Effects of body orientation and direction of movement on a knee joint angle reproduction test in healthy subjects: An experimental study

Abstract

BACKGROUND: Joint position sense test assess patient mobility and proprioceptive ability. Yet, application used under different conditions may biases reproduction error resulting in different therapeutic consequences. OBJECTIVE: To investigate knee angle reproduction test under different test conditions. METHODS: 25 healthy subjects (mean ± SD, age = 25 ± 2 years, activity level: 9 ± 2 training hours/week) performed knee angle reproduction test in the sitting and prone position, while changing the knee angle starting (i) from flexion and (ii) extension, (iii) inducing vibration on the semitendinosus tendon. RESULTS: Absolute mean knee angle reproduction error showed significant difference for body position and vibration (Position: 95% CI 0.71 to 2.32; p< 0.001. No Vibration & Vibration: 95% CI -1.71 to -0.12; p= 0.027). Relative knee angle reproduction error was significant different in all conditions (No Vibration & Vibration: 95% CI -3.30 to -0.45; p= 0.010. Body orientation: 95% CI 1.08 to 3.93; p< 0.001. Direction of movement: 95% CI 0.56 to 3.41; p= 0.007). CONCLUSION: Body orientation and movement direction influence the resulting knee angle reproduction error in healthy subjects. Practitioners are advised to use standardised test procedures when comparing different within- and between-patient results. Trial registration: DOI 10.17605/OSF.IO/AFWRP.

Factors that influence the angular error in active knee angle reproduction tests: A systematic review and meta‐analysis

“…In the middle of the physiological range of motion (ROM; 30–70° knee flexion), higher errors were noted in the prone position. At the lower (10–30°) and higher (70–100° knee flexion) end of the ROM, the error in the sitting position was higher [ 34 , 42 , 59 ]. Three studies (60%) investigated test–retest reliability and showed ICCs between 0.13 and 0.92 for the seated position and ICCs between 0.17 and 0.90 for the prone position [ 6 , 34 , 42 ].…”

“…Three studies (60%) investigated test–retest reliability and showed ICCs between 0.13 and 0.92 for the seated position and ICCs between 0.17 and 0.90 for the prone position [ 6 , 34 , 42 ]. The SEM values ranged from 0.40° to 1.98° in the seated position and from 0.45° to 3.14° in the prone position [ 6 , 34 , 42 , 59 ]. An overview of the overall AAE (mean ± SD) and SMD values is given in Figure 4 (see Supporting Information S1 for detailed study information).…”

“…Two studies (40%) investigated test–retest reliability and showed poor to good ICCs (0.13–0.87) for knee extension and poor to excellent ICCs (0.03–0.90) for knee flexion [ 6 , 42 ]. The SEM values ranged from 0.5° to 1.8° for knee extension and from 0.4° to 3.1° for knee flexion [ 6 , 42 , 59 ]. An overview of all the AAE (mean ± SD) and SMD values is given in Figure 5 (see Supporting Information S2 for detailed study information).…”

“…The systematic review revealed that body orientation had a significant effect on the AAE, with the seated position found to be favourable (SMD = −0.56; 95% CI = −1.00 to −0.12). Wieber et al previously proposed that significant differences in AAEs could result from disparities in body position, particularly the position of the head (upright vs. horizontal) [ 59 ]. In addition, variation in tactile feedback from the thigh might have influenced the observed differences in JPS.…”

“…The concentric muscular strain on the joint structures is higher and the pressure conditions in the joints are different when moving against the force of gravity. This might also be due to the increased activation of the muscle spindles and the Golgi tendon organ during contraction of the larger concentric quadriceps muscle [ 43 , 59 ]. Wieber et al discussed how pre‐tension of the m. quadriceps femoris, depending on the stretching ability, may result in better reproducibility [ 59 ].…”