Radiographic osteoarthritis of the knee classified by the Ahlbäck and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35–54 years with chronic knee pain Agility and Perturbation Training Techniques in Exercise Therapy for Reducing Pain and Improving Function in People With Knee Osteoarthritis: A Randomized Clinical Trial Multiple Psychological Factors Are Associated With Poorer Functioning in a Sample of Community-Dwelling Knee Osteoarthritis Patients Effectiveness of Periosteal Stimulation Therapy and Home Exercise Program in the Rehabilitation of Patients With Advanced Knee Osteoarthritis The effect of motor control and tactile acuity training on patients with non-specific low back pain and movement control impairment. The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10–15 years after anterior cruciate ligament reconstruction Addition of telephone coaching to a physiotherapist-delivered physical activity program in people with knee osteoarthritis: A randomised controlled trial protocol Lateral wedges with and without custom arch support for people with medial knee osteoarthritis and pronated feet: an exploratory randomized crossover study Individuals’ experience of living with osteoarthritis of the knee and perceptions of total knee arthroplasty Effects of Impairment-Based Exercise on Performance of Specific Self-Reported Functional Tasks in Individuals With Knee Osteoarthritis Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study Neuropathic pain symptoms on the modified painDETECT correlate with signs of central sensitization in knee osteoarthritis. Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. The effects of hip muscle strengthening on knee load, pain, and function in people with knee osteoarthritis: a protocol for a randomised, single-blind controlled trial Self-management for osteoarthritis of the knee: Does mode of delivery influence outcome? Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis. Joint Mobilization Enhances Mechanisms of Conditioned Pain Modulation in Individuals With Osteoarthritis of the Knee. A comparison of lower extremity muscle strength, obesity, and depression scores in elderly subjects with knee pain with and without radiographic evidence of knee osteoarthritis. A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study. Therapeutic effects of short-term monochromatic infrared energy therapy on patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index Impact of chronic musculoskeletal pathology on older adults: a study of differences between knee OA and low back pain.
OBJECTIVES To determine the prevalence of tibiofemoral radiographic knee osteoarthritis ( OA ) in people aged 35–54 years associated with chronic ( > 3 months ) knee pain  using two different radiographic grading systems . METHODS Population based postal survey in a r and om sample of inhabitants in a district in southern Sweden followed by  clinical examination and plain posteroanterior , weight bearing radiographical examination .  The Ahlbäck criteria ( focusing on joint space narrowing ) and the Kell- gren & Lawrence classification for knee OA were used for diagnosing tibiofemoral OA . RESULTS A question naire was sent to 2000 r and omly selected people aged 35–54 years . The response rate was 92.6 % . Fifteen per cent of these people reported chronic knee pain .  This group ( n=279 ) was offered a clinical and radiographic examination of the knee joint and 204 persons agreed to participate . According to the Kellgren & Lawrence classification 28 subjects had OA of the knee grade 2 or more and 16 grade 3 or more . Radiographically detected OA of the knee according to Ahlbäck was found in 20 cases . The minimum prevalence of radiological tibiofemoral knee OA with knee pain was thus 1.5 % for Kellgren & Lawrence grade 2 or more , 0.9 % for grade 3 or more , and 1.1 % according to the Ahlbäck classification . The agreement between the Kellgren & Lawrence grade s 2–3 versus Ahlbäck grade I as well as grade 3–4 versus Ahlbäck grade I – II was good ( κ 0.76 and 0.78 respectively ) . CONCLUSION The prevalence of radiographic tibiofemoral OA combined with  chronic knee pain in people aged 35–54 years was around 1 % as estimated by either the Kellgren & Lawrence or the Ahlbäck classifications systems . Prospect i ve follow up of this cohort should eluci date the significance of knee pain as a sign of developing OA Background Impairment-based exercise programs have yielded only small to moderate benefits in reducing pain and improving function in people with knee osteoarthritis ( OA ) . It has previously been proposed that adding agility and perturbation training to exercise programs for people with knee OA may improve treatment effects for pain and function . Objective The purpose of this study was to examine the effectiveness of adding agility and perturbation techniques to st and ard exercise therapy compared with the st and ard exercise program alone for people with knee OA . Design This was a single-blinded r and omized controlled trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise program . Measurements The outcome measures were self-reported knee pain and function , self-reported knee instability , a performance-based measure of function , and global rating of change . Results Although both groups exhibited improvement in self-reported function and in the global rating of change at the 2- , 6- , and 12-month follow-up periods , there were no differences between groups on these outcomes . There was no reduction in knee pain or improvement in performance-based function in either group . Limitations It is possible that more-intense application of the interventions or application of the interventions to participants with knee OA who were at greater risk for falling may have yielded additive effects of the agility and perturbation training approach . Conclusions Both intervention groups exhibited improvement in self-reported function and the global rating of change . Our results , however , did not support an additive effect of agility and perturbation training with st and ard exercise therapy in our sample of individuals with knee OA . Further study is needed to determine whether there are subgroups of individuals who might achieve an added benefit with this approach Background Knee osteoarthritis ( OA ) is the most common type of arthritis and imposes a heavy burden on individual welfare among elderly people . There is preliminary evidence that psychological factors play a role in functional ability and pain in knee OA patients , particularly with respect to the surgery outcome . Less is known about psychological factors among community-dwelling patients with knee OA . Objectives We aim ed to determine which psychological factors are associated with pain and functional ability among community-dwelling knee OA patients using a comprehensive set of psychological question naires . Methods In the cross-sectional baseline setting of a prospect i ve , r and omized controlled intervention study , 111 patients aged from 35 to 75 years with clinical symptoms and radiographic grading of knee OA were included . They completed a comprehensive set of psychological question naires , including measures of re sources and coping , fear and catastrophizing , and distress . Results In cross-sectional comparisons , pain self-efficacy , fear of movement , pain catastrophizing , and elevated anxiety were associated with pain and a poorer functional ability . In logistic regression analysis , independent association was seen between pain self-efficacy and poorer functioning . Knee OA patients also reported elevated levels of anxiety . Conclusions The results reveal that both pain self-efficacy and negatively charged emotion and expectations toward pain are important factors when dealing with knee OA patients . Failure to consider these will probably contribute to prolonged disability and further pain . The results call for the routine assessment of multiple psychological factors in knee OA Background : Osteoarthritis ( OA ) of the knee is the most common form of joint disease . It is one of the major causes of impaired function that reduces quality of life in older people worldwide . Periosteal Stimulation Therapy ( PST ) with boosters in combination with home exercises may be a suitable treatment option for such patients . Objectives : To examine the effectiveness of PST with boosters in addition to a home-based exercise program as compared with Transcutaneous Electrical Nerve Stimulation ( TENS ) combined with the same home-based exercise program in the management of chronic pain and functional impairments associated with advanced knee OA . Design : The study was a r and omized controlled trial . Material s and Methods : Sixty patients with Kellgren-Lawrence grade 3 or 4 knee OA were r and omized to receive PST or TENS once a week for 10 weeks , followed by boosters for 6 months in addition to a home exercise program .  Visual Analogue Scale ( VAS ) and the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) subscales were assessed at baseline , after the last PST session , and 6 months later . Results : Pain VAS and KOOS subscales were improved in both PST and TENS groups at 10 weeks and 6 months after intervention , with a statistically significant difference between the groups at both follow-up periods . Reduced pain VAS and increased KOOS subscales in the PST group were statistically significantly different from the TENS group during both follow-up periods . Conclusion : PST with boosters combined with a home exercise program was shown to be beneficial for improving subjective knee pain and functional performance of older patients with advanced knee OA BACKGROUND Movement control impairment is a clinical subgroup of non-specific low back pain which can be assessed reliably . There is a strong correlation between tactile acuity and movement control suggesting these two treatments might have additive effects . The first research aim was to determine if patients with a motor control impairment demonstrated improvement in outcome with combined tactile acuity and motor control training . The second aim was to determine if tactile acuity training enhanced the effect of motor control training . METHOD The primary study was a single-arm cohort study conducted in three physiotherapy practice s in the German-speaking part of Switzerl and . 