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ABSTRACT: Recent scientific advances in the treatment of hip and knee osteoarthritis (OA) relating to education, exercise, weight control and passive non-pharmacological and non-surgical treatments such as manual therapy, orthoses/orthotics and other aids are described.
A systematic literature search was performed in Medline from July 2011 to 10 April 2012 using the terms 'osteoarthritis, knee', 'osteoarthritis, hip' rehabilitation, physical therapy, exercise therapy and preoperative intervention; both as text words and as MeSH terms where possible. Trials evaluating rehabilitation interventions were included if they were randomized controlled trials (RCTs) or systematic reviews. Outcome papers were identified by combining the initial search with the terms 'outcome', 'measure*', 'valid*', 'reliabil*' or 'responsiveness'. Outcome studies were included if they contributed methodologically to advancing outcome measurement.
The literature search identified 550 potentially relevant papers. Seventeen RCTs on rehabilitation were selected and the results from these were supported by six systematic reviews. Sixteen outcomes papers were considered relevant, but did not add significantly to current knowledge about outcome measures in OA and so, were not included.
The current research focus on non-pharmacological and non-surgical treatments for hip and/or knee OA, when combined in systematic reviews, is improving the available evidence to identify best practice treatment. Education, exercise and weight loss are effective in the long term and supported as cost-effective first-line treatments.
Osteoarthritis and Cartilage 09/2012; 20(12):1477-83. · 3.90 Impact Factor
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Osteoarthritis and Cartilage 11/2011; 20(1):4-5. · 3.90 Impact Factor
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ABSTRACT: To translate and adapt the Hip disability and Osteoarthritis Outcome Score (HOOS) into French and to evaluate the psychometric properties of this new version, by testing feasibility, internal consistency, construct validity, reliability and responsiveness, in patients with hip osteoarthritis (OA).
The French version of the HOOS was developed according to published international guidelines to ensure content validity. The new version was then evaluated in two symptomatic hip OA populations, one with no indication for joint replacement (medical group), and the other waiting for total hip replacement (THR) (surgery group). The psychometric properties assessed were feasibility: percentage of responses, floor and ceiling effects; internal consistency using Cronbach's alpha; construct validity by evaluating correlations with the Lequesne's index and the visual analogic scale (VAS) for pain (Pearson's correlation coefficient); reliability: intra-class correlation coefficient (ICC), Bland et Altman representation; responsiveness by comparing the results of before and 1 month after injection of hyaluronic acid (medical group) and by comparing the pre and 3 months post THR results (surgery group) by calculating standardized response mean (SRM) and effect size (ES).
A total of 88 patients were recruited; 58 in the medicine group (mean age=61.8+/-9 years, range 42-81, 70% women) and 30 in the surgery group (mean age=67.5+/-9 years, range 50-81, 68% women). The percentage of item responses was excellent (99%). Neither a floor nor a ceiling effect was observed, except for a ceiling effect (17.8% of patients with worst possible score) observed prior to surgery in the sport and recreation subscale. The internal consistency was good for four of the five HOOS subscales. As expected, the strongest correlations were observed between all HOOS subscales and Lequesne's index or VAS pain, indicating good construct validity. The reliability was good, with an ICC>0.8 for all subscales. The responsiveness was good for all domains 1 month after hyaluronic acid injection (ES ranging from 0.73 to 1.86 and SRM from 0.51 to 1.04) and high for all domains 3 months after THR (ES ranging from 1.47 to 2.08 and SRM ranging from 1.97 to 3.24).
The French version of HOOS demonstrated good psychometric properties and appears to be useful for the evaluation of patient-relevant outcome whatever the severity of hip OA. This study provides a basis for the use of this French version of the HOOS in future clinical trials.
Osteoarthritis and Cartilage 04/2010; 18(4):522-9. · 3.90 Impact Factor
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ABSTRACT: To evaluate the psychometric properties of the French KOOS physical function (KOOS-PS) and HOOS physical function (HOOS-PS), specifically its feasibility, reliability, construct validity, and responsiveness.
