Czamara A1, Zajac B1, Krolikowska A1, Kulej M2
1College of Physiotherapy, Wroclaw, Poland, 2Wroclaw Medical University, Wroclaw, Poland
Background: So far, the literature doesn't clearly explain whether there is a relationship between the degree of OA, age and proprioception, and whether the proprioception assessment may complement the clinical examination in qualifying patients for physiotherapy or surgery.
Purpose: Determination of the diagnostic value of proprioception in terms of active knee joint (KJ) position sensation (AKJPS) in relation to X-ray examination, range of motion (ROM), circumferences and KJ pain in people of different ages and with different degrees of knee joint OA severity.
Methods: Group I, n=22, age x=69.0±5.5, knee joint (KJ) IV degree OA according to Kellgren-Lawrence (Q-L). Group II, n=20, age 71.0±7.1, II/III K-L OA. Group III, n=22, age 22.5±2.5 without OA. In the groups after orthopaedic examination and X-ray analysis, AKJPS error in the KJ flexion for 75° and AKJPS 45° using Biodex, pain intensity (Visual Analogue Scale, VAS), ROM and KJ circumferences were measured. In Group I, measurements were made separately for KJ qualified for total knee replacement (KJTR), then for the second KJ. In groups II and III for the right KJ and the left KJ, respectively.
Results: ANOVA analysis showed significant differences in AKJPS error for 45° and 75° KJ flexion between groups ( 0.001). In group I, the post-hoc test showed that KJTR had a significantly higher AKJPS error for 45° KJ bend compared to right and left KJ groups II and III and a larger AKJPS error in group II compared to group III, which was statistically significant respectively (p 0.05, p 0.001 and p 0.01), where the real mean values of the sensation error of this angle were x=8.10, x=4.90 and x=2.50, respectively. However, for the angle of 75°, a statistically significant higher AKJPS error was noted in KJTR group I compared to group III and between II and III for both joints (p 0.001 and p 0.01, respectively). In group I, the highest mean pain values were found in the VAS scale x=7.27 compared to the group II (x=0.80) and III (x=0.00), which was statistically significant in comparison to groups I to II and I to III (p=0.001). In addition, KJTR had significantly higher circumference values, limitations of KJ extension and flexion compared to group II and III results (p 0.01 to p 0.001). Between groups II and III there were no significant differences in KJ circuits, and differences in extension and KJ bends were on the verge of statistical significance (p=0.05).
Conclusion(s): Elderly people with advanced OA of the knee joint have greater proprioception disturbances, higher pain level, lower ROM, and larger KJTR circuits compared to older people with lower OA levels and especially significantly greater impairment of these parameters comparing to young people. In group II with moderate OA, there were proprioception disturbances that were not accompanied by pain, disturbances in circuits and KJ motion ranges, which indicates the diagnostic value of proprioception in the early qualification of patients for physio-prophylactics of OA.
Implications: In patients with moderate OA, the proprioception assessment may have a diagnostic value in the early qualification of patients for physio-prophylactics of OA.
Keywords: osteoarthritis, proprioception, joint position sense
Funding acknowledgements: The study was unfunded.
Purpose: Determination of the diagnostic value of proprioception in terms of active knee joint (KJ) position sensation (AKJPS) in relation to X-ray examination, range of motion (ROM), circumferences and KJ pain in people of different ages and with different degrees of knee joint OA severity.
Methods: Group I, n=22, age x=69.0±5.5, knee joint (KJ) IV degree OA according to Kellgren-Lawrence (Q-L). Group II, n=20, age 71.0±7.1, II/III K-L OA. Group III, n=22, age 22.5±2.5 without OA. In the groups after orthopaedic examination and X-ray analysis, AKJPS error in the KJ flexion for 75° and AKJPS 45° using Biodex, pain intensity (Visual Analogue Scale, VAS), ROM and KJ circumferences were measured. In Group I, measurements were made separately for KJ qualified for total knee replacement (KJTR), then for the second KJ. In groups II and III for the right KJ and the left KJ, respectively.
Results: ANOVA analysis showed significant differences in AKJPS error for 45° and 75° KJ flexion between groups ( 0.001). In group I, the post-hoc test showed that KJTR had a significantly higher AKJPS error for 45° KJ bend compared to right and left KJ groups II and III and a larger AKJPS error in group II compared to group III, which was statistically significant respectively (p 0.05, p 0.001 and p 0.01), where the real mean values of the sensation error of this angle were x=8.10, x=4.90 and x=2.50, respectively. However, for the angle of 75°, a statistically significant higher AKJPS error was noted in KJTR group I compared to group III and between II and III for both joints (p 0.001 and p 0.01, respectively). In group I, the highest mean pain values were found in the VAS scale x=7.27 compared to the group II (x=0.80) and III (x=0.00), which was statistically significant in comparison to groups I to II and I to III (p=0.001). In addition, KJTR had significantly higher circumference values, limitations of KJ extension and flexion compared to group II and III results (p 0.01 to p 0.001). Between groups II and III there were no significant differences in KJ circuits, and differences in extension and KJ bends were on the verge of statistical significance (p=0.05).
Conclusion(s): Elderly people with advanced OA of the knee joint have greater proprioception disturbances, higher pain level, lower ROM, and larger KJTR circuits compared to older people with lower OA levels and especially significantly greater impairment of these parameters comparing to young people. In group II with moderate OA, there were proprioception disturbances that were not accompanied by pain, disturbances in circuits and KJ motion ranges, which indicates the diagnostic value of proprioception in the early qualification of patients for physio-prophylactics of OA.
Implications: In patients with moderate OA, the proprioception assessment may have a diagnostic value in the early qualification of patients for physio-prophylactics of OA.
Keywords: osteoarthritis, proprioception, joint position sense
Funding acknowledgements: The study was unfunded.
Topic: Orthopaedics; Older people; Disability & rehabilitation
Ethics approval required: Yes
Institution: Wroclaw Medical University, Wroclaw, Poland
Ethics committee: Bioethical Committee of the Wroclaw Medical University
Ethics number: KB 90/2016
All authors, affiliations and abstracts have been published as submitted.
