Assessment of the Lequesne index of severity for osteoarthritis of the hip in an elderly population

Cross-cultural adaptation and psychometric testing of the Yoruba lequesne algofunctional index of knee osteoarthritis among patients with knee osteoarthritis

BACKGROUND

The Lequesne Algofunctional Index of Knee Osteoarthritis (LAIKOA) is a widely used knee osteoarthritis (KOA) outcome measure and is recommended by many international authorities. It has been cross-culturally adapted to many languages, excluding indigenous Nigerian languages. The aim of this study was to cross-culturally adapt and validate the LAIKOA into Yoruba language.

METHODS

This was a validation study. Yoruba LAIKOA was translated and culturally adapted from English version following Beaton's guidelines (including cognitive debriefing). The Yoruba LAIKOA was psychometrically tested for test-retest reliability, standard error of measurements (SEM), smallest detectable change (SDC), internal consistency, and construct validity among 108 Yoruba-speaking patients with KOA recruited from selected hospitals in Ibadan, Nigeria. Participants completed the Yoruba and English versions of LAIKOA, and the Yoruba version of Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM).

RESULTS

The mean age of participants was 63.60 ± 11.77 years. Acceptable internal consistency was observed for the global index and function domain (α = 0.63-0.82) and good test-retest for items and domains (ICC = 0.81-0.995). Item-to-scale correlation was significant (r = 0.28-0.69). Its three domains demonstrated structural validity when subjected to confirmatory factor analysis (CFI = 0.99, TLI = 0.99, RMSEA = 0.02). Construct validity was supported by the correlation between Yoruba LAIKOA and IKHOAM (r = -0.39, p = 0.011). The overall scores and domain scores of the Yoruba and English versions of LAIKOA did not differ significantly. The Yoruba LAIKOA has no floor or ceiling effects.

CONCLUSION

The Yoruba LAIKOA is reliable and valid, and it is recommended for use in clinical settings in southwestern Nigeria and other Yoruba-speaking populations.

Growing Trends in Scientific Publication in Physiotherapy Treatment of Knee Osteoarthritis: A Bibliometric Literature Analysis

There has been an increase in the life expectancy of people worldwide, especially in developing countries like India. Osteoarthritis, a condition that usually onsets during later decades of life, has also been on the rise, even with advancing technology. This has led osteoarthritis of the knee to become a global disabling condition of the lower extremity that increases dependency on the affected individual. A bibliometric study has not been conducted on knee osteoarthritis research. Therefore, a bibliometric analysis which includes statistical analysis of recent articles, books, and other forms of publications is done for evaluation of scientific output and to find the importance of scientific studies in terms of quality as well as quantity. The aim of this analysis was to evaluate the productivity of research articles indexed in PubMed related to the condition. The PubMed database was used and articles related to osteoarthritis of the knee, phonophoresis, and start excursion balance test were extracted. In the bib text format, all the files were downloaded and placed together. The R studio software (R Foundation for Statistical Computing, Vienna, Austria) for bibliometric analysis was then used, into which the research data was uploaded and a data framework of bibliometric analysis was made. Analysis of bibliometric publications related to knee osteoarthritis, phonophoresis, Otago exercises, star excursion balance test, ultrasound, and exercise therapy generated between 1989 and 2021 lists a total of 120 relevant documents from 75 sources with an average of 4.53 articles per year of publication. The use of an advanced PubMed database enables the extraction of adequate articles and powerful bibliometric analysis of the studies conducted on osteoarthritis of the knee published from 1989 to 2021. It includes an assessment of the contributions from major countries. This study allowed us to validate our methodology which can be used to evaluate research policies and promote international collaboration.

Health-related quality of life in patients with Kashin-Beck disease is lower than in those with osteoarthritis: a cross-sectional study

BACKGROUND

Kashin-Beck disease (KBD) is an endemic deformable bone and joint disease, which affects the quality of life (QOL) of patients. We conducted a cross-sectional study of the QOL of KBD patients by a new KBD quality of life (KBDQOL) questionnaire.

METHODS

A total of 252 KBD patients and 248 OA patients came from Northwest China, and 260 healthy people living in the same area as KBD and osteoarthritis (OA) patients served as the controls. KBDQOL questionnaire was used to evaluate the QOL of all objects.

RESULTS

The average scores for physical functions, activity limitations, support of society, mental health and general health were significantly lower in KBD patients than that in OA patients and healthy people except for economics. Monofactor analysis showed that age, height, weight status, education level and grade of KBD had a significant effect on KBDQOL score. Multivariate analysis showed that grade of KBD was the influencing factor of physical function score; gender, age, height, grade of KBD and duration of symptoms were the influencing factors of activity restriction score; age and grade of KBD were factors affecting the general health score.