Consecutive outpatients consulting for primary knee or hip osteoarthritis (OA) in a rheumatology department were included. During the initial assessment, patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) or Hip disability and Osteoarthritis Outcome Score (HOOS) questionnaire and the OsteoArthritis Knee and Hip Quality Of Life questionnaire (OAKHQOL). The patients were given a second KOOS or HOOS questionnaire to complete and return by mail 2 weeks later. Feasibility was assessed by calculating the percentage of missing items and the floor and ceiling effects. Test-retest reliability was evaluated using the intra-class correlation coefficient (ICC). Convergent and divergent construct validity was determined by comparing the results of the KOOS-PS or HOOS-PS and OAKHQOL questionnaires using Spearman's rank test. Responsiveness was evaluated using data obtained in other hip or knee OA patients prior to and 1 month after intra-articular hyaluronic acid injection, using standardized response mean (SRM) and effect-size (ES).
Eighty-seven patients with knee OA and 50 hip OA patients were included. The KOOS-PS and HOOS-PS scores were obtained for all patients as there were no missing items. Neither a floor nor a ceiling effect was observed. The ICC of KOOS-PS and HOOS-PS was 0.861 (0.763-0.921) and 0.859 (0.725-0.929), respectively. A strong or moderate correlation was observed, as expected, between KOOS-PS, HOOS-PS, and the OAKHQOL physical activities, pain, and mental health domains. A weak correlation was observed, as expected, between KOOS-PS, HOOS-PS, and the other OAKHQOL domains, except for a moderate correlation between the KOOS-PS and social functioning. The responsiveness was demonstrated with SRM and ES of 0.80 and 0.51 (KOOS-PS), 1.10 and 0.62 (HOOS-PS), respectively.
The French versions of KOOS-PS and HOOS-PS are reliable, valid, and responsive questionnaires for capturing functional disability in people with knee and hip OA.
Osteoarthritis and Cartilage 07/2009; 17(12):1604-8. · 3.90 Impact Factor
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ABSTRACT: To evaluate the internal consistency of the Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS) and the Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) in total hip replacement (THR) and total knee (TKR) replacement. Construct validity and responsiveness were compared to the Western Ontario McMaster Universities' Osteoarthritis Index (WOMAC) Likert 3.0 physical function (PF) subscale and the PF excluding the items in the short measures (PF-exclusions).
Participants completed the full HOOS or KOOS, measures of fatigue, anxiety, depression and the Chronic Pain Grade (CPG) pre-surgery and the HOOS or KOOS 6 months post-surgery. Internal consistency for the HOOS-PS and KOOS-PS was calculated using Cronbach's alpha. For construct validity, it was hypothesized that correlations between the HOOS-PS or KOOS-PS and PF and PF-exclusions with fatigue, CPG, anxiety and depression and HOOS/KOOS pain scales would differ by magnitudes of <0.1. Standardized response means (SRMs) were calculated for the HOOS-PS, KOOS-PS, PF and PF-exclusions and hypothesized to be >1.
The THR group (n=201) had a mean age of 62.3 years; 53.2% were female. The TKR group (n=248) had a mean age of 64.5 years; 63.7% were female. Cronbach's alpha was 0.79 and 0.89 for the HOOS-PS and KOOS-PS, respectively, confirming that the measures represented a homogeneous construct. The correlation of the HOOS-PS to the PF and PF-exclusions was 0.90 and 0.86, respectively; r=0.90 (PF) and r=0.85 (PF-exclusions) for the KOOS-PS. The results supported the construct validity hypotheses. For THR, the SRM was 1.5, 1.7 and 1.7 for the HOOS-PS, PF and PF-exclusions; for TKR, the SRM was 1.4, 1.5 and 1.7, respectively.
