McMaster Universities Index Research Articles

Correlation between functional disability grade and radiographic severity among Nigerian patients with knee osteoarthritis

Background: Knee osteoarthritis (OA) is the most common form of degenerative arthritis in human and a leading cause of functional disability in the middle aged and elderly. The diagnosis of knee OA is often based on clinicoradiographic criteria. And in spite of the widespread utilization of knee radiograph in the diagnosis of knee OA, studies on the correlation between clinical and radiographic findings have been discordant. Although most studies of knee OA patients in Nigeria have incorporated knee radiograph in the diagnosis of the disease, the contribution of radiographic severity to functional disability in Nigerian patients is not well described. Objective: The aim of this article is to determine the pattern of radiographic knee OA in Nigerian patients and the correlation between radiographic grades of knee OA and functional disability. Materials and Methods: One hundred forty consecutive patients with knee OA attending the Rheumatology Clinic of Ahmadu Bello University Teaching Hospital were recruited for the study. Patients biodata and anthropometric parameters were ascertained. Patients had general and musculoskeletal examination. Knee radiographs were done for all patients and graded using the Kellgren-Lawrence (K-L) grading system. Pain and functional disability grades were measured using Likert 3.0 Western Ontario McMaster University index. Results: All 140 patients had definite knee OA on radiograph (K-L grade 2 and above). Grade 2 radiographic knee OA was noted in 51 (36.4%) patients, grade 3 in 71 (50.7%) patients, and grade 4 in 18 (12.9%) patients. Eighty-nine (63%) patients had severe radiographic knee OA. The mean pain and disability scores were significantly higher in patients with grade 3 or 4 radiographic knee OA compared to those with grade 2 radiographic knee OA. Both pain and functional disability moderately correlated with radiographic grades (rs = 0.36, P = 0.000) and (rs = 0.48, P = 0.000), respectively. Conclusion: The point prevalence of severe radiographic knee OA (K-L grade 3 or 4) is 63% in Nigerian knee OA patients. There is a moderate correlation between radiographic severity and functional disability in knee OA patients, with radiographic severity being an independent predictor of functional disability.

Pre-operative pressure pain thresholds do not meaningfully explain satisfaction or improvement in pain after knee replacement: a cohort study

Pain sensitization could be a risk factor for poor outcomes after knee replacement surgery (KR) for knee osteoarthritis (KOA). We aimed to evaluate the association between pre-operative central and peripheral pain sensitization measured using a digital pressure algometer and KR outcomes. Consecutive patients with severe KOA listed for KR were recruited. Sociodemographic and symptoms data were collected prior to surgery. Pre-operative pressure pain thresholds (PPTs) were measured using a digital pressure algometer at the index knee and forearm. Patient satisfaction at 6 and 12 months after KR was assessed using a 4-point Likert scale, and dichotomized to satisfied and dissatisfied to KR. Western Ontario and McMaster Universities Index (WOMAC) Pain and function was assessed. The associations between pre-operative PPTs with KR outcomes at 6 and 12 months were evaluated. Of the 243 patients recruited, response rate at 6 and 12 months were 95.5% and 96.7%. The dissatisfaction rates were 8.2% and 5.1% at 6 and 12 months. There was no statistically significant association between pre-operative index knee or forearm PPTs and patient satisfaction. PPTs measured at the knee, but not the forearm, were weakly associated with change in the WOMAC pain score at 12 months, after adjustment for confounding factors. Pre-operative central sensitization, measured by handheld digital algometry, was not statistically significantly associated with satisfaction or change in pain after KR. Pre-operative peripheral sensitization was associated with change in pain symptoms after KR; however, this association was weak and unlikely to be a meaningful predictor of KR outcome in clinical practice.

