Range of motion as an outcome measure for knee osteoarthritis interventions in clinical trials: an integrated review

Epskamp, Samantha; Dibley, Hayley; Ray, Elizabeth; Bond, Nicole; White, Joshua; Wilkinson, Amanda; Chapple, Cathy

doi:10.1080/10833196.2020.1867393

Cited by 11 publications

(9 citation statements)

References 77 publications

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“…We combined patient-reported outcome measures (pain and function) with physical outcomes (flexion data), thereby increasing the robustness of our estimates. This accords with recommendations for a holistic approach in disability measures with a combination of physical and patient-reported outcomes [ 35 , 122 ]. This method for estimating an MCIC may be useful where it is difficult to formulate sensitive anchor questions or where recall bias is an issue [ 16 ].…”

Section: Discussionsupporting

confidence: 53%

“…The tools included intermittent and constant osteoarthritis pain, Knee injury and Osteoarthritis Outcome Score, Lower Extremity Functional Scale, Numeric Pain Rating Scale, Patient-Reported Outcome Measurement Information System, and 36-Item Short-Form Health Survey, VAS and WOMAC. We included studies that measured flexion using a universal goniometer, electrogoniometer or inclinometer in a static position as flexion assessed using the above tools is considered a valid and accessible outcome measure in knee OA [ 33 – 35 ]. Studies that assessed knee flexion during functional activities (for example gait, squatting, stair climbing) were excluded as they do not consider the full flexion range.…”

Section: Methodsmentioning

confidence: 99%

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Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach

Silva,

Woodward,

Fearon

et al. 2024

Syst Rev

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Background Minimal clinically important change (MCIC) represents the minimum patient-perceived improvement in an outcome after treatment, in an individual or within a group over time. This study aimed to determine MCIC of knee flexion in people with knee OA after non-surgical interventions using a meta-analytical approach. Methods Four databases (MEDLINE, Cochrane, Web of Science and CINAHL) were searched for studies of randomised clinical trials of non-surgical interventions with intervention duration of ≤ 3 months that reported change in (Δ) (mean change between baseline and immediately after the intervention) knee flexion with Δ pain or Δ function measured using tools that have established MCIC values. The risk of bias in the included studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Bayesian meta-analytic models were used to determine relationships between Δ flexion with Δ pain and Δ function after non-surgical interventions and MCIC of knee flexion. Results Seventy-two studies (k = 72, n = 5174) were eligible. Meta-analyses included 140 intervention arms (k = 61, n = 4516) that reported Δ flexion with Δ pain using the visual analog scale (pain-VAS) and Δ function using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale (function-WOMAC). Linear relationships between Δ pain at rest-VAS (0–100 mm) with Δ flexion were − 0.29 (− 0.44; − 0.15) (β: posterior median (CrI: credible interval)). Relationships between Δ pain during activity VAS and Δ flexion were − 0.29 (− 0.41, − 0.18), and Δ pain-general VAS and Δ flexion were − 0.33 (− 0.42, − 0.23). The relationship between Δ function-WOMAC (out of 100) and Δ flexion was − 0.15 (− 0.25, − 0.07). Increased Δ flexion was associated with decreased Δ pain-VAS and increased Δ function-WOMAC. The point estimates for MCIC of knee flexion ranged from 3.8 to 6.4°. Conclusions The estimated knee flexion MCIC values from this study are the first to be reported using a novel meta-analytical method. The novel meta-analytical method may be useful to estimate MCIC for other measures where anchor questions are problematic. Systematic review registration PROSPERO CRD42022323927.

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Section: Discussionsupporting

confidence: 53%

Section: Methodsmentioning

confidence: 99%

Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach

Silva,

Woodward,

Fearon

et al. 2024

Syst Rev

View full text Add to dashboard Cite

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“…Knee ROM is commonly used as an outcome measure in clinical studies of people with knee OA, rheumatoid arthritis (RA), and in athletes. 21 , 22 Steultjens et al demonstrated that the mean knee ROM in an OA group was 19% lower than in control group. 21 In another study, McCarthy et al reported that patients with knee OA had significantly lower knee flexion ROM than matched controls.…”

Section: Discussionmentioning

confidence: 99%

UC-II Undenatured Type II Collagen for Knee Joint Flexibility: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Study