The short HOOS-PS and KOOS-PS represent homogenous short measures of PF with similar construct validity and responsiveness to the 17-item PF. The HOOS-PS and KOOS-PS are parsimonious, valid and responsive for evaluating PF in THR and TKR.
Osteoarthritis and Cartilage 01/2009; 17(7):843-7. · 3.90 Impact Factor
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ABSTRACT: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF).
102 consecutive patients with knee OA, 63 women and 39 men, mean age 71 (51-86) assigned for TKR at the Department of Orthopaedics at Lund University Hospital were included in the study. The self-administered questionnaires Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were mailed preoperatively and 6 months, 12 months and at 5 years postoperatively.
Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P<0.001). The percentage of patients performing more demanding functions related to sports and recreation increased postoperatively. The best postoperative result was reported at the 1 year follow-up. Compared to the 1 year follow-up, a significant (P<or=0.01) decline was seen at 5 years in the KOOS subscale activity of daily living (ADL) function (82-73) and the SF-36 subscale bodily pain (72-63), PF (61-51) and vitality (69-59). Patients who scored in the lowest quartile preoperatively in the KOOS subscales pain and ADL made the greatest improvements to 1 year (18-82, 22-80) but also declined the most from 12 months to 5 years (82-72, 80-66). Being 10 years older pre-operatively predicted 5-7 points worse scores in KOOS pain and KOOS symptoms at 1 and 5 years. When adjusted for age, sex and comorbid conditions, pre-operative SF-36 scores did not predict postoperative KOOS pain or PF scores.
Compared to preoperatively, a significant improvement was still seen 5 years postoperatively. However, the best result was reported at 1 year, indicating a decline from 1 to 5 years after TKR. To fully evaluate the results of TKR with regard to pain and PF, follow-ups longer than 2 years are needed, and items of more demanding PFs should be included. Older age to some extent predicted more postoperative pain and other symptoms, however, no predictors of postoperative PF were found, indicating the difficulty of determining preoperatively who will benefit more or less from the procedure.
Osteoarthritis and Cartilage 11/2008; 17(5):601-6. · 3.90 Impact Factor
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ABSTRACT: To investigate changes in the knee during the first year after acute rupture of the anterior cruciate ligament (ACL) of volumes of joint fluid (JF), bone marrow lesions (BMLs), and cartilage volume (VC), and cartilage thickness (ThCcAB) and cartilage surface area (AC). To identify factors associated with these changes.
Fifty-eight subjects (mean age 26 years, 16 women) with an ACL rupture to a previously un-injured knee were followed prospectively using a 1.5T MR imager at baseline (within 5 weeks from injury), 3 months, 6 months, and 1 year. Thirty-four subjects were treated with ACL reconstruction followed by a structured rehabilitation program and 24 subjects were treated with structured rehabilitation only. Morphometric data were acquired from computer-assisted segmentation of MR images. Morphometric cartilage change was reported as mean change divided by the standard deviation of change (standard response mean, SRM).
JF and BML volumes gradually decreased over the first year, although BML persisted in 62% of the knees after 1 year. One year after the ACL injury, a reduction of VC, AC and ThCcAB (SRM -0.440 or greater) was found in the trochlea femur (TrF), while an increase of VC and ThCcAB was found in the central medial femur (cMF) (SRM greater than 0.477). ACL reconstruction was directly and significantly related to increased JF volume at 3 and 6 months (P<0.001), BML volume at 6 months (P=0.031), VC and ThCcAB in cMF (P<0.002) and decreased cartilage area in TrF (P=0.010) at 12 months.
Following an acute ACL tear, cMF and TrF showed the greatest consistent changes of cartilage morphometry. An ACL reconstruction performed within a mean of 6 weeks from injury was associated with increased ThCcAB and VC in cMF and decreased AC in TrF, compared to knees treated without reconstruction. This may suggest a delayed structural restitution in ACL reconstructed knees.