Development of the Italian version of the High-Activity Arthroplasty Score (HAAS-I) following hip and knee total arthroplasty: cross-cultural adaptation, reliability, validity and sensitivity to change

BackgroundThe number of physically active individuals who develop knee and hip arthritis and who undergo arthroplasties of these joints ie ever increasing. It has become necessary to develop evaluation scales which address the specific issues raised by such individuals. The High Activity Arthroplasty Score is one such scales, originally developed in English.MethodsThe HAAS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the pre-final version to establish its correspondence with the original English version. The psychometric testing included reliability by means of internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficients) and construct validity by Pearson’s correlations with a pain intensity numerical rating scale (NRS), the Western Ontario and McMaster University index (WOMAC, for THA subjects), the Knee injury and Osteoarthritis Outcome Scale (KOOS; for TKA subjects) and the Short-Form 36 Health Survey (SF-36).ResultsThe questionnaire was administered to 67 subjects with THA and 61 with TKA and proved to be acceptable. The questionnaire showed good internal consistency (0.85 for THA and 0.91 for TKA) and a high level of test–retest reliability (ICC = 0.97 with 95% CI 0.95–0.98 for THA; ICC = 0.95 with 95% CI 0.92–0.98 for TKA). There was a moderate correlation between the HAAS-I and NRS (r = − 0.40), there was a high correlation between the HAAS-I and WOMAC (r = − 0.68) and there were moderate to high correlations between the HAAS-I and SF-36 subscales (r = 0.34 to 0.63) for THA. There was a moderate correlation between the HAAS-I and NRS (r = − 0.77); there was a high correlation between the HAAS-I and KOOS subscales (r = − 0.79 to r = − 0.91); and there were low correlations between the HAAS-I and SF-36 subscales (r = 0.01 to 0.29) for TKA.ConclusionsThe HAAS-I was successfully translated into Italian and proved to have good psychometric properties that replicated the results of existing versions. Its use is recommended for clinical and research purposes.

Fluoroscopic Guided Radiofrequency of Genicular Nerves for Pain Alleviation in Chronic Knee Osteoarthritis: A Single-Blind Randomized Controlled Trial

Nowadays, pain and disability due to chronic knee arthritis is a very common problem in middle aged people. A lot of modalities for management are available, including conservative analgesics and up to surgical interventions. Radiofrequency ablation of genicular nerves is assumed to be an effective less invasive and safe pain alleviation modality. To evaluate the efficacy of fluoroscopic guided radiofrequency neurotomy of the genicular nerves for alleviation of chronic pain and improvement of function in patients with knee osteoarthritis. A single-blind randomized controlled trial. Pain management unit, and Rheumatology and Rehabilitation clinics of Assiut University hospitals, Assiut, Egypt. This study involved 60 patients with chronic knee osteoarthritis. Radiofrequency neurotomy of the genicular nerves was done for 30 patients (Group A) while the other 30 patients (Group C) received conventional analgesics only. The outcome measures included visual analog scale (VAS), Western Ontario and McMaster Universities Index (WOMAC), and Likert scale for patient satisfaction in the 2nd week,3rd, and 6th months. There were significant differences regarding the VAS in the 2nd week, 3rd, and 6th months between the 2 groups, and a significant difference in total WOMAC index in the 6th month only. There were significant changes when comparing pretreatment values with the values during the whole follow-up period with regard to the VAS and total WOMAC index in both groups. No diagnostic block was done prior to radiofrequency. We recommend the use of such a technique on a larger number of OA patients, with a longer follow-up period. RF can ameliorate pain and disability in chronic knee osteoarthritis in a safe and effective manner. Chronic pain, radiofrequency (RF), knee osteoarthritis.

