Japanese Knee Osteoarthritis Measure Research Articles

Validity and reliability of the Japanese Orthopaedic Association score for osteoarthritic knees

BackgroundA variety of outcome measures are available to evaluate physical impairment and disability in patients with knee osteoarthritis, and most physician-rated measures are not validated. The objective of this study was to assess the validity and reliability of an observer-based knee scoring system of the Japanese Orthopaedic Association (the JOA) commonly used in Japanese clinical practice, and to determine demographic variables affecting the score. MethodsA consecutive series of 85 patients with primary knee osteoarthritis completed the JOA (four domains pain on walking, pain on ascending or descending stairs, range of motion, and joint effusion), two validated patient-rated measures including the generic instrument of the Medical Outcomes Study 36-Item Short-Form (the SF-36) Health Survey, and the disease-specific scale of the Japanese Knee Osteoarthritis Measure (the JKOM), and a performance based timed-up-and-go test (TUG). Concurrent validity was determined by examining correlations of the JOA with the SF-36 and the JKOM. Construct validity was verified by correlating each domain of the JOA with objective measurements of TUG using Spearman’s rank correlation coefficient. Intra- and interobserver reliability and internal consistency of the JOA were evaluated with another cohort of 32 patients who had a knee disorder at baseline and again at a mean of 18 days later. ResultsThe JOA was significantly correlated with validated patient-rated outcome measures (the JKOM, the SF-36), indicating concurrent validity of the JOA. Domains of the JOA had significant correlations with the TUG, showing adequate construct validity. Intra- and interobserver reliability for the JOA showed a moderate to almost perfect agreement, and internal consistency of Cronbach’s α indicated that the JOA score was a highly reliable instrument to assess knee osteoarthritis. As a demographic variable, age was highly correlated with the JOA. ConclusionsThe JOA, generally used as an observer-derived knee scoring system, is a valid and reliable tool for evaluating functional status in patients with knee osteoarthritis.

Oral Administration of Polymer Hyaluronic Acid Alleviates Symptoms of Knee Osteoarthritis: A Double-Blind, Placebo-Controlled Study over a 12-Month Period

This study was conducted to investigate the efficacy of oral hyaluronic acid (HA) administration for osteoarthritis (OA) in knee joints. Sixty osteoarthritic subjects (Kellgren-Lawrence grade 2 or 3) were randomly assigned to the HA or placebo group. The subjects in the HA group were given 200 mg of HA once a day everyday for 12 months, while the subjects in the placebo group were given placebo. The subjects in both groups were requested to conduct quadriceps strengthening exercise everyday as part of the treatment. The subjects' symptoms were evaluated by the Japanese Knee Osteoarthritis Measure (JKOM) score. The symptoms of the subjects as determined by the JKOM score improved with time in both the HA and placebo groups. This improvement tended to be more obvious with the HA group, and this trend was more obvious with the subjects aged 70 years or less. For these relatively younger subjects, the JKOM score was significantly better than the one for the placebo group at the 2nd and 4th months after the initiation of administration. Oral administration of HA may improve the symptoms of knee OA in patients aged 70 years or younger when combined with the quadriceps strengthening exercise.

A four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance: a randomized controlled trial

Objective: To investigate whether a four-week walking exercise programme in patients with knee osteoarthritis improves the ability of dual-task performance in older adults with knee osteoarthritis. Design: A randomized controlled trial with two groups: a walking group and a control group. Subjects: Forty older adults with knee osteoarthritis, 20 participants in each group. Intervention: The walking intervention was designed to increase the number of steps walked daily. The walking group was instructed to increase their number of steps to 3000 steps more than before the intervention. Main outcome measures: Dual-task performance was computed by an automaticity index: the walking velocity under single-task condition/under dual-task conditions × 100 (%), defined as automaticity. The nearer to 100% automaticity, the better the dual-task performance. Decrease of the Trail Making Test (TMT) performance was defined as ΔTMT. ΔTMT was calculated as the difference between times (part B–part A) as a measure of executive function. In addition, functional ability was measured by the Japanese Knee Osteoarthritis Measure. Results: The walking group improved significantly in automaticity (P < 0.001, from 75.2 (7.6) to 86.9 (10.4), ΔTMT (P < 0.001, from 63.4 (43.1) to 48.3 (29.6)) and Japanese Knee Osteoarthritis Measure score (P < 0.001, from 54.4 to 51.9) compared with before the intervention, while the control group displayed no significant differences. Conclusions: We found that walking exercise improves executive function and dual-task performance.

