Knee Extensor Power Relates to Mobility Performance in People With Knee Osteoarthritis: Cross-Sectional Analysis

BackgroundQuadriceps femoris muscle strengthening is a common rehabilitation exercise for knee osteoarthritis (OA). More information is needed to determine whether targeting muscle power is a useful adjunct to strengthening for people with knee OA.ObjectiveThe purpose of this study was to identify the predictive ability of knee extensor strength and knee extensor power in the performance of physical tasks in adults with knee OA.DesignThis study used a cross-sectional design.MethodsFifty-five participants with clinical knee OA were included (43 women; mean [SD] age=60.9 [6.9] years). Dependent variables were: timed stair ascent, timed stair descent, and the Six-Minute Walk Test (6MWT). Independent variables were: peak knee extensor strength and mean peak knee extensor power. Covariates were: age, body mass index, and self-efficacy. Multiple regression analyses were run for each dependent variable with just covariates, then a second model including strength, and then a third model including power. The R2 values were compared between models.ResultsPower explained greater variance than strength in all models. Over and above the covariates, power explained an additional 6% of the variance in the 6MWT, increasing the R2 value from .33 to .39; 8% in the stair ascent test, increasing the R2 value from .52 to .60; and 3% in the stair descent test, increasing the R2 value from .44 to .47.LimitationsThe sample demonstrated very good mobility and muscle function scores and may not be indicative of those with severe knee OA.ConclusionsIn adults with knee OA, knee extensor power was a stronger determinant of walking and stair performance when compared with knee extensor strength. Clinicians should consider these results when advising patients on exercise to maintain or improve mobility.

Download Full-text

Should We Use Unilateral or Bilateral Tasks to Assess Maximal and Explosive Knee Extensor Strength in Patients with Knee Osteoarthritis? A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm10194353 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4353

Author(s):

Jonas Pfeifle ◽

David Hasler ◽

Nicola Maffiuletti

Keyword(s):

Knee Osteoarthritis ◽

Clinical Relevance ◽

Knee Extensor ◽

Cross Sectional Study ◽

Cross Sectional ◽

Strength Performance ◽

Explosive Strength ◽

Knee Extensor Strength ◽

And Performance ◽

Voluntary Contractions

Deficits in maximal and explosive knee extensor strength, which are usually assessed with unilateral tasks, are substantial in patients with knee osteoarthritis (KOA). The aim of this study was to investigate the clinical relevance of unilateral vs. bilateral tasks for assessing knee extensor strength in patients with KOA. This was achieved primarily by comparing unilateral and bilateral inter-limb strength asymmetries and secondarily by examining the relationship between unilaterally and bilaterally measured strength, and performance-based and self-reported function. Twenty-four patients with unilateral KOA (mean age: 65 ± 7 years) performed isometric gradual and explosive maximal voluntary contractions to assess, respectively their maximal and explosive strength. Performance-based and self-reported function were also evaluated with standard functional tests and questionnaires, respectively. Inter-limb asymmetries of maximal and explosive strength did not differ significantly between unilateral (mean asymmetry: 26 ± 15%) and bilateral tasks (22 ± 21%). In the same way, the relationships between knee extensor strength—measured either unilaterally or bilaterally—and performance-based or self-reported function were not influenced by the type of task. In conclusion, it does not seem to make a difference in terms of clinical relevance whether maximal and explosive knee extensor strength are evaluated with unilateral or bilateral tasks in KOA patients.

Download Full-text

Knee Extensor and Flexor Muscle Power Explains Stair Ascension Time in Patients With Unilateral Late-Stage Knee Osteoarthritis: A Cross-Sectional Study

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2014.09.011 ◽

2015 ◽

Vol 96 (2) ◽

pp. 253-259 ◽

Cited By ~ 12

Author(s):

Anu M. Valtonen ◽

Tapani Pöyhönen ◽

Mikko Manninen ◽

Ari Heinonen ◽

Sarianna Sipilä

Keyword(s):

Knee Osteoarthritis ◽

Late Stage ◽

Muscle Power ◽

Knee Extensor ◽

Cross Sectional Study ◽

Sectional Study ◽

Flexor Muscle ◽

Cross Sectional

Download Full-text

THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

Berkala Ilmiah Kedokteran Duta Wacana ◽

10.21460/bikdw.v5i1.164 ◽

2020 ◽

Vol 5 (1) ◽

pp. 29

Author(s):

