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Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort

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Abstract

The objective of this study was to evaluate whether self-reported knee instability is associated with activity limitations in patients with knee osteoarthritis (OA), in addition to knee pain and muscle strength. A cohort of 248 patients diagnosed with knee OA was examined. Self-reported knee instability was defined as the perception of any episode of buckling, shifting, or giving way of the knee in the past 3 months. Knee pain was assessed using a numeric rating scale, and knee extensor and flexor strength were measured using an isokinetic dynamometer. Activity limitations were measured by using the Western Ontario and McMasters Universities Osteoarthritis Index physical function questionnaire, the timed Get Up and Go, and the timed stair climbing and three questionnaires evaluating walking, climbing stairs, and rising from a chair. Other potential determinants of activity limitations were also collected, including joint proprioception, joint laxity, age, sex, body mass index (BMI), disease duration, and radiographic disease severity. Regression analyses evaluated the effect of adding self-reported knee instability to knee pain and muscle strength, when examining associations with the activity limitations measures. Self-reported knee instability was common (65 %) in this cohort of patients with knee OA. Analyses revealed that self-reported knee instability is significantly associated with activity limitations, even after controlling for knee pain and muscle strength. Joint proprioception, joint laxity, age, sex, BMI, duration of complaints, and radiographic severity did not confound the associations. In conclusion, self-reported knee instability is associated with activity limitations in patients with knee OA, in addition to knee pain and muscle strength. Clinically, self-reported knee instability should be assessed in addition to knee pain and muscle strength.

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References

  1. Dekker J, van Dijk GM, Veenhof C (2009) Risk factors for functional decline in osteoarthritis of the hip or knee. Curr Opin Rheumatol 21(5):520–524

    Article  PubMed  Google Scholar 

  2. Sharma L, Cahue S, Song J, Hayes K, Pai Y, Dunlop D (2003) Physical functioning over three years in knee osteoarthritis. Role of psychosocial, local mechanical, and neuromuscular factors. Arthritis Rheum 12:3359–3370

    Article  Google Scholar 

  3. Felson DT, Niu J, McClennan C et al (2007) Knee buckling: prevalence, risk factors, and associated limitations in function. Ann Intern Med 147:534–540

    PubMed  Google Scholar 

  4. Fitzgerald GK, Piva SR, Irrgang JJ (2004) Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. Arthritis Rheum 51:941–946

    Article  PubMed  Google Scholar 

  5. Knoop J, van der Leeden M, van der Esch M, Thorstensson C, Gerritsen M, Voorneman R, Lems WF, Roorda LD, Dekker J, Steultjens MPM (2012) Lower muscle strength is associated with self-reported knee instability in osteoarthritis of the knee: results from the AM-OA cohort. Arthritis Care Res 64:38–45

    Article  Google Scholar 

  6. Schmitt LC, Fitzgerald GK, Reisman AS, Rudolph KS (2008) Instability, laxity, and physical function in patients with medial knee osteoarthritis. Phys Ther 88:1506–1516

    Article  PubMed  Google Scholar 

  7. Schmitt LC, Rudolph KS (2008) Muscle stabilization strategies in people with medial knee osteoarthritis: the effect of instability. J Orthop Res 26(9):1180–1185

    Article  PubMed  Google Scholar 

  8. Van der Esch M, Steultjens MPM, Knol D, Dinant H, Dekker J (2006) Joint laxity modifies the relationship between muscle strength and disability in patients with osteoarthritis of the knee. Arthritis Rheum 55:953–959

    Article  PubMed  Google Scholar 

  9. Van der Esch M, Steultjens MPM, Harlaar J, Knol DL, Lems W, Dekker J (2007) Joint proprioception, muscle strength and functional ability in patients with osteoarthritis of the knee. Arthritis Rheum 57:787–793

    Article  PubMed  Google Scholar 

  10. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W, Cooke TD, Greenwald R, Hochberg M et al (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049

    Article  PubMed  CAS  Google Scholar 

  11. Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD (1998) Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am 80:1132–1145

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  13. Roorda LD, Jones CA, Waltz M, Lankhorst GJ, Bouter LM, van der Eijken JW, Willems WJ, Heyligers IC, Voaklander DC, Kelly KD, Suarez-Almazor ME (2004) Satisfactory cross cultural equivalence of the Dutch WOMAC in patients with hip osteoarthritis waiting for arthroplasty. Ann Rheum Dis 63:36–42