Factors Predicting Health-related Quality of Life in Knee Osteoarthritis Among Community-dwelling Women in Japan: The Hizen-Oshima Study

Knee osteoarthritis is the most common chronic joint disorder in elderly people. However, a population-based, longitudinal study on health-related quality of life in knee osteoarthritis has not been conducted in Japan. We studied 333 women aged 50 years and older at baseline, with 8 to 9 years of follow-up. Anteroposterior weight-bearing knee radiographs were obtained at baseline and graded according to the Kellgren-Lawrence criteria. Definite osteoarthritis was defined as Kellgren-Lawrence grade 2 or higher in at least 1 joint. At baseline, all participants were asked if they had knee pain and comorbidities (heart disease, lung disease, stroke, or diabetes mellitus). Height (m), weight (kg), and chair stand time were measured. At follow-up, quality of life in knee osteoarthritis was evaluated using the Japanese Knee Osteoarthritis Measure score. Multiple linear regression analysis showed that age, knee osteoarthritis, knee pain, comorbidity, and increasing chair stand time were independently related to subsequent health-related quality of life. These findings suggest that treating knee osteoarthritis and comorbidities, managing pain, and optimizing lower extremity muscle strength may be effective targets for intervention.

Comparison of MRI-based assessment systems for osteoarthritic knees: the irregularity index system and WORMS

PurposeSeveral MRI-based evaluation systems for osteoarthritis (OA) of the knee have been developed. Among them the whole-organ magnetic resonance imaging score (WORMS), which evaluates the status of the entire knee joint, appears to be representative. We developed an irregularity index system to measure irregularities of the contours of the femoral condyle on MRI. Only the contour of the condyle was assessed by the irregularity index, whereas several items comprising the knee joint were taken into account by WORMS. This study compared the irregularity index and WORMS in terms of their correlations with clinical scores. MethodsThirty-one medial-type OA knees were studied. Kellgren-Lawrence grading was used for X-ray grading: 8 were grade II, 11 were grade III, and 12 were grade IV. Japanese Orthopaedic Association scores and Japanese knee osteoarthritis measure scores were used for clinical assessments. We determined the correlations between MRI-based assessment scores and clinical scores. ResultsBoth the irregularity index and WORMS exhibited positive correlations with these clinical scores. The irregularity index was associated with bone cysts of the medial compartment and menisci in the articular features of WORMS. ConclusionsThese MRI-based methods are useful for evaluating OA severity. However, the irregularity index may have advantages over WORMS because of its semi-automatic features.

Effect of a glucosamine-based combination supplement containing chondroitin sulfate and antioxidant micronutrients in subjects with symptomatic knee osteoarthritis: A pilot study

In the present study, we aimed to investigate the potential effect of a glucosamine (1,200 mg/day)-based dietary supplement combined with chondroitin sulfate and three antioxidant micronutrients, namely methylsulfonylmethane, guava leaf extract, and vitamin D (test supplement) on osteoarthritis (OA) of the knee. A 16-week, randomized, double-blinded, placebo-controlled trial was conducted involving 32 subjects with symptomatic knee OA. Clinical outcomes were measured using the Japanese Knee Osteoarthritis Measure (JKOM) for symptoms and a study diary-based visual analog scale (diary VAS) for pain at baseline and at weeks 4, 8, 12 and 16 during the 16-week intervention period. Furthermore, biomarkers for cartilage type II collagen degradation (C2C) and synovitis hyaluronan (HA) were measured. As compared with the baseline, the JKOM pain subscale was significantly improved at all of the four assessment time points in the test group, but was not at any time point in the placebo group. On the other hand, all of the four symptom subscales and the aggregated total symptoms were significantly improved in the two groups at one or more time points. However, all of these clinical improvements were greater in extent in the test group than in the placebo group, and there were significant differences between groups in the magnitude of changes from baseline for one subscale 'general activities' and the aggregated total symptoms at week 8 (P<0.05). The results of efficacy assessments with the diary VAS showed that all of the three pain subscales were significantly improved only in the test group at almost all the time points. Moreover, serum levels of C2C and HA were decreased by 10 and 25%, respectively, at week 16 in the test group, albeit not statistically significant, without any detectable changes in the placebo group. In conclusion, although the results obtained in this study were not conclusive, the tested glucosamine-based combination supplement is likely to have a beneficial effect on pain and other symptoms associated with knee OA.