CONCLUSION

The QOL of KBD patients was significantly lower than that of OA patients and healthy people. The KBDQOL questionnaire may be a promising tool for assessing the QOL of KBD patients.

Patient-Reported Quality of Care for Osteoarthritis in General Practice in South Tyrol, Italy: Protocol for Translation, Validation and Assessment of the OsteoArthritis Quality Indicator Questionnaire (OA-QI)

BACKGROUND

Evidence-based recommendations for the treatment of knee and hip osteoarthritis are similar internationally. Nevertheless, clinical practice varies across countries. Instruments for measuring quality have been developed to improve health care through targeted interventions. Studies on health service quality must consider the structural and cultural characteristics of countries, because each of their strengths and weaknesses differ. However, such instruments for health-related patient-reported outcomes for osteoarthritis have not yet been validated in German and Italian languages.

OBJECTIVES

In order to be able to set targeted measures for the improvement of prevention and non-surgical treatment of osteoarthritis in South Tyrol, Italy, the quality of care must be recorded. Therefore, the aim of the project is to update, translate, and validate the OsteoArthritis Quality Indicator (OA-QI) questionnaire version 2, an established and validated questionnaire in Norwegian and English, for Germany and Italy. The second aim is to determine the quality of care for osteoarthritis of the hip and knee in a sample of patients who consult general practice in South Tyrol, and for comparison with patients who are admitted to rehabilitative spa-treatments for osteoarthritis in the state of Salzburg, Austria.

DISCUSSION

The results of this study will enable the identification and closure of gaps in osteoarthritis care. Although it is expected that body weight and exercise will play special roles, other areas of nonsurgical care might also be involved.

Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial

Background

Intra articular (IA) injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) are of the new methods in the management of hip osteoarthritis (OA). The aim of this study was to compare the effectiveness of IA injections of PRP, HA and their combination in patients with hip OA. HA and PRP are two IA interventions that can be used in OA in the preoperative stages. Due to the different mechanisms of action, these two are proposed to have a synergistic effect by combining.

Methods

This is a randomized clinical trial with three parallel groups. In this study, patients with grade 2 and 3 hip OA were included, and were randomly divided into three injection groups: PRP, HA and PRP + HA. In either group, two injections with 2 weeks’ interval were performed into the hip joint under ultrasound guidance. Patients were assessed before the intervention, 2 months and 6 months after the second injection, using the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne questionnaires.

Results

One hundred five patients were enrolled randomly in HA, PRP and PRP + HA groups. All three groups showed significant improvement in WOMAC, VAS, and Lequesne at 2 months and 6 months compared with baseline. Comparison of the 3 groups demonstrated significant differences regarding WOMAC and Lequesne total scores and the activities of daily living (ADL) subscale of Lequesne (P = 0.041, 0.001 and 0.002, respectively), in which the observed improvement at 6th month was significantly higher in the PRP + HA and PRP groups compared to the HA group.

Conclusion

Although all 3 interventions were associated with improvement of pain and function in patients with hip OA, the therapeutic effects of PRP and PRP + HA injections lasted longer (6 months), and the effects of these two interventions on patients’ performance, disability, and ADL were superior to HA in the long run. Moreover, the addition of HA to PRP was not associated with a significant increase in the therapeutic results.

Trial registration

The study was registered at Iranian Registry of Clinical Trials (IRCT) website http://www.irct.ir/, a WHO Primary Register setup, with the registration number of IRCT20130523013442N30 on 29/11/2019.

Radial T2* mapping reveals early meniscal abnormalities in patients with knee osteoarthritis

OBJECTIVE

We aimed to validate a 2D radial T2* mapping method and its ability to reveal subtle alterations in the menisci of patients with knee osteoarthritis (OA).

METHODS

Of 40 enrolled participants, 20 were diagnosed with OA, and 20 were age- and sex-matched asymptomatic controls. Data from the right knee of each participant were collected using a 1.5-T MRI equipped with a single-channel knee coil. T2* values were acquired using a conventional T2* mapping protocol and a radial T2* mapping method. Mean T2* values in the meniscal white zones, meniscal red zones, and total menisci were calculated. Numerical simulation was performed for validation.

RESULTS

Both simulation and clinical data confirmed that 2D radial T2* mapping provided better discrimination than the conventional method. Compared to controls, the OA group showed significantly greater mean (standard deviation) T2* values in the white zones (9.33 [2.29] ms vs. 6.04 [1.05] ms), red zones (9.18 [2.03] ms vs. 6.81 [1.28] ms), and total menisci (9.26 [2.06] ms vs. 6.34 [1.14] ms). Correlations were found between the Lequesne index and the meniscal T2* values in all three regions (r = 0.528, p = 0.017; r = 0.635, p = 0.003; and r = 0.556, p = 0.011, respectively).

