Determinants of disability in osteoarthritis of the knee.

T E McAlindon, C Cooper, J R Kirwan, P A Dieppe

Rheumatology Unit, Bristol Royal Infirmary, United Kingdom.

OBJECTIVES: To evaluate the influences of radiographic severity, quadriceps strength, knee pain, age, and gender on functional ability in patients with osteoarthritis of the knee. METHODS: Equal numbers of knee pain positive and negative respondents to a survey of registrants aged more than 55 years at a general practice were invited to attend for knee radiographs and quadriceps femoris isometric strength estimations. Disability was measured using the Stanford Health Assessment Questionnaire. RESULTS: Complete data were available on 70 men (mean age 72.7 years) and 89 women (mean age 68.1 years); 44% reported knee pain, 48% had radiographic features of osteoarthritis, and 32% reported some degree of disability. Significant correlations were observed between disability and radiographic score, quadriceps strength, and knee pain. Logistic regression analysis, however, showed significant independent contributions from quadriceps strength (odds ratio 0.84 kgF), knee pain (odds ratio 1.67), and age (odds ratio 1.06 per year) only; the radiographic score had no influence on the model. These results were not influenced by confining the analysis to the group with radiographic features of osteoarthritis. CONCLUSIONS: Quadriceps strength, knee pain, and age are more important determinants of functional impairment in elderly subjects than the severity of knee osteoarthritis as assessed radiographically. Strategies designed to optimise muscle strength may have the potential to reduce a vast burden of disability, dependency, and cost.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Henriksen, M, Alkjaer, T, Simonsen, E B, Bliddal, H (2009). Experimental muscle pain during a forward lunge -- the effects on knee joint dynamics and electromyographic activity. Br. J. Sports. Med. 43: 503-507 [Abstract] [Full Text]  
• Guler, H., Karazincir, S., Turhanoglu, A. D., Sahin, G., Balci, A., Ozer, C. (2009). Effect of Coexisting Foot Deformity on Disability in Women with Knee Osteoarthritis. J. Am. Podiatr. Med. Assoc. 99: 23-27 [Abstract] [Full Text]  
• Schmitt, L. C, Fitzgerald, G K., Reisman, A. S, Rudolph, K. S (2008). Instability, Laxity, and Physical Function in Patients With Medial Knee Osteoarthritis. ptjournal 88: 1506-1516 [Abstract] [Full Text]  
• Duncan, R., Peat, G., Thomas, E., Wood, L., Hay, E., Croft, P. (2008). How do pain and function vary with compartmental distribution and severity of radiographic knee osteoarthritis?. Rheumatology (Oxford) 47: 1704-1707 [Abstract] [Full Text]  
• Thomas, E, Peat, G, Mallen, C, Wood, L, Lacey, R, Duncan, R, Croft, P (2008). Predicting the course of functional limitation among older adults with knee pain: do local signs, symptoms and radiographs add anything to general indicators?. Ann Rheum Dis 67: 1390-1398 [Abstract] [Full Text]  
• Jan, M.-H., Lin, J.-J., Liau, J.-J., Lin, Y.-F., Lin, D.-H. (2008). Investigation of Clinical Effects of High- and Low-Resistance Training for Patients With Knee Osteoarthritis: A Randomized Controlled Trial. ptjournal 88: 427-436 [Abstract] [Full Text]  
• Wood, L., Peat, G., Thomas, E., Hay, E. M, Sim, J. (2008). Associations Between Physical Examination and Self-Reported Physical Function in Older Community-Dwelling Adults With Knee Pain. ptjournal 88: 33-42 [Abstract] [Full Text]  