Osteoarthritis and Cartilage 09/2008; 17(2):161-7. · 3.90 Impact Factor
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ABSTRACT: To map by magnetic resonance imaging (MRI) and quantitative MRI (qMRI) concomitant fractures and meniscal injuries, and location and volume of traumatic bone marrow lesions (BMLs) in the acutely anterior cruciate ligament (ACL) injured knee. To relate BML location and volume to cortical depression fractures, meniscal injuries and patient characteristics.
One hundred and twenty-one subjects (26% women, mean age 26 years) with an ACL rupture to a previously un-injured knee were studied using a 1.5T MR imager within 3 weeks from trauma. Meniscal injuries and fractures were classified by type, size and location. BML location and volume were quantified using a multi-spectral image data set analyzed by computer software, edited by an expert radiologist.
Fractures were found in 73 (60%) knees. In 67 (92%) of these knees at least one cortical depression fracture was found. Uni-compartmental meniscal tears were found in 44 (36%) subjects and bi-compartmental in 24 (20%). One hundred and nineteen (98%) knees had at least one BML, all but four (97%) located in the lateral compartment. Knees with a cortical depression fracture had larger BML volumes (P<0.001) than knees without a cortical depression fracture, but no associations were found between meniscal tears and BML volume or fractures. Older age at injury was associated with smaller BML volumes (P<0.01).
A majority of the ACL injured knees had a cortical depression fracture, which was associated with larger BML volumes. This indicates strong compressive forces to the articular surface and cartilage at the time of injury, which may constitute an additional risk factor for later knee osteoarthritis development.
Osteoarthritis and Cartilage 08/2008; 16(7):829-36. · 3.90 Impact Factor
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ABSTRACT: The aim of this study is to investigate if self-reported activity level or knee functions are influenced by subject characteristics, level of competition and history of knee injury. Cross-Sectional study using questionnaires distributed at a personal visit. One hundred and eighty-eight (65 women) amateur football players in 10 football clubs from each division below national level participated in the study. Self-reported Tegner Activity Scale, and the Knee injury and Osteoarthritis Outcome Score (KOOS) are the main outcome measures. Older age, female gender and lower level of competition (football division) were independently associated with lower self-reported Tegner Activity Scale (P < 0.001). Subjects reporting history of knee injury had significantly worse KOOS scores (P < 0.001 for all subscales). In future studies, a clear description of how the Tegner Activity Scale was administered is recommended. We suggest that self-reported Tegner Activity Scale scores should be adjusted for age, gender and level of competition. In amateur football players, KOOS scores do not need adjustment for age and gender.
Knee Surgery Sports Traumatology Arthroscopy 07/2008; 16(7):713-9. · 2.21 Impact Factor
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A M Davis,
A V Perruccio,
M Canizares,
A Tennant,
G A Hawker,
P G Conaghan, E M Roos,
J M Jordan,
J-F Maillefert,
M Dougados,
L S Lohmander
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ABSTRACT: To derive a cross-culturally valid, short measure of physical function using function subscales (daily living and sports and recreation) of the Hip disability and Osteoarthritis Outcome Score (HOOS).
Rasch analysis was conducted on data from individuals from multiple countries who had hip osteoarthritis (OA). Fit of the data to the Rasch model was evaluated by model chi(2) and item fit statistics (chi(2), size of residual, and F-test). Differential item functioning was evaluated by gender, age and country. Unidimensionality was evaluated by factor analysis of residuals. Individual data sets were analyzed and data pooled and re-analyzed for fit to the model. Regression modeling was conducted to derive a nomogram converting raw summed scores to Rasch derived interval scores.
Seven data sets were included (n=2991), ages 19-96 years, male/female ratio was 1:1.23. The final model included five HOOS items. From the easiest to most difficult, the items (logit) were as follows: sitting (1.832), descending stairs (0.729), getting in/out of bath or shower (0.255), twisting/pivoting on loaded leg (-0.221) and running (-2.595). The separation index was 0.80.