Revision Hip Arthroscopy After Labral Reconstruction Using Iliotibial Band Autograft: Surgical Findings and Comparison of Outcomes With Labral Reconstructions Not Requiring Revision

To determine the causes of revision hip arthroscopy in patients who underwent labral reconstruction and to compare outcomes of these patients with patients who did not require a revision following reconstruction. Patients who underwent revision hip arthroscopy after previous labral reconstruction from 2006 to 2014 were included. Patients with less than 2-year follow-up, preoperative joint space of ≤2mm, or who underwent other reconstructive procedures at the time of labral reconstruction were excluded. Each patient was matched by year of surgery, age, gender, and the number of previous surgeries with 2 patients that underwent labral reconstruction but did not require a revision following the reconstruction. Preoperatively and at a minimum 2-year follow-up, outcome scores were collected including the Hip Outcome Score-Activities of Daily Living (HOS-ADL) and HOS-Sports Scale, modified Harris Hip Score, Western Ontario and McMaster Universities Index (WOMAC), the 12-Item Short Form Health Survey (SF-12) Physical Component Summary, and the patient satisfaction outcome were collected. Differences between the preoperative and the postoperative outcomes score of each patient in the 2 groups was assessed using the paired t test. The Mann-Whitney U test was used to compare the 2 groups. From 347 patients who underwent iliotibial band autograft labrum reconstruction from 2006 to 2014, 28 hips (8%) in 26 patients (18 females and 8 males) had revision arthroscopy after labral reconstruction. The mean age was 32years (range: 16-64). The mean number of hip surgeries prior to the labral reconstruction was 1.9 ± 1.2. The average time from the last labral reconstruction procedure to revision labral reconstruction was 27months (range: 5-59). Procedures performed at revision included lysis of adhesions (100%), additional femoroacetabular impingement (FAI) correction (50%), ligamentum teres debridement (50%), psoas release (29%), labral augmentation or reconstruction (14%), and others. Following revision surgery after previous labral reconstruction, 4 patients (14%) underwent total hip arthroplasty and 2 (7%) patients required a subsequent revision arthroscopy (age 67 and 23) at 15months and 16months. The average follow-up time was 3.6 years ± 1year after revision following labral reconstruction and after labral reconstruction in the nonrevision group. No significant difference was detected in the outcome scores and postoperative satisfaction between the 2 groups. The HOS-ADL improved 16 points in the nonrevision group and 19 points in the revision group. Patients who underwent revision surgery after labral reconstruction were mostly female, with 2or more surgeries prior to reconstruction, and 14% required THA and 7% had recurrent scarring. In those who did not fail, outcomes significantly improved and were similar with patients who did not need revision. Adhesions and residual FAI were the most common findings during revision labral reconstruction. Level III, retrospective comparative study.

Outpatient balneological treatment of osteoarthritis in older persons : Aretrospective study.

To evaluate the effectiveness and safety of outpatient balneological treatment consisting of hydrotherapy and peloid therapy in elderly patients with osteoarthritis. In this retrospective observational study all patients aged ≥65years with any type of osteoarthritis who received balneological treatment (hydrotherapy and peloid therapy) at our clinic between 2007 and 2016 were included. Hydrotherapy was applied as head-out immersion in atap water pool at 36-38 °C for 20 min and then peloid therapy was applied as a local peloid pack on the painful region or joint at 42-43 °C for 20 min, on each weekday for 2 weeks. Patients were evaluated before and after the treatment and outcome measurements were pain, patient's global assessment, physician's global assessment, Western Ontario and McMaster Universities index, Lequesne hip index, Waddell index, neck pain and disability scale, and health assessment questionnaire. In total, 235 osteoarthritis patients comprising 61 generalized, 91knee, 6hip; 32lumbar, 12cervical, 1foot and 32hand osteoarthritis, were included in the analysis. We found significant improvements in pain and function scores in generalized, knee, lumbar, cervical and hand osteoarthritis. Patient's global assessment was also improved in all subtypes except hip (p = 1.000) and hand (p = 0.132) osteoarthritis subtypes. The majority of patients (59.1%) fulfilled the outcome measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. The treatment demonstrated agood safety profile. Study results provide initial evidence for the potential beneficial effects and safety of outpatient balneological treatment (hydrotherapy and peloid therapy) in the management of older patients with osteoarthritis. Future randomized controlled studies are needed to confirm these results.

