Dataset Information

Assessing Radiographic Knee Osteoarthritis: An Online Training Tutorial for the Kellgren-Lawrence Grading Scale.

ABSTRACT:

Introduction

Knee osteoarthritis (OA) is a degenerative form of arthritis commonly diagnosed in older adults. It presents clinically with patient complaints of pain and impaired function, which are thought to result from cartilage degeneration and other skeletal changes. These changes can by examined radiographically and quantified using the semiquantitative grading scale known as the Kellgren-Lawrence (KL) scale. Currently, no standard training exists for KL grading, which may explain the unsatisfactory reliability of this tool in OA research. Therefore, the objective of this project was to develop a training tutorial for KL grading of knee OA to educate assessors on possible areas of inconsistency in grading.

Methods

The tutorial was developed in an e-learning authoring tool, Articulate Presenter. The content focuses on the poor reliability of KL grading, normal anatomy of a knee radiograph, and multiple examples of bony changes within the knee and their relation to different grades of the KL scale. The tutorial was presented to a group of health sciences graduate students at the University of Colorado Denver.

Results

Students were able to complete the training and an associated assessment in under an hour and reported improved confidence with assessing radiographic knee OA. Furthermore, they demonstrated favorable inter- and intrarater reliability scores in applying KL grading.

Discussion

To our knowledge, this is the first attempt to standardize training in KL grading for knee OA and to examine the effects of this training on reliability.

SUBMITTER: Hayes B

PROVIDER: S-EPMC6440422 | biostudies-literature | 2016 Nov

REPOSITORIES: biostudies-literature

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Publications

Assessing Radiographic Knee Osteoarthritis: An Online Training Tutorial for the Kellgren-Lawrence Grading Scale.

Hayes Bethany B Kittelson Andrew A Loyd Brian B Wellsandt Elizabeth E Flug Jonathan J Stevens-Lapsley Jennifer J

MedEdPORTAL : the journal of teaching and learning resources 20161118

<h4>Introduction</h4>Knee osteoarthritis (OA) is a degenerative form of arthritis commonly diagnosed in older adults. It presents clinically with patient complaints of pain and impaired function, which are thought to result from cartilage degeneration and other skeletal changes. These changes can by examined radiographically and quantified using the semiquantitative grading scale known as the Kellgren-Lawrence (KL) scale. Currently, no standard training exists for KL grading, which may explain t ...[more]

PMID: 30984845

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Project description:INTRODUCTION: Osteoarthritis (OA) is considered to be a multifactorial and polygenic disease and diagnosis is mainly clinical and radiological. Correlation between radiographic data and clinical status has been reported. However, very few studies, especially in Caucasian people, describe the association between the Kellgren and Lawrence OA grading scale (KL) and genetic alterations to better understand OA etiopathogenesis and susceptibility. In order to update the knee OA grading, in this study we assessed the associations between KL grade, clinical features such as American Knee Society Score (AKSS), age, and polymorphisms in the principal osteoarthritis susceptibility (OS) genes in Sicilian individuals. METHODS: In 66 Sicilian individuals affected by primary knee OA, the clinical and radiographic evaluation was performed using 2 sub-scores of AKSS (knee score (KS) and function score (FS)) and KL. The patients were also classified according to age. Online Mendelian Inheritance in Man (OMIM) and Database of Single Nucleotide Polymorphisms (dbSNP) Short Genetic Variations databases were used to select gene regions containing the following polymorphisms to analyze: FRZB rs288326 and rs7775, MATN3 rs77245812, ASPN D14 repeats, PTHR2 rs76758470, GDF5 rs143383 and DVWA rs11718863. Patient genotypes were obtained using Sanger DNA sequencing analysis. RESULTS: In our cohort of patients a statistical association between the variables analyzed was reported in all associations tested (KL versus KS, FS and age). We observed that a mild to severe OA radiographic grade is related to severe clinical conditions and loss of articular function and that the severity of symptoms increases with age. Concerning the genotyping analysis, our results revealed a significant statistical association between KL grading and GDF5 rs143383 and DVWA rs11718863 genetic alterations. The latter was also associated with a more severe radiographic grade, displaying its predictive role as OA marker progression. Statistically significant association between clinical, radiographic and genetic signs observed, suggests extending the actual grading of knee OA based mainly on X-ray features. CONCLUSIONS: This work represents a multidisciplinary and translational medicine approach to study OA where clinical, radiological, and OS5 and OS6 SNPs evaluation could contribute to better define grading and progression of OA and to the development of new therapies.

Project description:BackgroundIntra-articular injections of hyaluronic acid-also called viscosupplementation (VS)-is frequently used for the symptomatic treatment of knee osteoarthritis, a painful and debilitating long-term disease, affecting an important fraction of elderly populations. Severity of knee osteoarthritis is generally described by Kellgren-Lawrence (KL) radiological classification. VS has been widely studied in many clinical trials; however, the results are rarely analyzed in detail according to KL grade.MethodA large, clinical, open-label study was performed in 2004-2007 on 1177 patients with knee osteoarthritis, each treated with VS consisting of 3 injections of Arthrum H 2% (LCA Pharmaceutical, Chartres, France). The characteristics of the patients at baseline included demographic profile, body mass index, KL grade, and clinical scores for pain and function using the Western Ontario and McMaster Universities index. Follow-up visits were at 3, 6, and 9 months after VS procedure. This large database was entirely reprocessed in 2019 to provide a separate analysis per KL grade, complemented by the assessment of the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International rates (%) of responders to the treatment. The analysis was carried out for both intention-to-treat and per-protocol completer populations.ResultsA primary outcome in the intention-to-treat analysis, variations of the Western Ontario and McMaster Universities index pain subscore from inclusion to the end of the study were 19.8, 19.8, 17.8, and 14.2 for KL grade I to KL grade IV patients, respectively, on a 0 to 100 scale. In the per-protocol analysis, under the same conditions, the variations were 20.6, 19.9, 17.1, and 11.7. All results were significant (P < 0.001) and clinically relevant for each KL grade. Significant improvements were also observed for the Western Ontario and McMaster Universities index function subscore and for the other secondary outcomes. The Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International responders rate reached 72% to 82% for KL grade I through III patients at Month 6 and Month 9. For KL grade IV patients, the maximum rate reached was 47.7% at Month 6. There was evidence that KL grade is a critical parameter, particularly if KL grade IV is present. Other parameters such as gender, body mass index, and age were not identified as prognostic factors of response to VS based on χ2 and odds ratio (95% CI) testing.ConclusionsDetailed analysis by KL grade supports that VS treatment with Arthrum H 2% applies to a large variety of patients with knee osteoarthritis.

Dataset Information

Assessing Radiographic Knee Osteoarthritis: An Online Training Tutorial for the Kellgren-Lawrence Grading Scale.

Introduction

Methods

Results

Discussion

Publications

Assessing Radiographic Knee Osteoarthritis: An Online Training Tutorial for the Kellgren-Lawrence Grading Scale.

Similar Datasets

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