The daily activity and sports and recreational items of the HOOS were reduced to five items achieving a feasible, short measure of physical function with interval level properties. This tool has potential for use as the function component of an OA severity scoring system. Further testing of this measure is warranted.
Osteoarthritis and Cartilage 06/2008; 16(5):551-9. · 3.90 Impact Factor
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A V Perruccio,
L Stefan Lohmander,
M Canizares,
A Tennant,
G A Hawker,
P G Conaghan, E M Roos,
J M Jordan,
J-F Maillefert,
M Dougados,
A M Davis
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ABSTRACT: To develop a short measure of physical function for knee osteoarthritis (OA) using multi-national data from individuals with varying degrees of severity of knee OA.
Rasch analysis, based on the partial credit model, was conducted on Knee injury and Osteoarthritis Outcome Score and Western Ontario McMaster Universities' Osteoarthritis Index data from individuals with knee OA, ranging from community to pre-total knee replacement samples from five countries. Fit of the data to the Rasch model was evaluated by overall model fit and item-level fit statistics (chi(2), size of residual, F-test). Invariance across age, gender and country was evaluated. Unidimensionality was evaluated by factor analysis of residuals. The derived short measure was further tested for fit through re-analyses in individual sub-samples. A nomogram converting raw summed scores to Rasch-derived interval scores was developed.
Thirteen data sets were included (n=2145), with an age range of 26-95 years, and a male/female ratio of 1:1.4. The final model included seven of the original 22 items. From easiest to most difficult, the items (logit) were as follows: rising from bed (1.366), putting on socks/stockings (1.109), rising from sitting (0.537), bending to the floor (0.433), twisting/pivoting on injured knee (-0.861), kneeling (-1.292) and squatting (-1.292). Sub-sample analyses confirmed findings.
Based on the use of accepted Rasch-based measurement methods and the compliment of countries, languages and OA severity represented in this study, our seven item short measure of physical function for knee OA is likely generalizable and widely applicable. This measure has potential for use as the function component in an OA severity scoring system.
Osteoarthritis and Cartilage 06/2008; 16(5):542-50. · 3.90 Impact Factor
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ABSTRACT: Muscular deficits and functional limitations have been found years after meniscectomy of the knee. The purpose of this randomized controlled trial was to examine the effect of functional exercise training on functional performance and isokinetic thigh muscle strength in middle-aged patients subsequent to meniscectomy for a degenerative tear. Four years after meniscectomy, 45 patients (29 men, 16 women) were randomized to functional exercise training, supervised by a physical therapist, three times weekly for 4 months or to no intervention. The exercise program comprised of postural stability training and functional strength and endurance exercises for leg and trunk muscles. Outcomes were three functional performance tests and isokinetic muscle strength. Thirty patients (16 exercisers/14 controls) completed the study. Compared with control patients, the exercise group showed significant improvement in one-leg hop (change 8 vs 2 cm; P=0.040), hamstrings strength 60 degrees /s (P=0.033), and quadriceps endurance 180 degrees /s (P=0.001). Functional exercise training was well tolerated and improved functional performance and thigh muscle strength in this group of middle-aged subjects with a previous degenerative meniscal injury and partial meniscectomy.
Scandinavian Journal of Medicine and Science in Sports 05/2008; 19(2):156-65. · 2.87 Impact Factor
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ABSTRACT: To adapt the Knee injury and Osteoarthritis Outcome Score (KOOS) into French and to evaluate the psychometric properties of this new version.