287 CORRELATION BETWEEN SYNOVITIS DETECTED ON ENHANCED-MAGNETIC RESONANCE IMAGING AND A HISTOLOGICAL ANALYSIS WITH A PATIENT-ORIENTED OUTCOME MEASURE FOR JAPANESE PATIENTS WITH END-STAGE KNEE OSTEOARTHRITIS RECEIVING JOINT REPLACEMENT SURGERY

Osteoarthritis (OA) is a disease that primarily results in the degeneration and destruction of the articular cartilage. However, synovitis that occurs secondarily by this primary phenomenon is crucial for both the structural and symptomatic progression of the disease. The Japanese Knee Osteoarthritis Measure (JKOM) was created as an outcome measure for Japanese patients with knee OA. This study was conducted to determine whether synovitis in knee OA correlates with the current disability of patients with knee OA who required total knee arthroplasty (TKA). Thirty-four Japanese patients with end-stage knee OA who required TKA were included in this study. The visual analog scale (VAS, 0–100) for pain and the JKOM score, as well as the Western Ontario and McMaster Universities Arthritis Index (WOMAC), were examined before the operation. Synovial samples were taken at the time of the operation. A histological analysis and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) were conducted to evaluate synovitis. Correlations between the synovitis score evaluated by histological analysis and Gd-MRI with either the pain VAS score or the JKOM score were examined using Spearman’s rank correlation coefficient. Neither the synovitis scores evaluated by the histological analysis nor those by a Gd-MRI correlated with the pain VAS score (n = 34, r = 0.25, p = 0.18 and r = 0.08, p = 0.75, respectively) and WOMAC (n = 14, r = 0.35, p = 0.22 and r = 0.45, p = 0.16, respectively) of the patients. However, they significantly correlated with the JKOM score of the patients (n = 34, r = 0.55, p = 0.001 and r = 0.71, p = 0.001, respectively). The severity of synovitis in OA was closely correlated with the current functional impairment and disability of the patients receiving TKA with end-stage knee OA.

Contribution of knee adduction moment impulse to pain and disability in Japanese women with medial knee osteoarthritis

Background An increase in the knee adduction moment is one of the risk factors of medial knee osteoarthritis. This study examined the relationship between knee adduction moment and self-reported pain and disability. We also investigated the influence of pain on the relationships between knee adduction moment and gait performance and disability. Methods Thirty-eight Japanese women with medial knee osteoarthritis participated in this study (66.37 years (41–79 years)). Gait analysis involved the measurement of the external knee adduction moment impulse in the stance duration and during 3 subdivisions of stance. The total, pain and stiffness, and physical function Japanese Knee Osteoarthritis Measure scores were determined. Findings The pain and stiffness, physical function, and total scores were positively correlated with the knee adduction moment impulses in the stance duration, and initial and second double support interval, and single limb support interval. The knee adduction moment impulse during the stance duration was related to the pain and stiffness subscale and gait velocity. The pain and stiffness subscale was related to the physical function subscale. Interpretation Our results suggest that increasing in the knee adduction moment impulse, a proxy for loading on the medial compartment of the knee, is related to increased pain during weight-bearing activities such as walking, thereby restricting walking performance and causing disability by reducing gait velocity. Thus, the reduction in the knee adduction moment impulse during gait may result in pain relief and may serve as a conservative treatment option with disease-modifying potential.