CONCLUSION

These findings indicate that in early OA, radial T2* mapping is an alternative means of assessing meniscal degeneration and can be used to monitor its progression.

KEY POINTS

• Radial T2* mapping outperforms Cartesian T2* mapping. • Radial T2* measurements are useful in assessing meniscal degeneration. • Meniscal T2* values correlate well with disease severity.

Hip scores: A current concept review

INTRODUCTION

During the past decades, several rating scales have been developed to assess the functional status of patients with hip pain.

SOURCE OF DATA

A search in Medline, PubMed, Cochrane and CINAHL was performedusing combinations of the following'hip', 'scoring system', 'scale', 'scores', 'outcome assessment', 'arthroplasty', 'arthroscopy' and 'clinical evaluation'.

AREAS OF AGREEMENT

A total 16 scoring systems are currently available for the evaluation of the hip.

AREAS OF CONTROVERSY

Two types of questionnaires are available: physician-rated and patient-rated questionnaires.

GROWING POINTS

Each hip score consists of different domains. Interpreting these domains becomes sometimes difficult, because, even though they can be common to more than one scoring system, each stresses them in a different way.

AREAS TIMELY FOR DEVELOPING RESEARCH

Although many scoring systems have been used to evaluate hip function, we are still far from a single outcome evaluation system which is reliable, valid and sensitive.

The challenges of assessing osteoarthritis and postoperative pain in dogs

The challenge of measuring pain in veterinary medicine is compounded by the lack of fully validated, reliable methods to measure and assess pain in nonverbal patients. In human medicine, there are numerous, validated pain assessment tools (PATs) for assessing various, specific types of pain. The advances in human medicine pain management and numerous validated pain scales should serve as incentives and templates to facilitate similar advances in the development of validated PATs for use in dogs (and other species). The limited number of canine PATs constrains our ability to adequately and reliably assess pain. Improving the ability to quantify osteoarthritis and postoperative pain in dogs would enhance the development of analgesics for animals, advance the management of animal pain, facilitate the use of animal pain models in preclinical trials for human analgesics, and provide insight into the quantification of pain responses in humans who lack the ability to adequately communicate. This review describes the need for practical, valid, and reliable PATs for use in veterinary patients and discusses some currently available PATs commonly used to evaluate acute and chronic pain in dogs.

Clinical effectiveness of knee rehabilitation techniques and implications for a self-care treatment model

BACKGROUND

Physiotherapy is a complex intervention frequently recommended for knee conditions. The International Classification of Functioning and Disability (ICF) can be used as a framework to evaluate evidence to develop care models and clinical guidelines.

OBJECTIVE

To evaluate the clinical effectiveness of knee rehabilitation modalities categorised according to the ICF domains.

DATA SOURCES

A keyword search of Medline, Cinahl, Amed, Embase and Cochrane databases from 1996 to 2010 using terms related to the knee joint and physiotherapeutic interventions.

STUDY SELECTION

Reviewer assessment using inclusion/exclusion criteria and a quality assessment tool compiled from the Critical Appraisal Skills Programme Tool, Consort and Cochrane Bone Joint and Muscle Trauma Groups.

DATA EXTRACTION

Information about the research design, intervention and subjects was extracted. Outcome measures and findings were categorised according to ICF domains.

DATA SYNTHESIS

The majority of studies evaluated exercise. Findings were supportive but specific recommendations were limited due to variations in content and application. There was limited quality research to support the theory that manual therapy, electrotherapy or taping in isolation contributes to recovery. Multimodality physiotherapy programmes were found to be beneficial and to reflect clinical practice, but the effectiveness of each component is unknown. Outcome measures from the participation domain of the ICF were used least frequently and were not generally true measures of participation.

CONCLUSION

Development of participation outcome measures is required to evaluate the long-term benefits of interventions. Rehabilitation should be based around delivery of effective exercise programmes incorporating participation outcomes to provide feedback and complement self-care for knee conditions.

Current evidence for osteoarthritis treatments

Osteoarthritis (OA) is the most common form of arthritis and the leading cause of chronic disability among older people. The burden of the disease is expected to rise with an aging population and the increasing prevalence of obesity. Despite this, there is as yet no cure for OA. However, in recent years, a number of potential therapeutic advances have been made, in part due to improved understanding of the underlying pathophysiology. This review provides the current evidence for symptomatic management of OA including nonpharmacological, pharmacological and surgical approaches. The current state of evidence for disease-modifying therapy in OA is also reviewed.

