Skip to main content

Determinants of physical functioning in women with knee osteoarthritis

Abstract

Background

Knee osteoarthritis (OA) is an important health problem with its high prevalence and association with pain and functional disability in physical tasks and activities especially in women.

Aims

To explore the impacts of widely seen demographic, pathological, psychological, and impairment factors on physical functioning in women with knee OA using the performance-based and self-reported measures.

Methods

One hundred and ten women with knee OA participated in this study. Performance-based measures included the 10-m walk test, timed up and go (TUG) test, and a stair test. Self-reported physical functioning was measured using the Western Ontario and McMasters Universities OA Index. Knee muscle strength, pain intensity, flexion range of motion (ROM), body mass index (BMI), radiographic severity, and anxious and depressive symptoms were measured. Age, disease duration, and comorbidities were recorded. Correlation and linear regression analyses were used to assess the associations.

Results

In the linear regression models, knee muscle weakness, limited knee flexion ROM, pain intensity, and older age contributed to 65% of variance in physical performance measures mostly explained by knee muscle weakness. Knee pain intensity, BMI, anxiety, and knee muscle weakness contributed to 60% of variance in WOMAC physical function score mostly explained by pain. Radiologic severity, depression, comorbidities, and disease duration did not have a significant association (P < 0.05). Performance-based measures had significant but moderate correlations with WOMAC physical function score (r range 0.51–0.57, P < 0.05).

Conclusion

In women with knee OA, knee muscle strength was the main determinant of performance-based physical functioning together with knee flexion ROM, knee pain, and age. Knee pain was the main determinant of self-reported physical functioning. BMI, anxiety, and knee muscle strength had some contributions as well. Performance-based and self-reported measures had moderate relations and evaluate different aspects of physical functioning. In the management of women with knee OA strengthening of weak knee muscles, improving limited flexion ROM, pain management, weight loss, and improving anxiety should be considered as a priority and performance-based and self-reported measures should be used together for a comprehensive evaluation of physical functioning.

This is a preview of subscription content, access via your institution.

References

  1. Arden N, Nevitt MC (2006) Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 20:3–25

    Article  PubMed  Google Scholar 

  2. Guccione AA, Felson DT, Anderson JJ et al (1994) The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 84:351–358

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38:1–14

    CAS  Article  PubMed  Google Scholar 

  4. Logerstedt DS, Zeni J Jr, Synder-Mackler L (2014) Sex differences in patients with different stages of knee osteoarthritis. Arch Phys Med Rehabil 95:2376–2381

    Article  PubMed  PubMed Central  Google Scholar 

  5. Osaki M, Tomita M, Abe Y et al (2012) Physical performance and knee osteoarthritis among community-dwelling women in Japan: the Hizen-Oshima study, cross-sectional study. Rheumatol Int 32:2245–2249

    Article  PubMed  Google Scholar 

  6. Oliveria SA, Felson DT, Reed JI et al (1995) Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthr Rheum 38:1134–1141

    CAS  Article  Google Scholar 

  7. Marks R (2007) Obesity profiles with knee osteoarthritis: correlation with pain, disability, disease progression. Obesity (Silver Spring) 15:1867–1874

    Article  Google Scholar 

  8. Reeuwijk KG, de Rooij M, van Dijk GM et al (2010) Osteoarthritis of the hip or knee: which coexisting disorders are disabling? Clin Rheumatol 29:739–747

    Article  PubMed  PubMed Central  Google Scholar 

  9. Øiestad BE, Juhl CB, Eitzen I et al (2015) Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis: a systematic review and meta-analysis. Osteoarthr Cartil 23:171–177

    Article  PubMed  Google Scholar 

  10. Dekker J, van Dijk GM, Veenhof C (2009) Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol 21:520–524

    Article  PubMed  Google Scholar 

  11. Badley EM (1995) The effect of osteoarthritis on disability and health care use in Canada. J Rheumatol Suppl 43:19–22

    CAS  PubMed  Google Scholar 

  12. Maly MR, Costigan PA, Olney SJ (2006) Determinants of self-report outcome measures in people with knee osteoarthritis. Arch Phys Med Rehabil 87:96–104

    Article  PubMed  Google Scholar 

  13. van Dijk GM, Veenhof C, Lankhorst GJ et al (2009) Limitations in activities in patients with osteoarthritis of the hip or knee: the relationship with body functions, comorbidity and cognitive functioning. Disabil Rehabil 31:1685–1691

    Article  PubMed  Google Scholar 

  14. Sharma L, Cahue S, Song J et al (2003) Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors. Arthr Rheum 48:3359–3370

    Article  Google Scholar 

  15. van Dijk GM, Veenhof C, Spreeuwenberg P et al (2010) Prognosis of limitations in activities in osteoarthritis of the hip or knee: a 3-year cohort study. Arch Phys Med Rehabil 91:58–66

    Article  PubMed  Google Scholar 

  16. Keefe FJ, Lefebvre JC, Egert JR et al (2000) The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: the role of catastrophizing. Pain 87:325–334

    CAS  Article  PubMed  Google Scholar 

  17. McKean KA, Landry SC, Hubley-Kozey CL et al (2007) Gender differences exist in osteoarthritic gait. Clin Biomech (Bristol Avon) 22:400–409

    Article  Google Scholar 

  18. Theis KA, Helmick CG, Hootman JM (2007) Arthritis burden and impact are greater among US women than men: intervention opportunities. J Womens Health (Larchmt) 16:441–453

    Article  Google Scholar 

  19. Altman R, Asch E, Bloch D et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Arthr Rheum 29:1039–1049

    CAS  Article  Google Scholar 

  20. Graham JE, Ostir GV, Fisher SR et al (2008) Assessing walking speed in clinical research: a systematic review. J Eval Clin Pract 14:552–562

