 1 m/s), and Japanese knee osteoarthritis measure score. Multivariate logistic regression analysis adjusted for age, height, weight, and gender showed a significant association between the stand-up test and bone density (OR 0.960, 95% confidence interval (95% CI) 0.927-0.994), gait speed (m/s) (OR 0.073, 95% CI 0.016–0.342), osteoporosis (OR 3.710, 95% CI 1.410–9.764), and SGSG (OR 7.849, 95% CI 1.628–37.845). ConclusionsThe stand-up test to screen for the risk for locomotive syndrome was associated with bone density, gait speed, osteoporosis, SGSG. The stand-up test is an easy test to use to screen for possible disability among the elderly.