Knee Instability and Basic and Advanced Function Decline in Knee Osteoarthritis.
Knee Instability and Basic and Advanced Function Decline in Knee Osteoarthritis.
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DOI：
10.1002/acr.22572
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发表时间：
2015-08
影响因子：
4.7
通讯作者：
Hayes KW
中科院分区：
文献类型：
--
作者：
Sharma L;Chmiel JS;Almagor O;Moisio K;Chang AH;Belisle L;Zhang Y;Hayes KW
膝关节骨性关节炎不稳定的表现包括对膝关节整体信心较低、对膝关节不会屈曲、屈曲和步态期间过度运动的信心较低。自信和屈服可能特别影响活动选择，导致导致残疾的事件。屈曲更有可能影响高级功能任务而不是基本功能任务。在这项前瞻性纵向研究中，我们测试了以下假设：步态过程中膝关节整体信心、屈曲信心、屈曲和额面运动与膝关节骨关节炎患者的先进 2 年功能结果相关。膝关节骨关节炎患者被询问整体膝关节信心（越高越差）、屈曲信心和膝关节屈曲，并进行定量步态分析以量化内翻-外翻偏移和角速度。使用 LLFDI 基础和高级下肢领域评分评估身体功能。 Logistic 回归用于评估基线不稳定性测量与基线至 2 年功能结果之间的关系，并调整潜在的混杂因素。样本包括 212 人（平均年龄 64.6 岁，76.9% 为女性）。屈曲与晚期不良显着相关（调整后 OR 2.08，95% CI：1.03-4.20），但与基本功能结果无关。整体膝关节信心与晚期结果显着相关（调整后 OR 1.65，95% CI：1.01-2.70），而屈曲信心与这两种结果之间的关联接近显着性。步态期间的内翻-外翻偏移和角速度均与这两种结果无关。膝关节屈曲和自信均与 2 年晚期功能结果不佳相关。目前的治疗方法并没有解决这些可改变的因素；解决这些问题的干预措施可能会改善膝关节骨关节炎的预后。
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. 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. 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. 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.