The French version of the KOOS was developed according to cross-cultural guidelines by using the "translation-back translation" method to ensure content validity. KOOS data were then obtained in patients with symptomatic knee osteoarthritis (OA). The translated questionnaire was evaluated in two knee OA population groups, one with no indication for joint replacement (medicine), and the other waiting for joint replacement (surgery). The psychometric properties evaluated were feasibility: percentage of responses, floor and ceiling effects; construct validity: internal consistency using Cronbach's alpha, correlations with osteoarthritis knee and hip quality of life domains using Spearman's rank test, and known group comparison between medicine and surgery groups; reliability: intra-class correlation coefficient (ICC), Bland and Altman representation; responsiveness using data obtained prior to and 3 months after surgery: standardized response mean (SRM), and effect size.
Thirty-seven patients were included in the medicine group (68% women, mean age=70+/-10 years) and 30 in the surgery group (73% women, mean age=71+/-10 years). The percentage of responses was excellent. Neither a floor nor a ceiling effect was observed, except for the sport and recreation subscale (20.6% of patients with the worst possible score in the medicine group, 40 and 0% in the surgery group prior to and after surgery, respectively). Results for internal consistency (Cronbach's alpha ranging from 0.76 to 0.93), and convergent and divergent construct validity were satisfactory. The patients waiting for knee surgery presented with significantly lower scores in all KOOS domains. The reproducibility of measurements of all KOOS subscales was good to excellent, with ICC ranging from 0.755 to 0.914. The responsiveness was high, with SRM ranging from 0.89 to 1.93, and effect size from 1.31 to 2.8.
The French version of KOOS is a valid, reliable, and responsive instrument to capture specific aspects of functional disability affecting quality of life of knee OA patients.
Osteoarthritis and Cartilage 05/2008; 16(4):423-8. · 3.90 Impact Factor
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ABSTRACT: In the present work, we describe the clinical course and predictors of change in self-reported outcomes and objectively assessed physical function over time in middle-aged subjects at high risk of, or with knee osteoarthritis (OA).
We examined 259 subjects (mean (SD) age 52.6 (10.4)) at mean 18 and 25 years after previous meniscectomy and 50 population-based age- and sex-matched reference subjects with the Knee injury and Osteoarthritis Outcome Score (KOOS), one-leg hop for distance and number of knee-bendings in 30 s. Radiographic OA was defined as equivalent to Kellgren and Lawrence grade 2 or worse.
At first assessment, meniscectomised subjects reported worse pain, function and quality of life compared with the reference group (p<0.001). They also performed fewer knee-bendings per 30 s (27 vs 31, p = 0.02). The meniscectomised patients worsened over the 4-10-year observation time in all measured outcomes (p<0.001), and to a greater extent than the reference group in pain (-5, 95% CI -10 to 0) and one-leg hop (-11, 95% CI -18 to -3). Being a woman, or having radiographic knee OA, enhanced the worsening in self-reported and objectively assessed outcomes. Older age and a higher body mass index (BMI) influenced objectively assessed physical function, but not self-reported outcomes.
Worsening over time in knee-related pain and function is greater in meniscectomised subjects compared with reference subjects. Rehabilitative efforts may be warranted in middle-aged meniscectomised patients, especially in women and those who have developed radiographic knee OA, who are at greater risk of worsening.
Annals of the rheumatic diseases 04/2008; 67(4):505-10. · 8.11 Impact Factor
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ABSTRACT: Reduced muscle function, causing greater knee joint load, is a potentially modifiable risk factor of knee osteoarthritis (OA). Exercise is an important treatment of knee OA, but the effect on joint load has not been determined. The aim of this study was to investigate the effect of exercise on knee adduction moment during one-leg rise and gait.
Patients below age 65 with early signs of radiographic knee OA, from a population-based cohort on OA development, were invited to participate in the study. They defined their most symptomatic knee as the index knee. Knee adduction moment during one-leg rise from a stool (48cm), and during gait was assessed using a three-dimensional motion analysis system, before and after eight weeks of supervised exercise.
