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Zuckerman S1,2, Lutz N1,2,3, Rasch H4, Seel F5, Ott-Senn Y6, Laouenan I7, Baumann U8, Merz J9
1University of Applied Sciences, Health, Bern, Switzerland, 2Bildungszentrum Gesundheit Basel-Stadt, Studiengang Physiotherapie, Basel, Switzerland, 3Vrije Universiteit Brussel, Department of Movement and Sport Sciences, Brussel, Belgium, 4Kantonsspital Baselland-Bruderholz, Institute for Radiology and Nuclear Medicine, Bruderholz, Switzerland, 5International Education Centre for Physiotherapy IAP, Eckartsweier, Germany, 6Rehaklinik Rheinfelden, Physiotherapy, Rheinfelden, Switzerland, 7Merian Iselin Spital, Physiotherapy, Basel, Switzerland, 8RückGrat, Physiotherapy, Therwil, Switzerland, 9Physiomitteldorf, Physiotherpie, Suhr, Switzerland
Background: Osteoarthritis (OA) is a leading cause of disability in elderly and often present at the knee. Mechanical forces and tibio-femoral malalignment are considered to bring on and develop knee OA. Early detection of knee compartment overloading might be important to prevent or delay the progress of OA. For clinical decisions in physiotherapy, it is important to know whether this impact zone is in the medial or in the lateral compartment as treatment for lateral and medial compartment OA differs. Various factors such as alignment, muscle balance and notably hip rotation were found to influence compartment overloading.
Purpose: The first goal of this study was to assess inter-rater reliability of routine clinical tests to examine knee and hip alignment and range of motion (ROM). Second, predicted impact zones via clinical exams were compared with impact zones obtained from SPECT-CT in order to evaluate concurrent validity.
Methods: A test battery to assess alignment and range of motion of the lower extremity was developed using a Delphi-method approach. Clinical tests were selected based on biomechanical reasoning and their practicability in therapy centers. Subjects with symptoms for knee OA were recruited and tested by two of total six independent raters to assess inter-rater reliability. After each testing sequence, a consensus discussion between the two raters took place. All subjects received a SPECT-CT, which served as reference for compartment overloading in the knee. Inter-rater reliability was calculated using the Kappa statistics. Concurrent validity was assessed via linear regression and relationships between clinical findings and impact zones were determined using logistic regression.
Results: 30 subjects were included to the study. Kappa values for clinical exams ranged between 0.19 (95% CI = -0.22 to 0.61) and 0.8 (95% CI = 0.8 to 0.8). Inter-rater reliability for determination of impact zones via clinical exams was 0.52 (95% CI = 0.28 to 0.76). Agreement between impact zones established through clinical examination and impact zone provided by SPECT-CT was found to be borderline significant (r = 0.3, p = 0.057). Valgus knee alignment was significantly related with the impact zone. No other relationships were found between clinical findings and impact zones.
Conclusion(s): A number of clinical examination tests yielded unfavourable results and are thus comparable to previous studies investigating reliability of manual testing. The highest value for agreement was found determining the knee angle in the frontal plane.
In line with previous research, our results suggest that impact zone in knee compartment might be predictable by accurate valgus measurement as significant relationship was found between frontal plane knee angle and impact zone tested by the gold standard SPECT-CT measure.
Implications: To improve test results, more standardization is needed to allow for higher inter-rater reliability and thus, better validity. In consequence, to verify the role of hip rotation in knee compartment overloading introducing a measuring device or grading system for testing might generate more consistent results.
Keywords: Knee-osteoarthritis, Clinical examination, Biomechanics
Funding acknowledgements: The study is founded by SFABS Schweizerische Fachgruppe für Analytische Biomechanik nach R. Sohier”.
Purpose: The first goal of this study was to assess inter-rater reliability of routine clinical tests to examine knee and hip alignment and range of motion (ROM). Second, predicted impact zones via clinical exams were compared with impact zones obtained from SPECT-CT in order to evaluate concurrent validity.
Methods: A test battery to assess alignment and range of motion of the lower extremity was developed using a Delphi-method approach. Clinical tests were selected based on biomechanical reasoning and their practicability in therapy centers. Subjects with symptoms for knee OA were recruited and tested by two of total six independent raters to assess inter-rater reliability. After each testing sequence, a consensus discussion between the two raters took place. All subjects received a SPECT-CT, which served as reference for compartment overloading in the knee. Inter-rater reliability was calculated using the Kappa statistics. Concurrent validity was assessed via linear regression and relationships between clinical findings and impact zones were determined using logistic regression.
Results: 30 subjects were included to the study. Kappa values for clinical exams ranged between 0.19 (95% CI = -0.22 to 0.61) and 0.8 (95% CI = 0.8 to 0.8). Inter-rater reliability for determination of impact zones via clinical exams was 0.52 (95% CI = 0.28 to 0.76). Agreement between impact zones established through clinical examination and impact zone provided by SPECT-CT was found to be borderline significant (r = 0.3, p = 0.057). Valgus knee alignment was significantly related with the impact zone. No other relationships were found between clinical findings and impact zones.
Conclusion(s): A number of clinical examination tests yielded unfavourable results and are thus comparable to previous studies investigating reliability of manual testing. The highest value for agreement was found determining the knee angle in the frontal plane.
In line with previous research, our results suggest that impact zone in knee compartment might be predictable by accurate valgus measurement as significant relationship was found between frontal plane knee angle and impact zone tested by the gold standard SPECT-CT measure.
Implications: To improve test results, more standardization is needed to allow for higher inter-rater reliability and thus, better validity. In consequence, to verify the role of hip rotation in knee compartment overloading introducing a measuring device or grading system for testing might generate more consistent results.
Keywords: Knee-osteoarthritis, Clinical examination, Biomechanics
Funding acknowledgements: The study is founded by SFABS Schweizerische Fachgruppe für Analytische Biomechanik nach R. Sohier”.
Topic: Musculoskeletal: lower limb; Outcome measurement
Ethics approval required: Yes
Institution: Ethikkommission Nordwest- und Zentralschweiz
Ethics committee: EKNZ
Ethics number: EKNZ 2014-236
All authors, affiliations and abstracts have been published as submitted.
