Diagnostic Accuracy of Quadriceps Muscle Strength Measure in Discriminating between Knee Osteoarthritis Patients with Mild and Moderate to Severe Radiographic Signs

Document Type : Original Article

Authors

1 PhD Candidate.Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

2 Associate Professor of Musculoskeletal Rehabilitation.Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

3 Professor of Musculoskeletal Rehabilitation.Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Assistant Professor of Physical Therapy.Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

5 Assistant Professor of Physical Therapy.Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background and Objective: Accurate diagnosis and discrimination of quadriceps muscle weakness between mild and moderate to severe grades of knee osteoarthritis (OA) can help timely treatment and prevention of future complications. Thus, our aim of this study was to evaluate the accuracy of quadriceps strength measure and to determine its optimal cutoff point in discriminating between two groups of mild and moderate to severe knee OA radiographic sign.
Subjects and Methods:  Based on the Kellgren-Lawrence (KL) grading scale, a total of 130 knee OA patients were classified into 65 patients with mild (a KL grade≤ 2) and 65 patients with moderate to severe (a KL grade≥3) radiographic sign. Quadriceps muscle strength was assessed using isometric dynamometer. The accuracy of this measure was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC), likelihood ratios (LR), and predictive values (PV).
Results: Our results showed that quadriceps muscle strength had high sensitivity and good level of accuracy in discriminating between the two groups of knee OA patients. Also, based on LR and PV results, quadriceps muscle strength had good ability for ruling out moderate to severe grade of knee OA patients and accurate diagnose of mild grade of patients, respectively.
Conclusion: Our findings provide evidence for good accuracy of quadriceps muscle strength in discriminating between the two groups of knee OA patients. Thus, it may be recommended that this measure be evaluated before planning for intervention.