Efficacy of peloidotherapy alone or in combination with hydrotherapy in osteoartritis

Aim of this study was to evaluate the efficacy of combined hydrotherapy and peloidotherapy compared to peloidotherapy alone in the treatment of patients with osteoarthritis. In this observational retrospective study 873 patients records who were undertaken balneolojical treatment at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, were analysed. The diagnoses were 175 generalized OA, 338 knee OA, 44 hip OA, 138 hand OA, 59 cervical OA, 67 lomber OA and 11 foot ankle OA. In total 606 patients given ten treatment sessions of hydrotherapy (tap water, 37 °C) and peloidotherapy(42-43 °C) for 2 weeks, 5 days per week. In total 226 patients also given same treatment protocol except hydrotherapy. Evaluations were done before and after treatment by pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index(WOMAC), Waddell Index (WI), Cervical Disability and Pain Scale (CDPS), Shoulder Disability Questionnaire(SDQ). At the end of the combination therapy significant improvements have been found in all assessments.

Total hip arthroplasty performed with a tissue-preserving technique using superior capsulotomy.

We present a minimally invasive tissue-sparing posterior superior (TSPS) approach that intends to protect the abductor muscles during total hip arthroplasty, prevents the release of the short rotator muscles, and provides the surgeon with the option to repair the posterior capsule. We hypothesized that the TSPS technique would produce a better clinical outcome, faster recovery, and lower complication rates, and that it would not jeopardize acetabular component position. A retrospective, observational study was conducted in a consecutive series of patients. A cohort of 130 patients (130 hips) operated with a standard posterolateral approach were compared with a cohort of 132 patients (132 hips) operated with a TSPS approach. Patients were assessed with the Harris hip score (HHS) and Western Ontario and McMaster Universities index (WOMAC), which were carried out preoperatively, one month (HHS only), three months, one year, and at four years post-operatively. Compared with the standard group, patients in the TSPS group showed a faster return to ambulation as reflected in better post-operative HHS and WOMAC scores up until one year (p < 0.05). No significant differences in HHS (p = 0.564) and WOMAC (p = 0.796) scores were found at the four-year follow-up. No major adverse events were observed in either group. The TSPS approach yielded better early clinical outcomes and appears to be a safe and reliable technique. However, these early differences do not appear to be sustained over time, as comparable mid-term clinical outcomes with similar complications rates were observed.

Frontal plane hip joint loading according to pain severity in people with hip osteoarthritis.

The primary objective was to examine the hip adduction moment during walking in people with hip osteoarthritis (OA) according to pain severity. Sixty-eight participants with unilateral symptomatic hip OA were included. Pain during walking was assessed on a 5-point Likert item within the Western Ontario and McMaster Universities Index (no pain = 12; mild pain n = 37; moderate pain n = 19). Measures of the external hip adduction moment (peaks, Nm/BW × BH (%) and impulse, Nm.s/BW × BH (%)) were determined. Other measures included frontal plane hip, pelvis and trunk kinematics, walking speed and peak isometric hip abductor strength. Variables were compared according to pain severity using linear models and biomechanical variables were examined. Participants with moderate pain had a significantly higher second peak hip adduction moment and impulse compared to those with less pain. There was no difference in any measure of hip adduction moment between those with mild pain and no pain. There were no differences in kinematics across pain severity categories. Participants with moderate pain had a significantly slower walking speed compared to participants with mild and no pain. Participants with moderate pain had weaker peak isometric hip abductor strength compared to those with mild pain and no pain. The hip adduction moment during walking, hip abduction strength and walking speed differs according to pain severity during walking in people with hip OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1637-1644, 2018.