Correlation between synovitis detected on enhanced-magnetic resonance imaging and a histological analysis with a patient-oriented outcome measure for Japanese patients with end-stage knee osteoarthritis receiving joint replacement surgery

Osteoarthritis (OA) is a disease that primarily results in the degeneration and destruction of the articular cartilage. However, synovitis that occurs secondarily by this primary phenomenon is crucial for both the structural and symptomatic progression of the disease. The Japanese Knee Osteoarthritis Measure (JKOM) was created as an outcome measure for Japanese patients with knee OA. This study was conducted to determine whether synovitis in knee OA correlates with the current disability of patients with knee OA who required total knee arthroplasty (TKA). Thirty-four Japanese patients with end-stage knee OA who required TKA were included in this study. The visual analog scale (VAS, 0-100) for pain and the JKOM score, as well as the Western Ontario and McMaster Universities Arthritis Index (WOMAC), were examined before the operation. Synovial samples were taken at the time of the operation. A histological analysis and gadolinium-enhanced magnetic resonance imaging (Gd-MRI) were conducted to evaluate synovitis. Correlations between the synovitis score evaluated by histological analysis and Gd-MRI with either the pain VAS score or the JKOM score were examined using Spearman's rank correlation coefficient. Neither the synovitis scores evaluated by the histological analysis nor those by a Gd-MRI correlated with the pain VAS score (n = 34, r = 0.25, p = 0.18 and r = 0.08, p = 0.75, respectively) and WOMAC (n = 14, r = 0.35, p = 0.22 and r = 0.45, p = 0.16, respectively) of the patients. However, they significantly correlated with the JKOM score of the patients (n = 34, r = 0.55, p = 0.001 and r = 0.71, p = 0.001, respectively). The severity of synovitis in OA was closely correlated with the current functional impairment and disability of the patients receiving TKA with end-stage knee OA.

Quality of Life, Knee Function, and Physical Activity in Japanese Elderly Women with Early-Stage Knee Osteoarthritis

To compare quality of life, knee function, and physical activity in 33 elderly women with or without early-stage knee osteoarthritis (OA). 33 Japanese elderly women (mean age, 66 years) with (n=18) or without (n=15) early-stage knee OA symptoms (knee pain and decreased range of motion [ROM]) were recruited. The height, weight, and body mass index, disease severity, quality of life (according to the Japanese Knee Osteoarthritis Measure [JKOM]), knee function (knee extension strength, ROM, 10-m gait time), and the amount of physical activity (net energy expenditure and step count) of the 2 groups were compared. The 2 patient groups did not differ significantly with respect to mean patient age, height, and body mass index, except for weight. Regarding knee function, mean knee extension strength, ROM (extension but not flexion), and 10-m gait speed (comfortable and maximum) were significantly inferior in patients with knee OA than in controls. Regarding the mean amount of physical activity undertaken, patients with knee OA did not differ significantly from controls with respect to net energy expenditure (179 vs. 212 Kcal/day) and step count (8016 vs. 9729 steps/day). Net energy expenditure (r= -0.65, p=0.04) and step count (r= -0.62, p=0.02) correlated negatively with JKOM scores in patients with knee OA but not in the controls. In Japanese elderly women with knee OA, quality of life (JKOM scores) correlated negatively with physical activity (net energy expenditure and step count). The 2 groups undertook similar amounts of physical activity, although those with knee OA exhibited less knee extension strength. Decreased knee extension strength coupled with high levels of physical activity may exacerbate the development of knee OA.

Effect of nonsteroidal anti-inflammatory drug plasters for knee osteoarthritis in Japanese: a randomized controlled trial

The objective of this study was to examine the effect of a nonsteroidal anti-inflammatory drug (NSAID) plaster for knee osteoarthritis among Japanese patients. An open-labeled, randomized, controlled, multiclinic trial was performed involving outpatient clinic groups. Two comparative groups—plaster NSAIDs and oral NSAIDs—were randomly allocated. The drugs used were limited to the current top three in both groups in Japan. Treatments were assessed after four weeks and compared with the baseline scores. Outcomes were evaluated by two psychometric measures: Japanese knee osteoarthritis measure, and pain with the visual analogue scale. The total number of patients included in the final evaluation was 165 (87 for the plaster group and 78 for the oral group). Between these two groups there were no significant differences in gender, age, body height and weight, body mass index, and X-ray grading. The subjects in both groups showed improvements in both scores at the end of intervention. The differences in the improvements in scores between the two groups were not significant, though the mean rank score and the 95% CI of the plaster group were slightly better than those of the oral group. In conclusion, the local application of a plaster with NSAIDs leads to the same level of improvement in knee osteoarthritis as oral NSAIDs.

