Steultjens, M.P.M.

Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis (Article)

2012-01-01T00:00:00Z

Objective. To examine the diagnostic accuracy of hip internal rotation, hip flexion, and knee flexion measurements for the presence of osteophytosis and joint space narrowing (JSN) in early symptomatic osteoarthritis (OA). Methods. The baseline data for 598 participants of the Cohort Hip &Cohort Knee study were used. Participants underwent a standardized physical and radiographic examination. The active range of motion (ROM) was assessed using a goniometer. The ROM cutoff with the highest discriminative ability for radiographic features of OA was defined by maximizing the sum of the sensitivity and specificity. Several diagnostic measures were calculated to establish the diagnostic accuracy of ROM measurements for the presence of radiographic features. Results. In patients with hip symptoms, hip internal rotation <24° and flexion <114° were found to be the cutoffs with the highest discriminative ability to distinguish between patients with and without radiographic features. In patients with knee symptoms, knee flexion <132° was the cutoff with the highest discriminative ability. The American College of Rheumatology (ACR) criterion of hip internal rotation <15° increased the probability of the presence of osteophytosis or JSN from 25% to 58%. The diagnostic accuracy of hip and knee flexion measurements was low. Conclusion. To reduce the number of patients that are not identified by the ACR criterion of hip internal rotation <15°, it is recommended to change the cutoff to internal rotation <24° in patients with early symptomatic OA. Individual hip and knee flexion measurements seem to be of little diagnostic value in early symptomatic OA.

Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort (Article)

2011-04-01T00:00:00Z

Objective: Reduced range of motion (ROM) is supposed to be a characteristic feature of osteoarthritis (OA). Because little is known about determinants of ROM, the objective of the present study was to explore the association between demographic, articular, and clinical factors and ROM in patients with early symptomatic knee and/or hip OA. Design: Baseline data of 598 participants of the Cohort Hip and Cohort Knee (CHECK) study were used in this cross-sectional study. Methods: Separate analyses were performed for participants with knee and participants with hip symptoms. Active knee flexion, and hip internal rotation, external rotation, flexion, adduction, and abduction were assessed using a goniometer. Participants underwent a standardised physical and radiographic examination, and completed a questionnaire. Exploratory regression analyses were performed to explore the association between ROM and demographic [i.e., age, gender, body mass index (BMI)], articular [i.e., osteophytosis, joint space narrowing (JSN)], and clinical (i.e., pain, stiffness) factors. Results: In patients with early symptomatic knee OA, osteophytosis, bony enlargement, crepitus, pain, and higher BMI were associated with lower knee flexion. JSN was associated with lower ROM in all planes of motion. In addition, osteophytosis, flattening of the femoral head, femoral buttressing, pain, morning stiffness, male gender, and higher BMI were found to be associated with lower hip ROM in two planes of motion. Conclusion: Features of articular degeneration are associated with lower knee ROM and lower hip ROM in patients with early OA. Pain, stiffness, higher BMI, and male gender are associated with lower ROM as well.

Reliability of the KT1000 arthrometer and the Lachman test in patients with an ACL rupture (Article)

2008-03-01T00:00:00Z

The underlying study is a cross sectional study on the reliability of the KT1000 arthrometer and the Lachman test to determine the within-session inter-rater reliability and intra-rater reliability of the KT1000 arthrometer and the Lachman test. Twenty patients with a complete tear of the anterior cruciate ligament (ACL) were examined in a single session each. During the assessment, two physical therapists measured the anterior-posterior translation of the knee using both the KT1000 arthrometer and the Lachman test. One examiner performed a repeated measurement of each test for determination of intra-rater reliability. The examiners were blinded to the findings of their colleague. The intraclass correlation coefficient (ICC) was used to describe the degree of reliability of the measurements. High ICCs were found for the intra-rater reliability and the inter-rater reliability of the Lachman test (ICC = 1.0 and 0.77). For the KT1000 arthrometer both ICCs were clearly lower (ICC = 0.47 and 0.14). The KT1000 arthrometer shows inadequate reliabilities, even when measurements are repeated within a single measurement session. Contrastingly, the Lachman test is a reliable measurement to determine the anterior-posterior laxity of the ACL deficit knee. The results of the present study suggest good within-session intra-rater reliability as well as inter-rater reliability for the Lachman test.