Comparison of Clinical Results and Injury Risk of Posterior Tibial Cortex Between Attune and Press Fit Condylar Sigma Knee Systems

BackgroundWe compared clinical and radiographic results after total knee arthroplasty (TKA) using Attune and Press Fit Condylar Sigma, and investigated whether use of the current prosthesis increased injury risk to the tibial cortex in Asian patients. We also assessed whether a preoperative posterior tibial slope angle (PSA) is associated with the injury when using the current prosthesis. MethodsThe 300 TKAs with Attune (group A) were compared to the 300 TKAs with Press Fit Condylar Sigma (group B). Demographics were not different, except follow-up periods (24.8 vs 33.3 months, P < .001). The Western Ontario and McMaster Universities Index and range of motion were compared. A minimum distance between tibial component stem and posterior tibial cortex (mDSC) was compared. The correlation between preoperative PSA and mDSC was analyzed in group A. ResultsThe postoperative Western Ontario and McMaster Universities Index and range of motion of group A were better than those of group B (17.7 vs 18.8, P = .004; 131.4° vs 129.0°, P = .008). The mDSC was shorter in group A (6.3 vs 7.0 mm, P < .001), which made up a higher proportion of the high-risk group for posterior tibial cortical injury with an mDSC of <4 mm (20.0% vs 10.7%, P = .002). A negative correlation was found between the preoperative PSA and mDSC in group A (r = −0.205, P < .001). ConclusionThe TKA using the current prosthesis provided more satisfactory results than the TKA using the previous prosthesis. However, the injury risk to the posterior tibial cortex increased in the knees with a large PSA when using the current prosthesis for Asian patients.

Application of Tranexamic Acid in Total Knee Arthroplasty - Prospective Randomized Trial.

Background:The use of tranexamic acid (TXA) in total knee arthroplasty (TKA) has shown good results. Bleeding may cause local complications consequently greater pain and reduced function postoperatively. No study has related the use of TXA to these facts.Objective:The aim was to evaluate the effects of TXA haemoglobin, Western Ontario and McMaster Universities Index (WOMAC), pain intensity and flexion gain after TKA.Methods:43 patients were randomized and then underwent TKA. TXA was applied to 22 of these patients before closure of the joint capsule. Haemoglobin measurements (mg/dL) were taken preoperatively and 24 and 48 hours after surgery. The WOMAC questionnaire and pain visual analogue scale (VAS) were applied, and flexion gain was measured up to the second postoperative month. Statistical analysis compared the results to determine whether there were differences between the groups for each of the evaluated times.Results:There were differences in favour of the drug 48 hours postoperatively for the haemoglobin variable (p = 0.01), in pain evaluation, 24 and 48 hours, postoperatively (p < 0.01) and in flexion gain, 24 hours after surgery (p = 0.03). There were no significant differences between the groups in the haemoglobin evaluation 24 hours postoperatively, in pain assessment 7 days, 21 days and 2 months, postoperatively, in flexion gain 48 hours, 7 days, 21 days and 2 months, postoperatively and in WOMAC after 2 months.Conclusion:In addition to reducing bleeding, topical TXA improved pain and increased flexion gain in the first hours after TKA.Trial Registration:RBR-9b4qgq

Arthrose, lésion méniscale dégénérative et ostéonécrose primitive du genou : une analyse simple de la marche améliore-t-elle la démarche diagnostique ?

IntroductionThe purpose of the current study was to compare the gait patterns in patients with three differing knee pathologies – knee osteoarthritis (OA), degenerative meniscal lesion (DML) and spontaneous osteonecrosis of the knee (SONK) and a group of healthy controls. HypothesisA simple gait test will detect differences between different knee pathologies. Material and methodsForty-seven patients with bilateral knee OA, 47 patients with DML, 28 patients with SONK and 27 healthy controls were included in this analysis. Patients underwent a spatiotemporal gait assessment and were asked to complete the Western Ontario and McMaster university (WOMAC) Index and the Short-Form (SF)-36 Health Survey. Anova tests, followed by Bonferroni multiple comparison tests and the Chi2 tests were performed for continuous and categorical variables, respectively. ResultsSignificant differences were found for all gait measures and clinical questionnaires between healthy controls and all knee conditions. Patients with SONK differed from patients with bilateral knee OA and DML in all gait measures and clinical questionnaires, except for WOMAC subscales. There were no significant differences between patients with bilateral knee OA and patients with DML. Symmetry was also examined and revealed asymmetry in some gait parameters in patients with SONK and DML. DiscussionBased on the differences in gait parameters that were found in the current study, adding an objective functional spatiotemporal gait test may assist in the diagnostic process of knee pathologies. Type of studyCase Control Study Level III.