Rasch analysis of the Oxford Knee Score

OBJECTIVES

Use Rasch analysis to examine the psychometric properties of the Oxford Knee Score (OKS), particularly in respect to unidimensionality, and consistency of item functioning before and after total knee replacement and across age and gender groups.

METHODS

The 12-item OKS was administered to 1,712 patients before the surgery, and 1,322 and 855 patients were administered the instrument repeatedly at the 6-month and 2-year postoperative assessments, respectively. Data were fitted to the Rasch partial credit model with the Winsteps program. Differential item functioning (DIF) analysis was performed, and fit statistics in combination with principal components analysis of the residuals were used to test the unidimensionality assumption. The fit criteria were set at 1.5 and 2.0 for infit mean-square (MNSQ) and outfit MNSQ, respectively.

RESULTS

At baseline, item difficulty ranged from -1.86 to 1.78 logits, and person measures had a mean+/-SD of -0.01+/-0.89. Misfit items were "limping" and "night pain" in preoperative data and "limping" and "kneeling" in postoperative data. After removing items limping and kneeling and recoding item night pain, none of the items misfit at each of the time points and there was stability of item difficulty ordering across time. In the modified OKS set, five items displayed DIF by age and three by gender.

CONCLUSION

The original OKS had adequate targeting and good coverage of knee severity levels in preoperative patients. The modified 10-item OKS data fit the Rasch model and had stable item difficulty ordering over time.

The Foot Posture Index: Rasch Analysis of a Novel, Foot-Specific Outcome Measure

OBJECTIVE

To investigate the internal construct validity of a clinician-assessed measure of foot position, the Foot Posture Index (FPI), versions FPI-8 and FPI-6.

DESIGN

Rasch analysis of baseline FPI scores from studies conducted during the development of the instrument.

SETTING

A community-based and a hospital-based study, conducted at 2 institutions.

PARTICIPANTS

Measures were obtained from 143 participants (98 men, 45 women; age range, 8-65y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Rasch analysis was undertaken using RUMM2020 software in order to evaluate the following properties of the FPI: unidimensionality of each item included in the FPI, the differential item functioning (DIF) of each item, and item and person separation indices.

RESULTS

In the developmental draft of the instrument, the 8-item FPI-8 showed some misfit to the Rasch model (chi(16)(2) test=27.63, P=.03), indicating lack of unidimensionality. Two items were identified as problematic in the Rasch modeling: Achilles' tendon insertion (Helbing's sign), which showed illogical response ordering and "congruence of the lateral border of the foot," which showed misfit, indicating that this item may be measuring a different construct (chi(2)(2) test=15.35, P<.01). All FPI-8 items showed an absence of DIF, and the person separation index (PSI) was good (PSI=.88). The revised FPI-6, which does not include the 2 problematic items, showed unidimensionality (chi(12)(2) test=11.49, P=.49), indicating a good overall fit to the model, and improvement over the preliminary version. With the removal of the 2 problematic items, there were no disordered thresholds; all items remained DIF free and all individual items displayed a good fit to the model. The person-separation index for the FPI was similar for both the 8-item (FPI-8=.880) and 6-item (FPI-6=.884) versions.

CONCLUSIONS

The original FPI-8 showed significant mismatching to the model. The 2 items in the FPI-8 that were identified as problematic in clinical validation studies were also found to be contributing to the lack of fit to the Rasch model. The finalized 6-item instrument showed good metric properties, including good individual item fit and good overall fit to the model, along with a lack of differential item functioning. This analysis provides further evidence for the validity of the FPI-6 as a clinical instrument for use in screening studies and shows that it has the potential to be analyzed using parametric strategies.

The assessment of disability associated with osteoarthritis

PURPOSE OF REVIEW

Disability (activity limitation) is an important and common health outcome for patients with osteoarthritis, making accurate measures essential. This paper explores self-report measures of activity limitation associated with osteoarthritis and reports on recent conceptual advances that impact on the measurement of activity limitation.

RECENT FINDINGS

The Western Ontario and McMaster Universities Osteoarthritis Index and the Short Form-36, the most commonly used measures to assess activity limitation, continue to be validated in osteoarthritis. There has been little consensus, however, about which measure to use across different types of osteoarthritis. While new measures have been developed to assess activity limitation, it remains unclear whether or not these are an improvement over existing measures. The International Classification of Functioning, Disability and Health is becoming an important consideration. Commonly used measures do not map directly onto individual constructs of this classification, however a new measure for Japanese people with knee osteoarthritis was developed based on these constructs.

SUMMARY

There have been significant developments in the conceptual approach to measuring activity limitation. Measures are needed that operationalize activity limitation as defined by the International Classification of Functioning, Disability and Health (within or ideally across cultures), providing a common underlying construct for measures and hence facilitating comparability across studies.