Validity and reliability of diagnostic tests in the diagnosis of knee osteoarthritis—pooled results
| ICC/kappa (95%CI) | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Test | No of studies (designs) | No of subjects | Mean age (range) | F% | Reference standards | Sensitivity (95% CI) | Specificity (95% CI) | LR (95% CI) | Intra | Inter | Refs | |
| Age ≥50 | 1 (cs) | 2865 | – | 54 | Radiographic | 0.90 | 0.23 | 1.20 | – | – | 25 | |
| Female | 2 (1 cc, 1 cs) | 3102 | – | 55 | Clinical or radiographic | 0.76 (0.69 to 0.83) | 0.31 (0.22 to 0.40) | 1.10 (0.94 to 1.29) | – | – | 11 25 | |
| Knee pain | 7 (1 cc, 6 cs) | 5401 | 62 (40–92) | 62 | Clinical, radiographic or MRI | 0.58 (0.40 to 0.77) | 0.62 (0.45 to 0.79) | 1.57 (1.26 to 1.96) | 0.84 (0.69 to 1.00) | 0.72 (0.67 to 0.76) | 11 25–30 | |
| Persistent* | 3 (3 cs) | 1505 | (40–79) | 100 | Clinical, radiographic | 0.53 (0.47 to 0.58) | 0.71 (0.62 to 0.79) | 1.67 (1.44 to 1.94) | ||||
| Usage-related | 4 (1 cc, 3 cs) | 3896 | 72 (50–92) | 54 | Clinical, radiographic | 0.95 (0.91 to 0.99) | 0.19 (0.11 to 0.26) | 1.16 (1.15 to 1.29) | ||||
| Functional limitation | 5 (3 cc, 2 cs) | 1945 | 64 (50–90) | 54 | Clinical or radiographic | 0.56 (0.27 to 0.86) | 0.63 (0.40 to 0.87) | 1.50 (1.23 to 1.84) | – | – | 11 26 31–33 | |
| Morning stiffness | 3 (1 cc, 2 cs) | 3151 | 67 (50–92) | 79 | Clinical or radiographic | 0.88 (0.82 to 0.93) | 0.52 (0.43 to 0.62) | 1.84 (1.49 to 2.27) | 0.90 (0.74 to 1.00) | 0.62 (0.51 to 1.73) | 11 25 27 | |
| Crepitus | 4 (2 cc, 2 cs) | 942 | 65 (50–92) | 72 | Clinical or radiographic | 0.89 (0.85 to 0.93) | 0.60 (0.54 to 0.67) | 2.23 (1.90 to 2.63) | 0.78 (0.60 to 0.96) | 0.23 (0.01 to 0.45) | 11 27 32 34 | |
| Bony enlargement | 3 (1 cc, 2 cs) | 3108 | 59 (44–74) | 55 | Clinical or radiographic | 0.55 (0.46 to 0.64) | 0.95 (0.91 to 0.99) | 11.81 (4.94 to 28.22) | 0.91 | – | 11 25 34 | |
| Restricted movement | 6 (3 cc, 2 cs, 1 sr) | 3661 | 62 (50–90) | 54 | Clinical or radiographic | 0.17 | 0.96 | 4.4 | 0.73 to 0.79 | 0.48 to 1.00 | 25 32 34–37 | |
| Palpable effusion | 2 (1 cc, 1 cs) | 3752 | 55 (50–90) | 55 | Clinical or radiographic | 0.43 (0.34 to 0.52) | 0.41 (0.32 to 0.50) | 0.73 (0.56 to 0.95) | – | – | 11 25 | |
| Instability | 2 (1 cc, 1 cs) | 243 | 58 (44–82) | 72 | Clinical or radiographic | 0.26 (0.07 to 0.46) | 0.79 (0.69 to 0.89) | 1.25 (0.89 to 1.77) | – | – | 11 34 | |
| JSN | 8 (4 cc, 4 cs) | 2615 | 55 (25–80) | 78 | Clinical, MRI, or arthroscopic | 0.44 (0.27 to 0.62) | 0.79 (0.66 to 0.92) | 2.19 (1.58 to 3.03) | 0.66 (0.51 to 0.81) | 0.44 (0.33 to 0.54) | 11 38–44 | |
| OST | 8 (5 cc, 6 cs) | 3250 | 57 (25–80) | 74 | Clinical, MRI or arthroscopic | 0.51 (0.32 to 0.69) | 0.83 (0.76 to 0.89) | 3.29 (2.41 to 4.48) | 0.71 (0.61 to 0.82) | 0.62 (0.56 to 0.67) | 11 38–47 | |
| Sclerosis | 5 (3 cc, 2 cs) | 788 | 55 (25–77) | 60 | Clinical or arthroscopic | 0.33 (0.03 to 0.63) | 0.89 (0.0.76 to 1.02) | 2.56 (1.92 to 3.42) | 0.00 to 0.86 (range) | −0.04 to −0.67 (range) | 11 39–41 44 | |
| Cysts | 2 (cc) | 387 | 53 (35–77) | 63 | Clinical or arthroscopic | 0.24 (−0.04 to 0.51) | 0.93 (0.82 to 1.05) | 2.98 (1.76 to 5.03) | – | – | 11 | 40 |
| SF CPPD | 3 (1 cc, 2 cs) | 3894 | 67 (34–98) | 51 | Clinical or radiographic | 0.56 (0.48 to 0.64) | 0.70 (0.64 to 0.76) | 1.87 (1.46 to 2.40) | – | – | 49–51 | |
| RF (+) | 1 (cc) | 237 | 55 | 73 | Clinical | 0.05 (0.003 to 0.11) | 0.51 (0.40 to 0.63) | 0.11 (0.04 to 0.30) | – | – | 11 | |
↵* Most days for at least a month.
cc, case control; CPPD, calcium pyrophosphate dihydrate; cs, cross sectional; ICC, intraclass correlation coefficient; JSN, joint space narrowing; KL, Kellgren and Lawrence; LR, likelihood ratio; OST, osteophyte; RF, rheumatoid factor; SF, synovial fluid; sr, systematic review.