    Article  PubMed  CAS  Google Scholar 

  14. Hurley MV, Scott DL, Rees J, Newham DJ (1997) Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis 56:641–648

    Article  PubMed  CAS  Google Scholar 

  15. Piva SR, Fitzgerald GK, Irrgang JJ, Bouzubar F, Starz TW (2004) Get up and go test in patients with knee osteoarthritis. Arch Phys Med Rehabil 85:284–289

    Article  PubMed  Google Scholar 

  16. Roorda LD, Roebroeck ME, van Tilburg T, Molenaar IW, Lankhorst GJ, Bouter LM, Boonstra AM, de Laat FA, Caron JJ, Burger BJ, Heyligers IC, Nollet F, Stover-van Herk I, Perez RS, Meijer JW, Rijken PM (2005) Measuring activity limitations in walking: development of a hierarchical scale for patients with lower-extremity disorders who live at home. Arch Phys Med Rehabil 86:2277–2283

    Article  PubMed  Google Scholar 

  17. Roorda LD, Roebroeck ME, van Tilburg T, Lankhorst GJ, Bouter LM (2004) Measuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home. Arch Phys Med Rehabil 85:967–971

    Article  PubMed  Google Scholar 

  18. Roorda LD, Roebroeck ME, Lankhorst GJ, van Tilburg T, Bouter LM (1996) Measuring functional limitations in rising and sitting down: development of a questionnaire. Arch Phys Med Rehabil 77:663–669

    Article  PubMed  CAS  Google Scholar 

  19. Roorda LD, Molenaar IW, Lankhorst GJ, Bouter LM (2005) Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home. Arch Phys Med Rehabil 86:2204–2210

    Article  PubMed  Google Scholar 

  20. Buckland-Wright JC, Wolfe F, Ward RJ, Flowers N, Hayne C (1999) Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study without fluoroscopy, of standing extended semiflexed (MTP), and schuss views. J Rheumatol 26:2664–2674

    PubMed  CAS  Google Scholar 

  21. Altman RD, Gold GE (2007) Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 15(Suppl A):A1–A56

    Article  PubMed  Google Scholar 

  22. Greenland S (2008) Invited commentary: variable selection versus shrinkage in the control of multiple confounders. Am J Epidemiol 167:523–529

    Article  PubMed  Google Scholar 

  23. Kleinbaum DG, Kupper LL, Nizam A , Muller KE (2008) Applied regression analysis and other multivariable methods, 4th edn. Duxbury Press, Belmont, pp 198–203

    Google Scholar 

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Acknowledgments

We gratefully acknowledge M. Fransen and A. Harmer for their assistance in correcting the manuscript. We also thank A. Jonkman for collecting the data.

Funding

No funding was obtained for this study.

Disclosures

None.

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Authors and Affiliations

  1. Amsterdam Rehabilitation Research Center, Reade, PO Box 58271, 1040 HG, Amsterdam, The Netherlands

    Martin van der Esch, Jesper Knoop, Marike van der Leeden, Suzanne Romviel, Joost Dekker & Leo D. Roorda

  2. Department of Rehabilitation Medicine and Department of Psychiatry, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands

    Marike van der Leeden & Joost Dekker

  3. Jan van Breemen Research Institute, Reade, Amsterdam, The Netherlands

    Ramon Voorneman, Martijn Gerritsen, Dick Reiding & Willem F. Lems

  4. Department of Epidemiology and Biostatistics, EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands

    Dirk L. Knol

  5. Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands

    Willem F. Lems

  6. University of Applied Sciences, Amsterdam, The Netherlands

    Martin van der Esch

Authors
  1. Martin van der Esch
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  2. Jesper Knoop
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  3. Marike van der Leeden
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  4. Ramon Voorneman
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  5. Martijn Gerritsen
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  6. Dick Reiding
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  7. Suzanne Romviel
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  8. Dirk L. Knol
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  9. Willem F. Lems
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  10. Joost Dekker
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  11. Leo D. Roorda
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Correspondence to Martin van der Esch.

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van der Esch, M., Knoop, J., van der Leeden, M. et al. Self-reported knee instability and activity limitations in patients with knee osteoarthritis: results of the Amsterdam osteoarthritis cohort. Clin Rheumatol 31, 1505–1510 (2012). https://doi.org/10.1007/s10067-012-2025-1

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  • DOI: https://doi.org/10.1007/s10067-012-2025-1

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