Association of Knee Confidence With Pain, Knee Instability, Muscle Strength, and Dynamic Varus–Valgus Joint Motion in Knee Osteoarthritis

Skou, Søren Thorgaard; Wrigley, Tim V.; Metcalf, Ben; Hinman, Rana S; Bennell, Kim L

doi:10.1002/acr.22208

Cited by 48 publications

(52 citation statements)

References 45 publications

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“…Worse knee confidence was associated with pain, self-reported knee instability, weakness, and varus-valgus motion during gait in the setting of medial tibiofemoral OA in a study in Australia (16). Knee buckling and the sensation of instability without buckling was associated with fear of falling, poor balance confidence, activity limitations, and poor function in the Multicenter Osteoarthritis Study (17).…”

Section: Resultsmentioning

confidence: 99%

Osteoarthritis year in review 2015: clinical

Sharma

2016

Osteoarthritis and Cartilage

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The purpose of this review is to highlight clinical research in osteoarthritis. A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms “osteoarthritis [All Fields] AND treatment [All Fields]” and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms “osteoarthritis [All Fields] AND epidemiology [All Fields]”, with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 148 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing.

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Section: Resultsmentioning

confidence: 99%

Osteoarthritis year in review 2015: clinical

Sharma

2016

Osteoarthritis and Cartilage

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“…(1-3, 6-8) Individuals with knee instability frequently “lack confidence” in their knees(4) and this is associated with a poor functional outcome. (5) Previously in the MOST cohort we found that persons with a history of buckling as well as those who experienced knee slipping/shifting were significantly more likely to concurrently have poor balance confidence and fear of falling.…”

Section: Discussionmentioning

confidence: 99%

“…Symptoms of knee instability are associated with loss of confidence in one's knees,(4, 5) loss of balance confidence overall, fear of falling (3) and functional limitation (2, 3, 6-8) independently of knee pain. Falls, fall injuries and fear of falling due to knee buckling may exacerbate the adverse consequences of knee instability, leading to restrictions in physical activity, deconditioning and loss of strength and function.…”

Section: Introductionmentioning

confidence: 99%

Symptoms of Knee Instability as Risk Factors for Recurrent Falls

Nevitt

Tolstykh

Shakoor

et al. 2016

Arthritis Care & Research

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Objectives Whether knee instability contributes to the increased risk of falls and fractures observed in persons with knee osteoarthritis (OA) has not been studied. We examined the association of knee buckling with the risk of falling and fall-related consequences in older adults with, or at high risk for, knee OA. Methods At the 60 month visit of the Multicenter Osteoarthritis Study, men and women ages 55 to 84 were asked about knee buckling in the past 3 months and whether they fell when a knee buckled. Falls and fall-related injuries in the past 12 months and balance confidence were assessed at 60 and 84 months. Multivariate logistic regression was used to assess the association of knee buckling with falls and their consequences. Results 1,842 subjects (59% women, mean [SD] age= 66.9 [7.8] and BMI= 30.3 [5.7]) were included. At 60 months 16.8% reported buckling and at 84 months 14.1% had recurrent (≥2) falls. Bucklers at 60 months had a 1.6 to 2.5-fold greater odds of recurrent falls, fear of falling and poor balance confidence at 84 months. Those who fell when a knee buckled at baseline had a 4.5-fold, 2-fold and 3-fold increased odds two years later of recurrent falls, significant fall injuries and fall injuries that limited activity, respectively, and were 4 times more likely to have poor balance confidence. Conclusion Interventions that reduce knee buckling may help prevent falls, fall-related injuries and adverse psychological consequences of falls in persons with knee OA.

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“…Specific strategies could incorporate education concerning risk of poor outcome and benefits associated with its prevention, recognize and address impediments to improving confidence, tailor to the individual’s self-management capabilities, and use telephone counseling and/or linkage to supportive social networks. Skou et al suggest that knee confidence might be improved by targeting self-reported knee instability, lower muscle strength, and greater dynamic varus-valgus motion (3). Future studies should continue this important work to identify the sources of confidence (3) and buckling (31); these parameters could then become the target of additional strategies.…”

Section: Discussionmentioning

confidence: 99%

“…Skou et al suggest that knee confidence might be improved by targeting self-reported knee instability, lower muscle strength, and greater dynamic varus-valgus motion (3). Future studies should continue this important work to identify the sources of confidence (3) and buckling (31); these parameters could then become the target of additional strategies.…”

Section: Discussionmentioning

confidence: 99%

Knee Instability and Basic and Advanced Function Decline in Knee Osteoarthritis

Sharma

Chmiel

Almagor

et al. 2015

Arthritis Care & Research

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Objective Manifestations of instability in knee OA include low overall knee confidence, low confidence that the knees will not buckle, buckling, and excessive motion during gait. Confidence and buckling may particularly influence activity choices, contributing to events leading to disability. Buckling is more likely to affect advanced than basic functional tasks. In this prospective, longitudinal study, we tested the hypotheses: overall knee confidence, buckling confidence, buckling, and frontal plane motion during gait are associated with advanced 2-year function outcome in persons with knee OA. Methods Persons with knee OA were queried about overall knee confidence (higher worse), buckling confidence, and knee buckling, and underwent quantitative gait analysis to quantify varus-valgus excursion and angular velocity. Physical function was assessed using the LLFDI Basic and Advanced Lower Extremity Domain scores. Logistic regression was used to evaluate the relationship between baseline instability measures and baseline-to-2-year function outcome, adjusting for potential confounders. Results 212 persons (mean age 64.6 years, 76.9% women) comprised the sample. Buckling was significantly associated with poor advanced (adjusted OR 2.08, 95% CI: 1.03–4.20) but not basic function outcome. Overall knee confidence was significantly associated with advanced outcome (adjusted OR 1.65, 95% CI: 1.01–2.70), while associations between buckling confidence and both outcomes approached significance. Neither varus-valgus excursion nor angular velocity during gait was associated with either outcome. Conclusion Knee buckling and confidence were each associated with poor 2-year advanced function outcome. Current treatment does not address these modifiable factors; interventions to address them may improve outcome in knee OA.

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Association of Knee Confidence With Pain, Knee Instability, Muscle Strength, and Dynamic Varus–Valgus Joint Motion in Knee Osteoarthritis

Cited by 48 publications

References 45 publications

Osteoarthritis year in review 2015: clinical

Osteoarthritis year in review 2015: clinical

Symptoms of Knee Instability as Risk Factors for Recurrent Falls

Knee Instability and Basic and Advanced Function Decline in Knee Osteoarthritis

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