Nelson Sudiyono

Keyword(s):

Knee Osteoarthritis ◽

Cross Sectional Study ◽

Functional Mobility ◽

Cross Sectional ◽

Knee Oa ◽

Walking Aids ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee ◽

Contralateral Hand ◽

Painful Knee

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. Results: The TUG time of aid-free walking is 4.75 (p < 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p < 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral. Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

Download Full-text

Association of Varus Thrust With Pain and Stiffness and Activities of Daily Living in Patients With Medial Knee Osteoarthritis

Physical Therapy ◽

10.2522/ptj.20140441 ◽

2016 ◽

Vol 96 (2) ◽

pp. 167-175 ◽

Cited By ~ 17

Author(s):

Naoto Fukutani ◽

Hirotaka Iijima ◽

Takahiko Fukumoto ◽

Daisuke Uritani ◽

Eishi Kaneda ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Activities Of Daily Living ◽

Daily Living ◽

Predictor Variable ◽

Cross Sectional Study ◽

Sensitivity Analyses ◽

Varus Alignment ◽

Cross Sectional ◽

Medial Knee ◽

Knee Oa

Background Increasing evidence highlights potential associations between varus thrust and health domains associated with knee osteoarthritis (OA). Objective The aim of this study was to investigate the association between varus thrust and 2 subcategories—“pain and stiffness” and “activities of daily living (ADL)”—of the Japanese Knee Osteoarthritis Measure (JKOM). Design This was a cross-sectional study. Methods In total, 296 outpatients with knee OA visiting orthopedic clinics were enrolled. The inclusion criteria were age ≥50 years, medial knee OA and Kellgren-Lawrence (K/L) grade ≥1 in one or both knees, and the ability to walk independently. Standard posterior-anterior knee radiographs were measured for varus alignment. Participants were video recorded while walking and were evaluated for the presence or absence of varus thrust. Pain and stiffness of the knee joint and ADL were evaluated using the JKOM. Multivariate regressions (outcomes: pain and stiffness and ADL; predictor variable: varus thrust) were performed. Results Varus thrust was present in 46 (16.2%) of 284 patients. Multivariate regression analyses demonstrated that varus thrust is independently associated with pain and stiffness, adjusted for age, sex, body mass index, K/L grade, and varus alignment (β=.17, P=.005). However, the association between varus thrust and ADL was not significant (β=.11, P=.058). Based on sensitivity analyses, including participants of K/L grade 1 had little influence on this analysis. Limitations Only 16.2% of participants had a varus thrust. Moreover, a cause-effect relationship between varus thrust and pain and stiffness remains unknown due to the cross-sectional design of this study. Conclusions Varus thrust was associated with pain and stiffness in patients with medial knee OA. However, the association between varus thrust and ADL did not reach significance.

Download Full-text

Work Ability and Employment in Rheumatoid Arthritis: A Cross-Sectional Study on the Role of Muscle Strength and Lower Extremity Function

International Journal of Rheumatology ◽

10.1155/2018/3756207 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Carolin Berner ◽

Sandra Haider ◽

Igor Grabovac ◽

Thomas Lamprecht ◽

Karl Heinrich Fenzl ◽

...

Keyword(s):