膝痛軽減を目的とした運動器の機能向上プログラムの有効性

The purposes of this study were to develop a new exercise program for the elderly with knee pain, and to evaluate the effects of the program. The participants in the present study were 37 community-dwelling elderly people (75 ± 7 years) with knee pain who were living in Tokyo. The participants were instructed to do a walking exercise with weights attached to each ankle together with an exercise to develop their ability to recognize pain objectively, at a weekly meeting, with training on alternate days at home. The measurements of this study were: one-leg standing time, functional reach (FR), timed up and go, 5 m walking time, knee extension strength, health-related quality of life (QOL) questionnaire (SF-36) and the Japanese Knee Osteoarthritis Measure (JKOM). The total JKOM scores decreased significantly (p<0.01). Each subscale of the JKOM decreased significantly (p<0.05). Furthermore, knee extension strength and FR increased significantly (p<0.01). Among the SF-36 subscale scores, physical functioning, role physical, role emotional and mental health improved significantly (p<0.05). The current results suggest that the new program introduced in the present study reduces knee pain and improves the activity of participants.

Effect of nonsteroidal anti-inflammatory drug plasters for knee osteoarthritis in Japanese: a randomized controlled trial

The objective of this study was to examine the effect of a nonsteroidal anti-inflammatory drug (NSAID) plaster for knee osteoarthritis among Japanese patients. An open-labeled, randomized, controlled, multiclinic trial was performed involving outpatient clinic groups. Two comparative groups-plaster NSAIDs and oral NSAIDs-were randomly allocated. The drugs used were limited to the current top three in both groups in Japan. Treatments were assessed after four weeks and compared with the baseline scores. Outcomes were evaluated by two psychometric measures: Japanese knee osteoarthritis measure, and pain with the visual analogue scale. The total number of patients included in the final evaluation was 165 (87 for the plaster group and 78 for the oral group). Between these two groups there were no significant differences in gender, age, body height and weight, body mass index, and X-ray grading. The subjects in both groups showed improvements in both scores at the end of intervention. The differences in the improvements in scores between the two groups were not significant, though the mean rank score and the 95% CI of the plaster group were slightly better than those of the oral group. In conclusion, the local application of a plaster with NSAIDs leads to the same level of improvement in knee osteoarthritis as oral NSAIDs.

Objective assessments of medial osteoarthritic knee severity by MRI: new computer software to evaluate femoral condyle contours

An irregular contour of the medial femoral condyle (MFC) on magnetic resonance imaging (MRI) appears to indicate the severity of medial-type knee osteoarthritis (OA). The purpose of this study was to establish a system to enable objective assessments of OA knee severity using newly developed software that semi-automatically measures irregularity of the MFC. (1) We evaluated 48 patients aged 50-83 years with 55 knees of medial-type OA. The following scores were recorded: Lysholm score, visual analogue scale (VAS) and the Japanese Knee Osteoarthritis Measure (JKOM). MFC irregularity was automatically calculated by newly programmed computer software. Four parameters for condyle irregularity were calculated: (a) the average thickness of the contour (ATC), (b) the ratio of the upper surface length to the lower surface length of the contour (RUL), (c) average squared thickness of the contour (ASTC) and (d) standard deviation of the contour thickness (SDC). (2) Nine knees that underwent total knee arthroplasty were further analysed histopathologically and compared with irregularity score. Statistically, the RUL and SDC were significantly correlated with the Lysholm score, VAS and JKOM, with good reliability. Histological examinations showed that an irregular contour reflected the density of cystic lesions formed in subchondral bone. An irregularity of MFC on MRI is correlated with OA disease severity clinically and histopathologically. The new computer software is useful to objectively assess OA disease severity.