• Mallen, C. D, Peat, G., Thomas, E., Lacey, R., Croft, P. (2007). Predicting poor functional outcome in community-dwelling older adults with knee pain: prognostic value of generic indicators. Ann Rheum Dis 66: 1456-1461 [Abstract] [Full Text]  
• Lohmander, L. S., Englund, P. M., Dahl, L. L., Roos, E. M. (2007). The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries: Osteoarthritis. Am J Sports Med 35: 1756-1769 [Abstract] [Full Text]  
• Henriksen, M., Alkjaer, T., Lund, H., Simonsen, E. B., Graven-Nielsen, T., Danneskiold-Samsoe, B., Bliddal, H. (2007). Experimental quadriceps muscle pain impairs knee joint control during walking. J. Appl. Physiol. 103: 132-139 [Abstract] [Full Text]  
• Hinman, R. S, Heywood, S. E, Day, A. R (2007). Aquatic Physical Therapy for Hip and Knee Osteoarthritis: Results of a Single-Blind Randomized Controlled Trial. ptjournal 87: 32-43 [Abstract] [Full Text]  
• Duncan, R, Peat, G, Thomas, E, Hay, E, McCall, I, Croft, P (2007). Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be?. Ann Rheum Dis 66: 86-91 [Abstract] [Full Text]  
• Hendry, M., Williams, N. H, Markland, D., Wilkinson, C., Maddison, P. (2006). Why should we exercise when our knees hurt? A qualitative study of primary care patients with osteoarthritis of the knee. Fam Pract 23: 558-567 [Abstract] [Full Text]  
• Hall, M C, Mockett, S P, Doherty, M (2006). Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function. Ann Rheum Dis 65: 865-870 [Abstract] [Full Text]  
• Sharif, M., Granell, R., Johansen, J., Clarke, S., Elson, C., Kirwan, J. R. (2006). Serum cartilage oligomeric matrix protein and other biomarker profiles in tibiofemoral and patellofemoral osteoarthritis of the knee. Rheumatology (Oxford) 45: 522-526 [Abstract] [Full Text]  
• Mizner, R. L., Petterson, S. C., Stevens, J. E., Vandenborne, K., Snyder-Mackler, L. (2005). Early Quadriceps Strength Loss After Total Knee Arthroplasty. The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation. JBJS 87: 1047-1053 [Abstract] [Full Text]  
• Barker, K., Lamb, S. E, Toye, F., Jackson, S., Barrington, S. (2004). Association between radiographic joint space narrowing, function, pain and muscle power in severe osteoarthritis of the knee. Clin Rehabil 18: 793-800 [Abstract]  
• Cheing, G. L., Hui-Chan, C. W. (2004). Would the addition of TENS to exercise training produce better physical performance outcomes in people with knee osteoarthritis than either intervention alone?. Clin Rehabil 18: 487-497 [Abstract]  
• Chen, J.-C., Dennerlein, J. T., Shih, T.-S., Chen, C.-J., Cheng, Y., Chang, W. P., Ryan, L. M., Christiani, D. C. (2004). Knee Pain and Driving Duration: A Secondary Analysis of the Taxi Drivers' Health Study. AJPH 94: 575-581 [Abstract] [Full Text]  
• Hinman, R. S., Crossley, K. M., McConnell, J., Bennell, K. L. (2004). Does the application of tape influence quadriceps sensorimotor function in knee osteoarthritis?. Rheumatology (Oxford) 43: 331-336 [Abstract] [Full Text]  
• Foley, A, Halbert, J, Hewitt, T, Crotty, M (2003). Does hydrotherapy improve strength and physical function in patients with osteoarthritis--a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis 62: 1162-1167 [Abstract] [Full Text]  
• Haq, I, Murphy, E, Dacre, J (2003). Osteoarthritis. Postgrad. Med. J. 79: 377-383 [Abstract] [Full Text]  
• Hinman, R. S., Bennell, K. L., Crossley, K. M., McConnell, J. (2003). Immediate effects of adhesive tape on pain and disability in individuals with knee osteoarthritis. Rheumatology (Oxford) 42: 865-869 [Abstract] [Full Text]  