Muscle Strength ◽

Lower Extremity ◽

Work Ability ◽

Employment Status ◽

Knee Extensor ◽

Lower Extremity Function ◽

Cross Sectional ◽

Hand Grip ◽

Extremity Function ◽

Knee Extensor Strength

Objective. The aim of the present study was to assess the association between muscle strength, lower extremity function, employment status, and work ability in RA patients. Methods. One hundred seropositive RA outpatients of working age were included in this cross-sectional study. Employment status was assessed by interview and work ability by the Work Ability Index-Single Item Scale (WAS). Muscle strength was determined using dynamometer measurement of isometric hand grip and knee extensor strength. Lower extremity function was measured using the short physical performance battery (SPPB). Regression models estimate the association between unemployment, work ability and muscle strength, and lower extremity function, controlling for sociodemographic and disease-related factors. Results. Forty-one percent of the RA patients were not gainfully employed, and their median work ability had a good WAS value (7.00 [4.00-7.00]). Patients with better knee extensor strength (OR=1.07, 95% CI [1.02-1.12) and better physical performance (OR=1.71, 95% CI [1.18-2.49]) had a significantly better chance of gainful employment. The odds for hand grip strength remained significant when adjusted for sociodemographic (OR=1.5, 95% CI [1.00-1.09]), but not for disease-specific variables. Better hand grip strength (β=0.25, p=0.039) and better knee extensor strength (β=0.45, p=0.001) as well as better lower extremity function (SPPB) (β=0.51, p<0.001) remained significantly associated with work ability following adjustment for sociodemographic and disease-specific variables. Conclusions. The association of employment status and work ability with parameters of physical fitness suggests that improvement in muscle strength and lower extremity function may positively influence work ability and employment in individuals with RA.

Download Full-text

Synovitis is associated with constant pain in knee osteoarthritis: a cross-sectional study of OMERACT knee ultrasound scores

The Journal of Rheumatology ◽

10.3899/jrheum.210285 ◽

2021 ◽

pp. jrheum.210285

Author(s):

Holly T. Philpott ◽

Trevor B. Birmingham ◽

Ryan Pinto ◽

Codie A. Primeau ◽

Dominique Arsenault ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Multinomial Logistic Regression ◽

Cross Sectional Study ◽

Cross Sectional ◽

Logistic Regression Models ◽

Knee Oa ◽

Pain Scores ◽

Constant Pain ◽

Secondary Analyses ◽

Pain Experiences

Objective To examine the association between ultrasound (US)-detected knee inflammation and intermittent and constant pain experiences in patients with knee osteoarthritis (OA). Methods Participants with radiographically early- (KL ≤ 2) and late-stage (KL ≥ 3) disease and frequent symptoms underwent musculoskeletal US measures of inflammation using the OMERACT knee US scoring system. Pain experiences were captured using the Intermittent and Constant OA Pain (ICOAP) tool. We assessed the association between US-synovitis and ICOAP pain experiences using a series of linear, logistic, or multinomial logistic regression models (as appropriate for each variable), while adjusting for age, sex, body mass index (BMI), and radiographic stage. Secondary analyses were performed similarly by radiographic stage. Results Pain and synovitis measures from 248 patients (453 knees) were included. Worse synovitis was associated with higher ICOAP constant pain scores (β 8.05 [95%CI 0.67, 15.43]), but not intermittent pain scores. Moderate-to-severe synovitis was associated with a 4.73-fold increased relative risk [95%CI 1.06, 8.80] of a constant pain pattern. In secondary analyses, moderate-to-severe synovitis in early radiographic OA was associated with 2.70-higher odds [95%CI 1.04, 7.02] of any constant pain, 3.28-higher odds [95%CI 1.43, 7.52] of any intermittent pain, and with higher intermittent (β 10.47 [95%CI 1.03, 19.91]) and constant (β 12.62 [95%CI 3.02, 22.23]) pain scores. No associations identified for synovitis in those with late radiographic OA. Conclusion In patients with knee OA, moderate-to-severe synovitis is most strongly associated with constant pain. Inflammation may play context-specific roles across pain experiences, especially in earlier radiographic stages of knee OA.

Download Full-text

Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study

Journal of Comorbidity ◽

10.1177/2235042x20974529 ◽

2020 ◽

Vol 10 ◽

pp. 2235042X2097452

Author(s):

Philippa JA Nicolson ◽

Esther Williamson ◽

Hopin Lee ◽

Alana Morris ◽

Angela Garrett ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Knee Osteoarthritis ◽