Keywords


1-Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle Impairments in Patients With Knee Osteoarthritis. Sports Health. 2012 Jul;4(4):284-92. PubMed PMID: 23016099. Pubmed Central PMCID: PMC3435919. eng.
2-Omori G, Koga Y, Tanaka M, Nawata A, Watanabe H, Narumi K, et al. Quadriceps muscle strength and its relationship to radiographic knee osteoarthritis in Japanese elderly. J Orthop Sci. 2013 Jul;18(4):536-42. PubMed PMID: 23559040. Epub 2013/04/06. eng.
3-Hurley M, Scott D, Rees J, Newham D. Sensorimotor changes and functional performance in patients with knee osteoarthritis. Ann Rheum Dis. 1997 Nov;56(11):641-8. PubMed PMID: 9462165. Pubmed Central PMCID: PMC1752287. eng.
4-Hinman RS, Hunt MA, Creaby MW, Wrigley TV, McManus FJ, Bennell KL. Hip muscle weakness in individuals with medial knee osteoarthritis. Arthritis Care Res (Hoboken). 2010 Aug;62(8):1190-3. PubMed PMID: 20704005. Epub 2010/08/13. eng.
5-Petterson SC, Barrance P, Buchanan T, Binder-Macleod S, Snyder-Mackler L. Mechanisms Undlerlying Quadriceps Weakness in Knee Osteoarthritis. Med Sci Sports Exerc. 2008 Mar;40(3):422-7. PubMed PMID: 18379202. Pubmed Central PMCID: PMC3573845. eng.
6-Slemenda C, Heilman DK, Brandt KD, Katz BP, Mazzuca SA, Braunstein EM, et al. Reduced quadriceps strength relative to body weight: a risk factor for knee osteoarthritis in women? Arthritis Rheum. 1998 Nov;41(11):1951-9. PubMed PMID: 9811049. Epub 1998/11/12. eng.
7-Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494-502. PubMed PMID: 13498604. Pubmed Central PMCID: PMC1006995. Epub 1957/12/01. eng.
8-Petersson IF, Boegard T, Saxne T, Silman AJ, Svensson B. Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain. Ann Rheum Dis. 1997 Aug;56(8):493-6. PubMed PMID: 9306873. Pubmed Central PMCID: PMC1752423. Epub 1997/08/01. eng.
9-Schiphof D, Kerkhof HJ, Damen J, de Klerk BM, Hofman A, Koes BW, et al. Factors for pain in patients with different grades of knee osteoarthritis. Arthritis Care Res (Hoboken). 2013 May;65(5):695-702. PubMed PMID: 23203619. Epub 2012/12/04. eng.
10-Maffiuletti NA. Assessment of hip and knee muscle function in orthopaedic practice and research. J Bone Joint Surg Am. 2010 Jan;92(1):220-9. PubMed PMID: 20048117. Epub 2010/01/06. eng.
11-Ikeda S, Tsumura H, Torisu T. Age-related quadriceps-dominant muscle atrophy and incident radiographic knee osteoarthritis. J Orthop Sci. 2005;10(2):121-6. PubMed PMID: 15815857. Epub 2005/04/09. eng.
12-Mohammadi F, Taghizadeh S, Ghaffarinejad F, Khorrami M, Sobhani S. Proprioception, dynamic balance and maximal quadriceps strength in females with knee osteoarthritis and normal control subjects. Int J Rheum Dis. 2008;11(1):39-44.
13-Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. BMJ. 2003 Jan 4;326(7379):41-4. PubMed PMID: 12511463. Pubmed Central PMCID: PMC1124931. Epub 2003/01/04. eng.
14-Eusebi P. Diagnostic accuracy measures. Cerebrovasc Dis. 2013;36(4):267-72. PubMed PMID: 24135733. Epub 2013/10/19. eng.
15-Florkowski CM. Sensitivity, Specificity, Receiver-Operating Characteristic (ROC) Curves and Likelihood Ratios: Communicating the Performance of Diagnostic Tests. Clin Biochem Rev. 2008 Aug;29(Suppl 1):S83-7. PubMed PMID: 18852864. Pubmed Central PMCID: PMC2556590. eng.
16-Greiner M, Pfeiffer D, Smith RD. Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests. Prev Vet Med. 2000 May 30;45(1-2):23-41. PubMed PMID: 10802332. Epub 2000/05/10. eng.
17-Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986 Aug;29(8):1039-49. PubMed PMID: 3741515. Epub 1986/08/01. eng.
18-Buckland-Wright C. Protocols for precise radio-anatomical positioning of the tibiofemoral and patellofemoral compartments of the knee. Osteoarthritis Cartilage. 1995 Sep;3 Suppl A:71-80. PubMed PMID: 8581753. Epub 1995/09/01. eng.
19-Sun Y, Gunther KP, Brenner H. Reliability of radiographic grading of osteoarthritis of the hip and knee. Scand J Rheumatol. 1997;26(3):155-65. PubMed PMID: 9225869. Epub 1997/01/01. eng.
20-Fransen M, Crosbie J, Edmonds J. Isometric muscle force measurement for clinicians treating patients with osteoarthritis of the knee. Arthritis Rheum. 2003 Feb 15;49(1):29-35. PubMed PMID: 12579591. Epub 2003/02/13. eng.
21-Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. J Strength Cond Res. 2005 Feb;19(1):231-40. PubMed PMID: 15705040. Epub 2005/02/12. eng.
22-Wikstrom EA, Tillman MD, Chmielewski TL, Cauraugh JH, Naugle KE, Borsa PA. Discriminating between copers and people with chronic ankle instability. J Athl Train. 2012 Mar-Apr;47(2):136-42. PubMed PMID: 22488278. Pubmed Central PMCID: PMC3418124. Epub 2012/04/11. eng.
23-Fritz JM, Wainner RS. Examining diagnostic tests: an evidence-based perspective. Phys Ther. 2001 Sep;81(9):1546-64. PubMed PMID: 11688591. Epub 2001/11/02. eng.
24-Šimundić AM. Measures of Diagnostic Accuracy: Basic Definitions. Ejifcc. 2009 Jan;19(4):203-11. PubMed PMID: 27683318. Pubmed Central PMCID: PMC4975285. eng.
25-Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010 Jun;18(6):769-75. PubMed PMID: 20188686. Pubmed Central PMCID: PMC2873062. Epub 2010/03/02. eng.
26-Oiestad BE, Juhl CB, Eitzen I, Thorlund JB. Knee extensor muscle weakness is a risk factor for development of knee osteoarthritis. A systematic review and meta-analysis. Osteoarthritis Cartilage. 2015 Feb;23(2):171-7. PubMed PMID: 25450853. Epub 2014/12/03. eng.
27-Rice DA, McNair PJ, Lewis GN. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects. Arthritis Res Ther. 2011;13(5):R151. PubMed PMID: 21933392. Pubmed Central PMCID: PMC3308081. eng.