Thirteen patients, seven women, mean age 54.5, 12/13 with Kellgren and Lawrence grade I or II, took part in the study. Peak knee adduction moment during one-leg rise was reduced by 0.08 (95% CI 0.01;0.16) Nm/kg, or 14%, for the index knee, and 0.05 (95% CI -0.04;0.14), or 8% for the opposite knee after eight weeks. The reductions in peak adduction moment during gait were smaller and not significant.
This study indicates that peak knee adduction moment could be reduced by supervised, individualized exercise in middle-aged patients presenting early signs of knee osteoarthritis, suggesting further investigation of this area. Peak adduction moment during one-leg rise seems to be more sensitive to deviations and change than peak adduction moment during gait in this population.
Osteoarthritis and Cartilage 11/2007; 15(10):1163-70. · 3.90 Impact Factor
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ABSTRACT: Reduced functional performance and muscular dysfunction after knee injury and in knee osteoarthritis (OA) is suggested to be a factor in OA development. Validated functional performance tests applicable in the clinic and large-scale studies are lacking. The aim was to study the reliability and validity of 10 functional performance tests.
Two hundred and eighty-five subjects, 15-22 years post-meniscectomy, performed 10 functional performance tests. The mean age was 54 years (SD+/-11.2) and 79% were men; 52% had radiographic OA, and 48% were categorized as symptomatic. The tests were evaluated for test-retest reliability, discriminative ability (younger vs older age, men vs women, symptom-free vs symptomatic) and floor and ceiling effects.
Two of the 10 tests, maximum number of knee bendings in 30 s and one-leg hop for distance, had good test-retest reliability (ICC 0.92, 95% CI 0.86-0.96 and 0.93, 95% CI 0.87-0.97) and were able to discriminate with regard to age, gender and symptoms, and had acceptable floor effects (9% and 3%, respectively).
This study suggests the use of two functional performance tests: knee bendings/30 s and one-leg hop for distance, easy to use for evaluation of interventions due to knee injury and knee OA and when attaining long-term data of natural disease history.
Scandinavian Journal of Medicine and Science in Sports 04/2007; 17(2):120-7. · 2.87 Impact Factor
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ABSTRACT: The Hip disability and Osteoarthritis Outcome Score (HOOS) was constructed in Sweden; this questionnaire has proved to be valid for persons with hip disability with or without hip osteoarthritis (OA) and with high demands of physical function.
The objective of this study was to evaluate the internal consistency, reliability, construct validity, and floor and ceiling effects of the Dutch version of the HOOS questionnaire.
After translation with a forward/backward protocol, 74 hip arthroplasty patients and 88 hip OA patients filled in the Dutch HOOS, as well as a Short Form-36 (SF-36), an Oxford Hip Score (OHS) and a VAS-pain questionnaire.
The Dutch version of the HOOS questionnaire achieved excellent scores in all of the clinimetric properties.
The Dutch HOOS questionnaire has a good internal consistency and reliability. Moreover, the construct validity is good and no floor and ceiling effects were found. The HOOS is a good instrument for patients with different stadia of hip OA.
Osteoarthritis and Cartilage 02/2007; 15(1):104-9. · 3.90 Impact Factor
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ABSTRACT: To cross-culturally adapt and validate Singapore English and Chinese versions of the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with knee osteoarthritis (OA) in Singapore.
Singapore English and Chinese versions were cross-culturally adapted from the source English KOOS following standard guidelines (including cognitive debriefing). Patients were asked to complete identical questionnaires containing the KOOS, Short Form 36 Health Survey, and EQ-5D twice within 6 days. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), dimensionality using item-to-domain correlations and convergent and divergent construct validity using 14 and 13 a priori hypotheses, respectively.