Efficacy of class IV diode laser on pain and dysfunction in patients with knee osteoarthritis: a randomized placebo-control trial

Objectives The aim of this study was to investigate the effect of class IV diode laser on knee pain and functions in patients with knee osteoarthritis. Patients and methods Fifty patients with a mean±SD) age of 55.68±8.88 years, height of 173.84±4.946 cm, weight of 83.86±5.28 kg, and BMI of 27.78±1.89 kg/cm2 were randomly assigned equally into two groups (25 patients in each group). Group I received a multiwave locked system laser plus exercises and group II received placebo laser plus exercises three times weekly for 4 weeks. Exercise program was applied for both groups three times weekly for 4 weeks. The exercises included range of motion, stretching, isometric, and isotonic resisted exercises to the quadriceps and hamstring muscles. Pain was evaluated using a visual analog scale and knee function by using the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC). Statistical analyses were performed to compare differences between baseline and post-treatment results for both groups. Results Visual analog scale and WOMAC were significantly decreased in both groups after 4 weeks of treatment, with a more significant decrease gained in group I (P>0.0001). Conclusion Class IV diode laser combined with exercise was more effective than exercise alone in the treatment of patients with knee osteoarthritis. Multiwave locked system laser combined with exercise effectively decreased pain and WOMAC as compared with the placebo laser plus exercises group.

Real-life effectiveness of spa therapy in rheumatic and musculoskeletal diseases: a retrospective study of 819 patients.

The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis (p=0.063) and rheumatoid arthritis (p=0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis (p=0.068), rheumatoid arthritis (p=0.111), and rotator cuff tendinitis (p=0.078) subgroups. In daily clinical practice, spa therapy is prescribed and practiced mainly for osteoarthritis, then fibromyalgia, lumbar/cervical disc herniation, and nonspecific low back pain; and less for ankylosing spondylitis, rheumatoid arthritis, and rotator cuff tendinitis. The study results suggest that real-life spa therapy may be effective in a variety of rheumatic and musculoskeletal diseases by improving pain and function.

Cross-cultural adaptation and psychometric analysis of the Arabic version of the oxford knee score in adult male with knee osteoarthritis

BackgroundThere are varieties of self-assessment questionnaire used for the evaluation of pain, functional disability, and health related quality of life in individuals with knee osteoarthritis (OA). The present study intended to adapt and translate the oxford knee score into the Arabic and investigated its psychometric properties in adult male with knee OA.MethodsNinety-seven adult male (mean age 57.55 ± 11.49 years) with knee OA participated. Patients were requested to complete the adapted Arabic version of the Oxford knee score (OKS-Ar), reduced “Western Ontario and McMaster Universities Index (WOMAC)”, and the Visual analogue scale (VAS). Patients were requested to complete 2nd form of OKS-Ar at least 1 week apart to assess the reproducibility of the score. The OKS was adapted and translated into Arabic by two independent Arabic native speakers (one rehabilitation professional having experience of knee OA patients and another one a trained translator) according to the international guidelines.ResultsAll the participants completed the 2nd form of OKS-Ar (Response rate 100%). Reliability and internal consistency was high with an ICC of 0.97, and the Cronbach’s alpha coefficient of 0.987, respectively. A significant relationship between the OKS-Ar and the WOMAC and VAS scores confirmed the construct validity (p < 0.001). The standard error of measurement (SEM) and the minimum detectable change (MDC) were 2.2 and 6.2, respectively.ConclusionsThe adapted Arabic version of the OKS demonstrated acceptable psychometric properties, including reliability, internal consistency, and the validity. The present study indicates that the OKS-Ar is a suitable questionnaire to measure pain and physical function in the Arabic speaking adult male patients with knee OA.