• Mannoni, A, Briganti, M P, Di Bari, M, Ferrucci, L, Costanzo, S, Serni, U, Masotti, G, Marchionni, N (2003). Epidemiological profile of symptomatic osteoarthritis in older adults: a population based study in Dicomano, Italy. Ann Rheum Dis 62: 576-578 [Abstract] [Full Text]  
• Sharma, L., Dunlop, D. D., Cahue, S., Song, J., Hayes, K. W. (2003). Quadriceps Strength and Osteoarthritis Progression in Malaligned and Lax Knees. ANN INTERN MED 138: 613-619 [Abstract] [Full Text]  
• Kuh, D., Bassey, J., Hardy, R., Aihie Sayer, A., Wadsworth, M., Cooper, C. (2002). Birth Weight, Childhood Size, and Muscle Strength in Adult Life: Evidence from a Birth Cohort Study. Am J Epidemiol 156: 627-633 [Abstract] [Full Text]  
• Chard, J., Dickson, J., Tallon, D., Dieppe, P. (2002). A comparison of the views of rheumatologists, general practitioners and patients on the treatment of osteoarthritis. Rheumatology (Oxford) 41: 1208-1210 [Full Text]  
• Hassan, B S, Doherty, S A, Mockett, S, Doherty, M (2002). Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis. Ann Rheum Dis 61: 422-428 [Abstract] [Full Text]  
• Bearne, L. M., Scott, D. L., Hurley, M. V. (2002). Exercise can reverse quadriceps sensorimotor dysfunction that is associated with rheumatoid arthritis without exacerbating disease activity. Rheumatology (Oxford) 41: 157-166 [Abstract] [Full Text]  
• Hassan, B S, Mockett, S, Doherty, M (2001). Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis 60: 612-618 [Abstract] [Full Text]  
• M, M. P, Dekker, J., van Baar, M. E, B, R. A, J, J. W (2001). Muscle strength, pain and disability in patients with osteoarthritis. Clin Rehabil 15: 331-341 [Abstract]  
• Kettunen, J. A., Kujala, U. M., Kaprio, J., Koskenvuo, M., Sarna, S. (2001). Lower-Limb Function Among Former Elite Male Athletes. Am J Sports Med 29: 2-8 [Abstract] [Full Text]  
• Felson, D. T., Lawrence, R. C., Dieppe, P. A., Hirsch, R., Helmick, C. G., Jordan, J. M., Kington, R. S., Lane, N. E., Nevitt, M. C., Zhang, Y., Sowers, M., McAlindon, T., Spector, T. D., Poole, A. R., Yanovski, S. Z., Ateshian, G., Sharma, L., Buckwalter, J. A., Brandt, K. D., Fries, J. F. (2000). Osteoarthritis: New Insights. Part 1: The Disease and Its Risk Factors. ANN INTERN MED 133: 635-646 [Abstract] [Full Text]  
• Turner, A. P, Barlow, J. H, Heathcote-Elliott, C. (2000). Long term health impact of playing professional football in the United Kingdom. Br. J. Sports. Med. 34: 332-336 [Abstract] [Full Text]  
• Steultjens, M. P. M., Dekker, J., van Baar, M. E., Oostendorp, R. A. B., Bijlsma, J. W. J. (2000). Range of joint motion and disability in patients with osteoarthritis of the knee or hip. Rheumatology (Oxford) 39: 955-961 [Abstract] [Full Text]  
• Lamb, S E, Guralnik, J M, Buchner, D M, Ferrucci, L M, Hochberg, M C, Simonsick, E M, Fried, L P (2000). Factors that modify the association between knee pain and mobility limitation in older women: the Women's Health and Aging Study. Ann Rheum Dis 59: 331-337 [Abstract] [Full Text]  
• Creamer, P., Lethbridge-Cejku, M., Hochberg, M. C. (2000). Factors associated with functional impairment in symptomatic knee osteoarthritis. Rheumatology (Oxford) 39: 490-496 [Abstract] [Full Text]  
• O'Reilly, S. C, Jones, A., Muir, K. R, Doherty, M. (1998). Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 57: 588-594 [Abstract] [Full Text]  
• Odding, E., Valkenburg, H. A, Algra, D., Vandenouweland, F. A, Grobbee, D. E, Hofman, A. (1998). Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study. Ann Rheum Dis 57: 203-208 [Abstract] [Full Text]  
• Hurley, M. V, Scott, D. L, Rees, J., Newham, D. J (1997). Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56: 641-648 [Abstract] [Full Text]