Extended report
Static postural sway, proprioception, and maximal voluntary
quadriceps contraction in patients with knee osteoarthritis and normal
control subjects
B S Hassana, S Mockettb, M Dohertya
a Academic
Rheumatology, University of Nottingham, Clinical Sciences Building,
City Hospital, Nottingham, NG5 1PB, UK, b Division of Physiotherapy
Education, University of Nottingham
Correspondence to: Professor Doherty Michael.Doherty{at}Nottingham.ac.uk
Accepted for publication 15 November
2000
OBJECTIVES
To
investigate whether subjects with knee osteoarthritis (OA) have reduced
static postural control, knee proprioceptive acuity, and maximal
voluntary contraction (MVC) of the quadriceps compared with normal
controls, and to determine possible independent predictors of static
postural sway.
METHODS77 subjects
with symptomatic and radiographic knee OA (58 women, 19 men; mean age
63.4 years, range 36-82) and 63 controls with asymptomatic and
clinically normal knees (45 women, 18 men; mean age 63 years, range
46-85) underwent assessment of static postural sway. 108 subjects (59 patients, 49 controls) also underwent assessment of knee proprioceptive
activity and MVC (including calculation of quadriceps activation). In
patients with knee OA knee pain, stiffness, and functional disability
were assessed using the WOMAC Index. The height (m) and weight (kg) of
all subjects was assessed.
RESULTSCompared with
controls, patients with knee OA were heavier (mean difference 15.3 kg,
p<0.001), had increased postural lateral sway (controls: median 2.3, interquartile (IQ) range 1.8-2.9; patients: median 4.7, IQ range
1.9-4.7, p<0.001), reduced proprioceptive acuity (controls: mean 7.9, 95% CI 6.9 to 8.9; patients: mean 12.0, 95% CI 10.5 to 13.6, p<0.001), weaker quadriceps strength (controls: mean 22.5, 95% CI
19.9 to 24.6; patients: mean 14.7, 95% CI 12.5 to 16.9, p<0.001), and
less percentage activation of quadriceps (controls: mean 87.4, 95% CI
80.7 to 94.2; patients: mean 66.0, 95% CI 58.8 to 73.2, p<0.001). The
significant predictors of postural sway were knee pain and the ratio of
MVC/body weight.
CONCLUSIONSCompared
with age and sex matched controls, subjects with symptomatic knee OA
have quadriceps weakness, reduced knee proprioception, and increased
postural sway. Pain and muscle strength may particularly influence
postural sway. The interaction between physiological, structural, and
functional abnormalities in knee OA deserves further study.
© 2001 by Annals of the Rheumatic Diseases
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