Association of Knee Confidence With Pain, Knee Instability, Muscle Strength, and Dynamic Varus–Valgus Joint Motion in Knee Osteoarthritis

Authors

  • Søren T. Skou,

    Corresponding author
    1. Aalborg University Hospital and Aalborg University, Aalborg, Denmark
    • Orthopaedic Surgery Research Unit, Aalborg University Hospital, Research and Innovation Center, 15 Søndre Skovvej, DK-9000 Aalborg, Denmark. E-mail: sots@rn.dk

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  • Tim V. Wrigley,

    1. The University of Melbourne, Melbourne, Victoria, Australia
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    • Mr. Wrigley receives royalties from sales of an osteoarthritis shoe developed with Asics (split between researchers and The University of Melbourne).

  • Ben R. Metcalf,

    1. The University of Melbourne, Melbourne, Victoria, Australia
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  • Rana S. Hinman,

    1. The University of Melbourne, Melbourne, Victoria, Australia
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    • Dr. Hinman has received honoraria (less than $10,000) from serving as an Editorial Board member of Physical Therapy and receives royalties from sales of an educational osteoarthritis DVD and an osteoarthritis shoe developed with Asics (split between researchers and The University of Melbourne).

  • Kim L. Bennell

    1. The University of Melbourne, Melbourne, Victoria, Australia
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    • Dr. Bennell has received speaking fees (less than $10,000) for a presentation at the International Association of Pain Conference (2012) and receives royalties from sales of an educational osteoarthritis DVD and an osteoarthritis shoe developed with Asics (split between researchers and The University of Melbourne).


Abstract

Objective

To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus–valgus joint motion during walking.

Methods

We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus–valgus joint motion during walking as independent variables.

Results

One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus–valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P < 0.001).

Conclusion

Worse knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus–valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target.

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