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Confounding pain and function: the WOMAC's failure to accurately predict lower extremity function.

ABSTRACT: Background:Investigations have revealed the Western Ontario and McMaster Universities Osteoarthritis Index's (WOMAC) inability to provide distinct assessments of pain and function. The Lower Extremity Functional Scale (LEFS) has not displayed this deficiency. Our purposes were to investigate further the WOMAC physical function's (WOMAC-PF) ability to accurately assess lower extremity mobility in patients undergoing total knee arthroplasty (TKA) and to establish a relationship between pre- and post-TKA WOMAC-PF and LEFS scores that accounts for the apparent bias WOMAC pain scores impose on WOMAC-PF scores. Methods:WOMAC, LEFS, and Timed-up-and-go measures were administered before TKA and 4 days, 6 weeks, and 3 months after TKA. To evaluate the WOMAC-PF and LEFS ability to provide a distinct assessment of pain and function, a paired t-test compared pre-TKA and 4 days after TKA values. Generalized estimating equation (GEE) analysis assessed the relationship between pre- and post-TKA values: dependent variable WOMAC-PF scores; independent variables LEFS scores, and measurement occasions. Results:Timed-up-and-go and LEFS demonstrated a reduction in lower extremity function (P < .001); pain decreased (P < .001); and there was no significant change in WOMAC-PF scores (P = .61). GEE analysis revealed a linear relationship between WOMAC-PF and LEFS with similar slope coefficients for all four occasions. The relationship between WOMAC-PF and LEFS scores was virtually identical for the postarthroplasty assessment occasions. Conclusions:Our findings support previous investigations that showed the WOMAC-PF's inability to provide a valid assessment in change in function. The GEE analysis coefficients can be used to convert LEFS scores to WOMAC-PF scores that adjust for the bias between pre- and post-TKA assessments.

SUBMITTER: Stratford P

PROVIDER: S-EPMC6287962 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Static lower extremity alignment (LEA) during normal stance has been used clinically as a tool to determine the presence of known anterior cruciate ligament (ACL) risk factors during dynamic tasks. Previous work investigating the relationship between static LEA during normal stance and risk factors for ACL injury is limited by the use of imprecise methods or because it focuses on knee valgus only and no other potentially important variables. The aim of this investigation was to determine the relationships between static LEA and the corresponding LEA during drop landings. Forty-one female athletes were recruited for the study (age: 19.8 ± 2.5 years, height: 1.73 ± 0.06 m, mass: 64.03 ± 6.66 kg). Lower limb kinematic data were collected using a 10 camera infrared motion capture system (500 Hz) with retro-reflective markers placed over key anatomical landmarks. This system was linked to two force platforms (1000 Hz) with subsequent three-dimensional kinematic and kinetic data developed using standard software (Visual3D). Following an appropriate warm-up, data collection involved participants standing with their arms partially abducted to record static LEA. This was following by a series of drop landings from a 0.4 m box onto the force platforms. Maximum LEA data during drop landings were then compared with static LEA. Analyses showed that in comparison to static stance, during landings the anterior tilt of the pelvis decreased while hip abduction and knee internal rotation increased. At best, static LEA variables were moderately correlated (r = -0.51 to 0.58) with peak values measured during drop landings. Additionally, regression analysis did not yield any significant predictors of any key peak hip or knee variables measured during drop landings (p = 0.15 to 0.89). When combined, the poor relationships observed between kinematics during static LEA and LEA during drop landings calls into question the practice of using static measures to predict LEA during even simple landing tasks. These findings suggest static assessments of LEA may have minimal value as an ACL injury screening tool.

Project description:BackgroundPoor pain and function outcomes are undesirable after an elective surgery such as total hip or knee arthroplasty (THA/TKA). Recent studies have indicated that the presence of contralateral joint influences outcomes of THA/TKA, however the impact of ipsilateral knee/hip involvement on THA/TKA outcomes has not been explored. The objective of this study was to assess the association of ipsilateral knee/hip joint involvement on short-term and medium-term pain and function outcomes after THA/TKA.MethodsIn this retrospective study of prospectively collected data, we used the data from the Mayo Clinic Total Joint Registry to assess the association of ipsilateral knee or hip joint involvement with moderate to severe pain and moderate to severe activity limitation at 2-year and 5-year follow-up after primary and revision THA and TKA using multivariable-adjusted logistic regression analyses.ResultsAt 2 years, 3,823 primary THA, 4,701 primary TKA, 1,218 revision THA and 725 revision TKA procedures were studied. After adjusting for multiple covariates, ipsilateral knee pain was significantly associated with outcomes after primary THA (all P values <0.01): (1) moderate to severe pain: at 2 years, odds ratio (OR), 2.3 (95% confidence interval (CI) 1.5 to 3.6); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.1 (95% CI 2.3 to 4.3); at 5 years, OR 3.6 (95% CI 2.6 to 5.0). Ipsilateral hip pain was significantly associated with outcomes after primary TKA (all P values <0.01): (1) moderate to severe pain: at 2 years, OR 3.3 (95% CI 2.3 to 4.7); at 5 years, OR 1.8 (95% CI 1.1 to 2.7); (2) moderate to severe activity limitation: at 2 years, OR 3.6 (95% CI 2.6 to 4.9); at 5 years, OR 2.2 (95% CI 1.6 to 3.2). Similar associations were noted for revision THA and TKA patients.ConclusionsTo the best of our knowledge, this is the first study showing that the presence of ipsilateral joint involvement after THA or TKA is strongly associated with poor pain and function outcomes. A potential way to improve outcomes is to address ipsilateral lower extremity joint involvement.

Project description:CONTEXT:Patellofemoral pain (PFP) is a chronic condition that presents with lower extremity muscle weakness, decreased flexibility, subjective functional limitations, pain, and decreased physical activity. Patterned electrical neuromuscular stimulation (PENS) has been shown to affect muscle activation and pain after a single treatment, but its use has not been studied in a rehabilitation trial. OBJECTIVE:To determine the effects of a 4-week impairment-based rehabilitation program using PENS on subjective function, pain, strength, range of motion, and physical activity in individuals with PFP. DESIGN:Randomized controlled trial. SETTING:Laboratory. PATIENTS OR OTHER PARTICIPANTS:A total of 21 patients with PFP (5 males, 16 females; age = 23.4 ± 7.6 years, height = 168.0 ± 7.5 cm, mass = 69.0 ± 19.5 kg). INTERVENTION(S):Participants completed a 4-week supervised rehabilitation program in conjunction with random assignment to receive PENS or sham treatments. MAIN OUTCOME MEASURE(S):Subjective function, pain, strength, range of motion, and physical activity levels were assessed prerehabilitation and postrehabilitation. Subjective function and pain were also assessed at 6 and 12 months postrehabilitation. Repeated-measures analyses of variance and Tukey post hoc testing were conducted with α ≤ .05. We calculated Cohen d effect sizes with 95% confidence intervals. RESULTS:Both groups had statistically and clinically meaningful differences in subjective function, pain, strength, range of motion, and activity level after 4 weeks of impairment-based rehabilitation. Improved subjective function was observed in both groups at 6 and 12 months after the interventions. The PENS group had improvements in current pain for all 3 postrehabilitation times compared with baseline measures. CONCLUSIONS:An impairment-based intervention effectively improved subjective function, pain, strength, range of motion, and physical activity levels in individuals with PFP. Participants who received PENS in addition to the rehabilitation program had improved current pain at 6 and 12 months postrehabilitation compared with baseline scores. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02441712.

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Confounding pain and function: the WOMAC's failure to accurately predict lower extremity function.

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