Reliability and validity of the 12-item WHODAS 2.0 in patients with Kashin-Beck disease.

The purpose of this study was to check the reliability and validity of the 12-item Chinese version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for the assessment of disability in patients with Kashin-Beck disease (KBD). We recruited 219 patients with KBD from the high-risk KBD area in the Shaanxi province, using stratified multistage random sampling. We assessed each patient using the Chinese version of the 12-item WHODAS 2.0 and the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC). Statistical evaluations of the instruments consisted of Cronbach's alpha, intraclass correlation coefficient (ICC), confirmatory factor analysis (CFA), and Pearson's correlation coefficient. Cronbach's alpha and ICC for the six domains ranged from 0.704 to 0.906 and 0.690 to 0.852, respectively. A six-factor structure fits the data well (CFI=0.967, TLI=0.944, RMSEA=0.08). Regarding convergent validity, the four domains of the 12-item WHODAS 2.0 (getting around, self-care, life activity, and participation) showed moderate-to-strong correlation for all three domains of the WOMAC (0.428<|r|<0.804). Regarding divergent validity, the two domains of the 12-item WHODAS 2.0 (understanding and communication, and getting along with people) showed weak correlation for the three domains of WOMAC (0.182<|r|<0.295). The Chinese version of 12-item WHODAS 2.0 questionnaire is a reliable and valid instrument when administered to KBD patients.

Evaluating therapeutic effect on WOMAC subscales in osteoarthritis RCTs: When model choice matters.

The study aimed at developing a method for modelling the Western Ontario and McMaster Universities index (WOMAC), accounting for correlation between its subscales and for heterogeneity of treatment effect (HTE), using data from 2 twin trials on knee osteoarthritis. Two randomized, double-blind, placebo-controlled clinical trials (twin trials). Studies aimed at investigating the effectiveness of a pharmacological treatment on clinical outcomes of knee osteoarthritis, measured using WOMAC index. To take into account that the WOMAC subscales are correlated and skewed, we proposed and compared multivariate gamma and Gaussian approaches with latent variable capturing correlation between outcomes. Besides the latent term, the interaction between the latent term and treatment, accounting for HTE, was further estimated. Modelling the subscales by using a gamma approach accounting for skewness of data, we found out different results compared with Gaussian models. The main difference regarded the latent variable interacting with treatment (accounting for unobserved heterogeneity), which is not significant for the Gaussian approach (P value=.102) and significant in the gamma model (P value<.002). Thus, indicating that unobserved covariates affect treatment's performance. Additionally, plotting the observed and the estimated values of WOMAC index of the Gaussian and gamma models, we showed that, compared with the Gaussian, the gamma one best fits the data, especially among poor responders. Multivariate gamma approach accounting for correlation between outcomes and for HTE has been demonstrated to be more suitable to model WOMAC subscales and to provide more information on effect of therapy.

Knee osteoarthritis, degenerative meniscal lesion and osteonecrosis of the knee: Can a simple gait test direct us to a better clinical diagnosis

IntroductionThe purpose of the current study was to compare the gait patterns in patients with three differing knee pathologies – knee osteoarthritis (OA), degenerative meniscal lesion (DML) and spontaneous osteonecrosis of the knee (SONK) and a group of healthy controls. HypothesisA simple gait test will detect differences between different knee pathologies. Material and methodsForty-seven patients with bilateral knee OA, 47 patients with DML, 28 patients with SONK and 27 healthy controls were included in this analysis. Patients underwent a spatiotemporal gait assessment and were asked to complete the Western Ontario and McMaster University (WOMAC) Index and the Short-Form (SF)-36 Health Survey. ANOVA tests, followed by Bonferroni multiple comparison tests and the Chi2 tests were performed for continuous and categorical variables, respectively. ResultsSignificant differences were found for all gait measures and clinical questionnaires between healthy controls and all knee conditions. Patients with SONK differed from patients with bilateral knee OA and DML in all gait measures and clinical questionnaires, except for WOMAC subscales. There were no significant differences between patients with bilateral knee OA and patients with DML. Symmetry was also examined and revealed asymmetry in some gait parameters in patients with SONK and DML. DiscussionBased on the differences in gait parameters that were found in the current study, adding an objective functional spatiotemporal gait test may assist in the diagnostic process of knee pathologies. Type of studyCase Control study Level III.