    Article  PubMed  PubMed Central  Google Scholar 

  21. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    CAS  Article  PubMed  Google Scholar 

  22. Rejeski WJ, Ettinger WH, Schumaker S et al (1995) Assessing performance-related disability in patients with knee osteoarthritis. Osteoarthr Cartil 3:157–167

    CAS  Article  PubMed  Google Scholar 

  23. Bellamy N, Buchanan WW, Goldsmith CH et al (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to anti-rheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  24. Tuzun EH, Eker L, Aytar A et al (2005) Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthr Cartil 13:28–33

    CAS  Article  PubMed  Google Scholar 

  25. Groll DL, To T, Bombardier C et al (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602

    Article  PubMed  Google Scholar 

  26. Sachez-Ramirez DC, van der Leeden M, van der Esch M et al (2013) Association of postural control with muscle strength, proprioception, self-reported knee instability and activity limitations in patients with knee osteoarthritis. J Rehabil Med 45:192–197

    Article  Google Scholar 

  27. Norkin CC, White DJ (1986) Measurements of joint motion: a guide to goniometry. F.A. Davis, Philadelphia

    Google Scholar 

  28. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. Axford J, Butt A, Heron C et al (2010) Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol 29:1277–1283

    Article  PubMed  Google Scholar 

  30. Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C et al (2010) Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil 89:541–548

    Article  PubMed  PubMed Central  Google Scholar 

  31. Amin S, Baker K, Niu J et al (2009) Quadriceps strength and the risk of cartilage loss and symptom progression in the knee osteoarthritis. Arthr Rheum 60:189–198

    Article  Google Scholar 

  32. van der Esch M, Holla JF, van der Leeden M et al (2014) Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil 95:1962–1968

    Article  PubMed  Google Scholar 

  33. Felson DT, Zhang Y (1998) An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthr Rheum 41:1343–1355

    CAS  Article  Google Scholar 

  34. Terwee CB, van der Slikke RM, van Lummel RC et al (2006) Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee osteoarthritis. J Clin Epidemiol 59:724–731

    Article  PubMed  Google Scholar 

  35. Kauppila AM, Kyllonen E, Mikkonen P et al (2009) Disability in end-stage knee osteoarthritis. Disabil Rehabil 31:370–380

    Article  PubMed  Google Scholar 

  36. Dekker J, Tola P, Aufdemkampe G, Winckers M (1993) Negative affect, pain and disability in osteoarthritis patients: the mediating role of muscle weakness. Behav Res Ther 31:203–206

    CAS  Article  PubMed  Google Scholar 

  37. Szoeke CE, Cicuttini FM, Guthrie JR et al (2006) Factors affecting the prevalence of osteoarthritis in healthy middle-aged women: data from the longitudinal Melbourne Women’s Midlife Health Project. Bone 39:1149–1155

    CAS  Article  PubMed  Google Scholar 

  38. Creamer P, Lethbridge-Cejku M, Hochberg MC (2000) Factors associated with functional impairment in symptomatic knee osteoarthritis. Rheumatology (Oxford) 39:490–496

    CAS  Article  Google Scholar 

  39. Salaffi F, Cavalieri F, Nolli M et al (1991) Analysis of disability in knee osteoarthritis. Relationship with age and psychological variables but not with radiographic score. J Rheumatol 18:1581–1586

    CAS  PubMed  Google Scholar 

  40. Chen L, Nelson DR, Zhao Y et al (2013) Relationship between muscle mass and muscle strength, and the impact of comorbidities: a population-based, cross-sectional study of older adults in the United States. BMC Geriatr 13:74

    Article  PubMed  PubMed Central  Google Scholar 

  41. Moon SS (2014) Low skeletal muscle mass is associated with insulin resistance, diabetes, and metabolic syndrome in the Korean population: the Korea National Health and Nutrition Examination Survey (KNHANES) 2009–2010. Endocr J 61:61–70

    CAS  Article  PubMed  Google Scholar 

  42. Holla JF, Steultjens MP, Roorda LD et al (2010) Prognostic factors for the two-year course of activity limitations in early osteoarthritis of the hip and/or knee. Arthr Care Res (Hoboken) 62:1415–1425

    Article  Google Scholar 

  43. Leeuw M, Goossens ME, Linton SJ et al (2006) The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30:77–94

    Article  PubMed  Google Scholar 

  44. Scopaz KA, Piva SR, Wisniewski S et al (2009) Relationships of fear, anxiety, and depression with physical function in patients with knee osteoarthritis. Arch Phys Med Rehabil 90:1866–1873

    Article  PubMed  PubMed Central  Google Scholar 

  45. Peat G, Croft P, Hay E (2001) Clinical assessment of the osteoarthritis patient. Best Pract Res Clin Rheumatol 15:527–544

    CAS  Article  PubMed  Google Scholar 

  46. Claessens AA, Schouten JS, van den Ouweland FA et al (1990) Do clinical findings associate with radiographic osteoarthritis of the knee? Ann Rheum Dis 49:771–774

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  47. Odding E, Valkenburg HA, Algra D et al (1998) Associations of radiological osteoarthritis of the hip and knee with locomotor disability in the Rotterdam Study. Ann Rheum Dis 57:203–208

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR (2006) Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthr Rheum 54:230–235

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hakan Nur.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest

Funding

The authors received no financial support for the research and/or authorship of this article.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nur, H., Sertkaya, B.S. & Tuncer, T. Determinants of physical functioning in women with knee osteoarthritis. Aging Clin Exp Res 30, 299–306 (2018). https://doi.org/10.1007/s40520-017-0784-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-017-0784-x

Keywords

  • Knee osteoarthritis
  • Women
  • Muscle strength
  • Range of motion
  • Pain
  • Anxiety