Singapore English and Chinese KOOS versions were well accepted by patients in pilot testing and were therefore administered to a consecutive sample of 127 English and 131 Chinese-speaking Singaporeans with knee OA. Cronbach's alpha exceeded 0.7 for all domains except for Chinese pain and symptoms domains. ICC exceeded 0.7 for all domains except for English sport and recreation and Chinese knee-related QoL domains. Hypothesized item-to-domain correlations (Spearman's rho>or=0.4) were observed for 38 items in English and 29 in Chinese versions. Convergent construct validity was supported by the presence of hypothesized moderate/strong correlations (rho=0.37-0.65) for 13 and 11 a priori hypotheses in the English and Chinese KOOS, respectively. Divergent construct validity was supported by the presence of weak correlations (rho=0.02-0.34) for 12 and 11 a priori hypotheses in the English and Chinese KOOS, respectively.
The Singapore English and Chinese KOOS were well accepted and demonstrated acceptable reliability and validity in Asian patients with knee OA in Singapore.
Osteoarthritis and Cartilage 12/2006; 14(11):1098-103. · 3.90 Impact Factor
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ABSTRACT: To compare the improvement of hip and knee osteoarthritis during treatment with naproxen.
Men and women aged 40 to 75 years with symptomatic osteoarthritis of the knee or hip of at least three months' duration participated in a six week placebo controlled, double blind study with naproxen 500 mg twice daily as one treatment arm. Naproxen was given to 403 patients (280 knee, 123 hip) and placebo to 108 patients (75 knee, 33 hip). WOMAC (Western Ontario and McMaster Universities osteoarthritis index) 3.1 visual analogue scale and SF-36 (36 item short form health survey) were used to assess response to treatment between baseline and week 6.
There were no differences at baseline between knee and hip osteoarthritis for any of the WOMAC subscales or SF-36 domains. Improvement was between 4 and 7 mm greater for knee than for hip for all WOMAC subscales (pain, delta = 4.7 mm (p = 0.03); stiffness, delta = 6.6 mm (p = 0.004); function, delta = 4.8 mm (p = 0.06)). Effect size was about 0.8 for all WOMAC subscales for the knee and between 0.5 and 0.6 for the hip. Knee patients treated with naproxen improved 4.6 (p = 0.033) more than hip patients for SF-36 bodily pain and 10.3 (p = 0.014) more for SF-36 role-physical.
Patients with knee osteoarthritis improved more with naproxen treatment than patients with hip osteoarthritis, as monitored by WOMAC and the SF-36 domains bodily pain and role-physical. These findings warrant further investigation and strongly suggest that efficacy of treatment of osteoarthritis of knee and hip should be evaluated separately.
Annals of the Rheumatic Diseases 07/2006; 65(6):781-4. · 8.73 Impact Factor
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ABSTRACT: The objective of this study was to compare subjects who sustained an ACL injury during soccer 16 years ago with a control group with regard to knee kinematics and kinetics of gait, step activity and cross over hop. Secondly, in the injured subjects, the purpose was to study the impact on kinematics and kinetics of characteristics such as operative status, meniscal resection, being symptomatic, having knee extensor weakness and of having radiographic knee OA. Data from a 3-dimensional gait analysis system (VICON) were used to calculate kinetics and kinematics during gait, step activity and cross over hop of 12 male subjects who had an anterior cruciate ligament injury 16 years earlier. Twelve uninjured subjects matched for age, sex, BMI and activity level served as controls. No significant differences in knee kinematics and kinetics between the ACL group and the control group were found. The variability of some parameters of step and all parameters of hop activity was generally larger in the ACL injured subjects compared with the controls. The ACL injured subjects had a significantly worse clinical status compared with the controls. Reduced knee extension strength was associated with joint moment reductions especially during step activity and cross over hop. Despite a significantly worse clinical status, as determined by self-report and isokinetic strength testing, no significant differences were seen in knee joint kinetics and kinematics in an ACL injured group 16 years after injury compared with a matched control group. The variation was larger among the ACL injured subjects indicating the need for larger study groups in gait and movement analysis in long-term follow-up of ACL injury.
Knee Surgery Sports Traumatology Arthroscopy 07/2006; 14(6):546-54. · 2.21 Impact Factor