Schön

Knaub

Alt

et al. 2022

Journal of Integrative and Complementary Medicine

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Objective: Joint-related stress models have been used in the past to induce a standardized load on physical structures, allowing researchers to observe changes in perceived stress on joints as accurately as possible in healthy individuals. Previous studies support the efficacy of UC-II ® undenatured type II collagen (“undenatured collagen”) supplementation in maintaining joint health. The purpose of this study was to assess the effect of undenatured collagen on knee flexibility in healthy subjects who experience activity-related joint discomfort (ArJD). Methods: This randomized, double-blind, placebo (PLA)-controlled study was conducted in healthy subjects with ArJD who had no history of osteoarthritis, or joint diseases. Ninety-six ( n = 96, 20–55 years old) subjects who reported joint discomfort while performing a standardized single-leg-step-down test were randomized to receive either PLA ( n = 48) or 40 mg of undenatured collagen ( n = 48) supplementation daily for 24 weeks. Range of motion (ROM) flexion and extension were measured using a digital goniometer. Results: At the end of the study, a statistically significant increase in knee ROM flexion was observed in the undenatured collagen group versus the PLA group (3.23° vs. 0.21°; p = 0.025). In addition, an increase in knee ROM extension by 2.21° was observed over time in the undenatured collagen group ( p = 0.0061), while the PLA group showed a nonsignificant increase by 1.27° ( p > 0.05). Subgroup analysis by age showed a significant increase in knee ROM flexion in subjects >35 years old in the undenatured collagen supplemented group compared with PLA (6.79° vs. 0.30°; p = 0.0092). Conclusion: Overall, these results suggest that daily supplementation of 40 mg of undenatured collagen improved knee joint ROM flexibility and extensibility in healthy subjects with ArJD.

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“…Subjects were also advised to keep their low back flat on the table during the procedure to limit further possible pelvic rotation during the measurement [ 2 , 8 ]. The standard error of measurement reported for the universal goniometric measurement of knee extensions ranged from 0.72° to 4.2°, with most of the studies reporting it to be around 1.5° ± 0.5° [ 19 , 20 , 21 ].…”

Section: Methodsmentioning

confidence: 99%

Immediate and Long-Term Effectiveness of Proprioceptive Neuromuscular Facilitation and Static Stretching on Joint Range of Motion, Flexibility, and Electromyographic Activity of Knee Muscles in Older Adults

Zaidi

Ahamad

Fatima

et al. 2023

JCM

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Introduction and Objective: Previously, various stretching techniques were compared to study their effects on the different physiological parameters of hamstring muscles in the elderly population. There is no research that compares the immediate and long-term effects of proprioceptive neuromuscular facilitation-contract–relax (PNF-CR) and static stretching (SS) techniques on knee range of motion (ROM), hamstring flexibility, and knee flexor muscle EMG activity in the elderly. This study intends to compare the same. Methods: A total of 30 males aged 55–75 years were randomly assigned into the PNF-CR group (n = 10), SS group (n = 10), and control group (n = 10). The PNF-CR group received four trials of the contract–relax technique, the SS group received passive stretching of an 80 s duration by the therapist, and the control group received no intervention. A total of 12 sessions were given during the four-week period. Knee range of motion, electromyographic activity of the biceps femoris, and the sit-and-reach test were taken for the dominant side thrice: pre-intervention, immediately after stretching, and after the training period. Results: A statistically significant difference was observed in the maximum voluntary isometric contraction (MVIC) of biceps femoris between the PNF and the control groups (p = 0.01) after four weeks of intervention. The knee ROM and hamstring flexibility for the PNF group showed significant improvement immediately post-test (p = 0.01) and after four weeks of training (p = 0.07 and p = 0.001). SS showed significant results for both ROM and flexibility after four weeks of intervention (p = 0.001), and significant immediate post-test improvements were seen for ROM only (p = 0.007). Conclusions: PNF stretching has an immediate, as well as long-term, effect on knee ROM and hamstring flexibility, whereas it has only a long-term effect on muscle electromyographic activity. SS has an immediate, as well as long-term, effect on knee ROM and only a long-term effect on hamstring flexibility, without any immediate or long-term effects on muscle electromyographic activity.

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Range of motion as an outcome measure for knee osteoarthritis interventions in clinical trials: an integrated review

Cited by 11 publications

References 77 publications

Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach

Minimal clinically important change of knee flexion in people with knee osteoarthritis after non-surgical interventions using a meta-analytical approach

UC-II Undenatured Type II Collagen for Knee Joint Flexibility: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Clinical Study

Immediate and Long-Term Effectiveness of Proprioceptive Neuromuscular Facilitation and Static Stretching on Joint Range of Motion, Flexibility, and Electromyographic Activity of Knee Muscles in Older Adults

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