Synergistic Effects ◽

Self Care ◽

Postal Questionnaire ◽

Community Dwelling ◽

Mobility Limitations ◽

Cross Sectional ◽

Knee Oa

Objective: To estimate synergistic effects of hip/knee osteoarthritis (OA) and comorbidities on mobility or self-care limitations among older adults. Methods: We used baseline, cross-sectional data from the Oxford Pain, Activity and Lifestyle (OPAL) study. Participants were community-dwelling adults aged 65 years or older who completed a postal questionnaire. Participants reported demographic information, hip/knee OA, comorbidities and mobility and self-care limitations. We used modified Poisson regression models to estimate the independent and combined relative risks (RR) of mobility or self-care limitations, the relative excess risk due to interaction (RERI) between hip/knee OA and comorbidities, attributable proportion of the risk due to the interaction and the ratio of the combined effect and the sum of the individual effects, known as the synergy index. Results: Of the 4,972 participants included, 1,532 (30.8%) had hip/knee OA, and of them 42.9% reported mobility limitations and 8.4% reported self-care limitations. Synergistic effects impacting self-care limitations were observed between hip/knee OA and anxiety (RR: 3.09, 95% Confidence Interval (CI): 2.00 to 4.78; RERI: 0.93, 95% CI: 0.01 to 1.90), and between hip/knee OA and depressive symptoms (RR: 2.71, 95% CI: 1.75 to 4.20; RERI: 0.58, 95% CI: 0.03 to 1.48). The portion of the total RR attributable to this synergism was 30% and 22% respectively. Conclusions: This study demonstrates that synergism between hip/knee OA and anxiety or depressive symptoms contribute to self-care limitations. These findings highlight the importance of assessing and addressing anxiety or depressive symptoms when managing older adults with hip/knee OA to minimize self-care limitations.

Download Full-text

Associations of knee extensor strength and standing balance with physical function in knee osteoarthritis

Arthritis Care & Research ◽

10.1002/acr.20615 ◽

2011 ◽

Vol 63 (12) ◽

pp. 1706-1714 ◽

Cited By ~ 24

Author(s):

Yong-Hao Pua ◽

Zhiqi Liang ◽

Peck-Hoon Ong ◽

Adam L. Bryant ◽

Ngai-Nung Lo ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Physical Function ◽

Knee Extensor ◽

Standing Balance ◽

Knee Extensor Strength

Download Full-text

Clinically Important Improvement in Function Is Common in People with or at High Risk of Knee OA: The MOST Study

The Journal of Rheumatology ◽

10.3899/jrheum.090989 ◽

2010 ◽

Vol 37 (6) ◽

pp. 1244-1251 ◽

Cited By ~ 33

Author(s):

DANIEL K. WHITE ◽

JULIE J. KEYSOR ◽

MICHAEL P. LAVALLEY ◽

CORA E. LEWIS ◽

JAMES C. TORNER ◽

...

Keyword(s):

Risk Factors ◽

Depressive Symptoms ◽

High Risk ◽

Knee Pain ◽

Walking Speed ◽

Knee Extensor ◽

Baseline Risk ◽

Knee Oa ◽

Important Improvement ◽

Knee Extensor Strength

Objective.To calculate the frequency of clinically important improvement in function over 30 months and identify risk factors in people who have or are at risk of knee osteoarthritis (OA).Methods.Subjects were from the Multicenter Osteoarthritis (MOST), a longitudinal study of persons with or at high risk of knee OA. We defined minimal clinically important improvement (MCII) with the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) physical function using 3 different methods. Baseline risk factors tested for improvement included age, sex, educational attainment, presence of radiographic knee OA (ROA), the number of comorbidities, body mass index (BMI), knee pain, walking speed, isokinetic knee extensor strength, depressive symptoms, physical activity, and medication usage. We used logistic regression to evaluate the association of baseline risk factors with MCII.Results.Of the 1801 subjects (mean age 63 yrs, BMI = 31, 63% women), most had mild limitations in baseline function (WOMAC = 19 ± 11). Regardless of how defined, a substantial percentage of subjects (24%–39%) reached MCII at 30 months. Compared to their counterparts, people with MCII were less likely to have ROA and to use medications, and were more likely to have a lower BMI, less knee pain, a faster walking speed, more knee strength, and fewer depressive symptoms. After adjustment, MCII was 40% to 50% less likely in those with ROA, and 1.9 to 2.0 times more likely in those walking 1.0 meters/second faster than counterparts.Conclusion.Clinically important improvement is frequent in people with or at high risk of knee OA. The absence of ROA and a faster walking speed appear to be associated with clinically important improvements.

Download Full-text