Therapeutic home exercise versus intraarticular hyaluronate injection for osteoarthritis of the knee: 6-month prospective randomized open-labeled trial

Background.Treatment for osteoarthritis (OA) of the knee is controversial. Only a few studies have compared the effects of intraarticular injection of hyaluronate with those of home exercise for knee OA. We prospectively evaluated the therapeutic effects of each treatment. Methods.A total of 102 female subjects (mean age 70.4 years) were randomly divided into two groups and followed up to the 24th week. The primary outcome measure was judged by three pain/function scales as follows: a visual analogue scale, the Japanese Knee Osteoarthritis Measure, and the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International criteria. For secondary outcome measures, all data were categorized for logistic regression analysis and the chi-squared test to address factors affecting these outcomes. Results.The two treatment groups demonstrated equal improvement regarding all three scales, and there was statistically no difference in between-group analyses, although there seemed to be better improvement in range of motion at 24 weeks in the home exercise group. In categorical analysis, OA stage was classified as early and advanced OA at 3 mm of joint space width obtained from standing anteroposterior radiographs. Logistic regression analysis revealed that the OA stage at the baseline of the knee affected these improvements. For early OA the improvement rate regarding hydrops was significantly higher in the home exercise group, whereas for advanced OA there was a tendency for the rate of improvement in ROM to be inferior in the hyaluronidate group. Conclusions.Taking into account the cost, convenience, and invasiveness to patients, exercise is thought to have some advantage over intraarticular injection of hyaluronate for the therapy of OA of the knee.

Effect of Home Exercise of Quadriceps on Knee Osteoarthritis Compared with Nonsteroidal Antiinflammatory Drugs

To examine the effect of home-based exercise on knee osteoarthritis among Japanese in comparison with that of nonsteroidal antiinflammatory drugs (NSAIDs). An open-labeled, randomized, controlled, multiclinic trial compared home-based quadriceps exercise with NSAIDs. Treatments were basically evaluated after 8 wks and compared with the baseline scores. Outcomes were evaluated with a set of psychometric measurements including the Western Ontario and McMaster Universities Arthritis Index (WOMAC), 36-Item Short-Form Health Survey (SF-36), Japanese Knee Osteoarthritis Measure (JKOM), and pain with the visual analog scale. A total of 142 patients entered this trial to provide the baseline data. After 21 cases withdrew, the final number analyzed was 121 cases: 63 for the exercise group and 58 for the NSAIDs group. Between these two groups, there was no significant difference in gender, age, body height and weight, body mass index, or each score at baseline. The subjects in both groups showed improvements in all scores at the end of intervention. The difference in improvement rate of each score between the two groups was not statistically significant, though the mean rank score measured with JKOM in the exercise was slightly better than that of the NSAIDs. Home-based exercise using quadriceps strengthening improves knee osteoarthritis no less than NSAIDs.

膝痛を有する中高齢女性の痛み対処方略と痛みの程度，痛みによる活動制限との関係

The present study examined the association of pain coping strategy with pain and activity restriction among middle-aged and elderly women with the knee pain. The participants were 134 female community residents (62.1+/-8.2 years) with knee pain. The pain and activity restriction were assessed with the Japanese Knee Osteoarthritis Measure (JKOM). The pain coping strategy was evaluated using the Japanese short version of the Coping Strategy Questionnaire (CSQ). A theoretical model was developed to explain the relationships among age, pain, activity restriction, and pain coping strategy. This model was then tested using structural equation modeling (SEM). The overall fit index was adequate for the final model (GFI=.980, AGFI=.946, CFI=.995, RMSEA=.022). SEM indicated that increasing age had a significant association with increasing pain, and indirect influence on progressive activity restriction. Also, aggravating pain was significantly associated with adopting more "praying or hoping", "catastrophizing", and "increasing pain behavior" as pain coping strategy, and indirectly affected progress in activity restriction. The results indicate that reducing the use of maladaptive coping strategy would be important to promote the ability of pain self-management among middle-aged and elderly women with knee pain. The present study suggests that it would be necessary to incorporate the cognitive-behavioral approaches in order to modify the use of maladaptive coping strategy in existing therapeutic exercise intervention for knee pain.