Adaptation of the osteoarthritis-specific quality of life scale (the OAQoL) for use in Germany, Hungary, Italy, Spain and Turkey

The Osteoarthritis Quality of Life scale (OAQoL) is specific to individuals with osteoarthritis. The present study describes the adaptation of the OAQoL for use in the following five European languages: German, Hungarian, Italian, Spanish and Turkish. The study involved three stages in each language; translation, cognitive debriefing (face and content validity) and validation. The validation stage assessed internal consistency (Cronbach's alpha), reproducibility (test-retest reliability using Spearman's rank correlations), convergent and divergent validity (correlations with the Health Assessment Questionnaire, The Western Ontario and McMaster Universities Index of osteoarthritis and Nottingham Health Profile) and known group validity. The OAQoL was successfully translated into the target languages with minimal problems. Cognitive debriefing interviewees found the measures easy to complete and identified few problems with content. Internal consistency ranged from 0.94 to 0.97 and test-retest reliability (reproducibility) from 0.87 to 0.98. These values indicate that the new language versions produce very low levels of measurement error. Median OAQoL scores were higher for patients reporting a current flare of osteoarthritis in all countries. Scores were also related, as expected, to perceived severity of osteoarthritis. The OAQoL was successfully adapted for use in Germany, Hungary, Italy, Spain and Turkey. The addition of these new language versions will prove valuable to multinational clinical trials and to clinical practice in the respective countries.

Association of mechanical factors with medial knee osteoarthritis: Across-sectional study from Matsudai Knee Osteoarthritis Survey.

Knee osteoarthritis (OA) is a multifactorial disease that is affected by mechanical factors. The aim of present study was to investigate the association between multiple mechanical factors and medial knee OA in a large epidemiological cohort. Six hundred and ninety-nine subjects (323 males and 376 females), participating in the Matsudai Knee Osteoarthritis Survey 2010, were included. Twelve mechanical factors were selected and their association with the radiographic grade of knee OA, the Western Ontario and McMaster University Index (WOMAC) pain score, and the WOMAC function score was evaluated. A logistic regression analysis identified varus thrust to be associated with the radiographic grade of knee OA in males (OR: 1.876, 95% CI: 1.332-2.663) and females (2.61, 1.922-3.542), the WOMAC pain score in males (1.997, 1.463-2.672), and the WOMAC function score in females (1.449, 1.12-1.874). Quadriceps muscle strength was associated with the radiographic OA grade in males (0.605, 0.399-0.917) and females (0.636, 0.469-0.863), the WOMAC pain score in females (0.537, 0.445-0.789), and the WOMAC function score in males (0.581, 0.44-0.766). The knee flexion angle was also associated with the radiographic OA grade in males (0.344, 0.19-0.621) and females (0.121, 0.022-0.653), and the WOMAC pain score in males (0.287, 0.156-0.53) and females (0.537, 0.336-0.859). Obesity was associated with the radiographic OA grade in males (1.543, 1.041-2.287) and females (1.589, 1.176-2.146), the WOMAC pain score in female (2.017, 1.517-2.68). Femolo-tibial angle had no significant association with the radiographic knee OA grade or with the WOMAC pain and function scores. Among patients with medial knee OA, dynamic mechanical factors, such as varus thrust, quadriceps muscle strength, and range of motion were more likely to be associated with the radiographic grade of knee OA and to be the WOMAC pain and function scores, compared to static mechanical factors.