40 patients ( 23 males and 17 females ) suffering from non-specific low back pain ( NSLBP ) and movement control impairment were treated . Patients were assessed at baseline and immediately post treatment . Treatment included exercises to lumbopelvic control and graphesthesia training to improve tactile acuity . Treatment effects were evaluated using the Rol and Morris disability question naire ( RMQ ) and the patient-specific functional scale ( PSFS ) . The performance on a set of six movement control tests and lumbar two-point discrimination were also assessed . The results of this cohort study were compared with a historic control group which was comparable with the primary study but included only motor control exercises . RESULTS All the outcomes improved significantly with the combined training ( RMQ - 2.2 pts . , PSFS - 2.8 pts . ; MCTB - 2.02 pts . & TPD - 17.07 mm ; all p < 0.05 ) . In comparison to the outcomes of the historic control , there was no significant differences in movement control , patient-specific functional complaints or disability between the groups . CONCLUSIONS The results of this study , based on a before and after intervention comparison , showed that outcome improved significantly following combined tactile acuity and motor control training . However , compared to an earlier study , the tactile acuity training did not have an additional effect to the results . The use of historical controls does not control for allocation bias and the results obtained here require verification in a r and omized controlled trial Background There are conflicting results in the literature regarding the association between radiographic knee osteoarthritis ( OA ) and symptoms and function in subjects with previous anterior cruciate ligament ( ACL ) reconstruction . Aim To investigate the associations between radiographic tibiofemoral knee OA and knee pain , symptoms , function and knee-related quality of life ( QOL ) 10–15 years after ACL reconstruction . Study design Cross-sectional study . Material and methods 258 subjects were consecutively included at the time of ACL reconstruction and followed up prospect ively . The authors included the Knee Injury and Osteoarthritis Outcome Score to evaluate knee pain , other symptoms ( symptoms ) , activities of daily living and sport and recreation ( Sport/Rec ) and QOL . The subjects underwent st and ing radiographs 10–15 years after the ACL reconstruction . The radiographs were grade d with the Kellgren and Lawrence ( K&L ) classification ( grade 0–4 ) . Results 210 subjects ( 81 % ) consented to participate in the 10–15-year follow-up . Radiographic knee OA ( K&L ≥ grade 2 ) was detected in 71 % , and 24 % showed moderate or severe radiographic knee OA ( K&L grade s 3 and 4 ) . No significant associations were detected between radiographic knee OA ( K&L grade ≥2 ) and pain , function or QOL , respectively , but subjects with radiographic knee OA showed significantly increased symptoms . Severe radiographic knee OA ( K&L grade 4 ) was significantly associated with more pain , symptoms , impaired Sport/Rec and reduced QOL . Conclusion Subjects with radiographic knee OA showed significantly more symptoms than those without OA , and subjects with severe radiographic knee OA had significantly more pain , impaired function and reduced quality of life than those without radiographic knee OA 10–15 years after ACL reconstruction Background Knee osteoarthritis ( OA ) is one of the most common and costly chronic musculoskeletal conditions world-wide and is associated with substantial pain and disability . Many people with knee OA also experience co-morbidities that further add to the OA burden . Uptake of and adherence to physical activity recommendations is suboptimal in this patient population , leading to poorer OA outcomes and greater impact of associated co-morbidities . This pragmatic r and omised controlled trial will investigate the clinical - and cost-effectiveness of adding telephone coaching to a physiotherapist-delivered physical activity intervention for people with knee OA . Methods / Design 168 people with clinical ly diagnosed knee OA will be recruited from the community in metropolitan and regional areas and r and omly allocated to physiotherapy only , or physiotherapy plus nurse-delivered telephone coaching . Physiotherapy involves five treatment sessions over 6 months , incorporating a home exercise program of 4–6 exercises ( targeting knee extensor and hip abductor strength ) and advice to increase daily physical activity . Telephone coaching comprises 6–12 telephone calls over 6 months by health practitioners trained in applying the Health Change Australia ( HCA ) Model of Health Change to provide behaviour change support . The telephone coaching intervention aims to maximise adherence to the physiotherapy program , as well as facilitate increased levels of participation in general physical activity . The primary outcomes are pain measured by an 11-point numeric rating scale and self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale after 6 months . Secondary outcomes include physical activity levels , quality -of-life , and potential moderators and mediators of outcomes including self-efficacy , pain coping and depression . Relative cost-effectiveness will be determined from health service usage and outcome data . Follow-up assessment s will also occur at 12 and 18 months . Discussion The findings will help determine whether the addition of telephone coaching sessions can improve sustainability of outcomes from a physiotherapist-delivered physical activity intervention in people with knee OA.Trial Registration Australian New Zeal and Clinical Trials Registry reference : Background Pronated foot posture is associated with many clinical and biomechanical outcomes unique to medial compartment knee osteoarthritis ( OA ) . Though shoe-worn insole treatment , including lateral wedges , is commonly studied in this patient population , their effects on the specific subgroup of people with medial knee OA and concomitant pronated feet are unknown . The purpose of this study was to evaluate whether lateral wedge insoles with custom arch support are more beneficial than lateral wedge insoles alone for knee and foot symptoms in people with medial tibiofemoral knee osteoarthritis ( OA ) and pronated feet . Methods Twenty-six people with pronated feet and symptomatic medial knee OA participated in a r and omized crossover study comparing  five degree lateral wedge foot insoles with and without custom foot arch support . Each intervention was worn for two months , separated by a two-month washout period of no insoles wear . Main outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) pain and physical function subscales , the revised short-form Foot Function Index ( FFI-R ) pain and stiffness subscales , and the timed stair climb test . Regression modeling was conducted to examine treatment , period , and interaction effects . Results Twenty-two participants completed the study , and no carryover or interaction effects were observed for any outcome . Significant treatment effects were observed for the timed stair climb , with greater improvements seen with the lateral wedges with arch support . Within-condition significant improvements were observed for WOMAC pain and physical function , as well as FFI-R pain and stiffness with lateral wedges with arch support use . More adverse effects were reported with the lateral wedges alone , while more people preferred the lateral wedges with arch support overall . Conclusions Addition of custom arch support to a st and ard lateral wedge insole may improve  foot and knee symptoms in people with knee OA and concomitant pronated feet . These preliminary findings suggest further research evaluating the role of shoe-worn insoles for treatment of this specific sub-group of people with knee OA is warranted . Trial registration Clinical trials.gov identifier : NCT02234895 This study investigated the physical and psychosocial consequences of living with osteoarthritis ( OA ) in daily life and peoples ’ views of total knee arthroplasty ( TKA ) and the role of physiotherapy . In-depth interview data were used from a prospect i ve qualitative study conducted by the senior author ( KY ) . Participants were 15 volunteers with knee OA who were awaiting TKA at a specialized orthopaedic tertiary care facility in Toronto . A modified grounded theory method approach was used to analyze the interview data . The findings showed that experiences for the participants with OA were conceptualized as a “ breakpoint . ” The breakpoint was centred on the experiences/processes of living with unremitting pain , the limitations of mobility , leisure and social activities , and the result ing consequences to the participant 's physical and psychological well-being . In addition to the above experiences , participants also discussed their perceptions of  TKA surgery .  The findings showed that expectations of TKA were linked to participants ’ knowledge of the procedure and its outcomes . The participants listed acquaintances , friends , family members , and doctors as the main sources of knowledge for TKA . On the basis of the above analysis , recommendations are made for developing a preoperative physiotherapy program that would focus on minimizing preoperative disability and maximizing postoperative recovery Background Little is known regarding how impairment-based exercises may improve performance of specific functional tasks in people with knee osteoarthritis ( OA ) . Objective The purpose of this study was to compare the probability that participation in an impairment-based exercise program or the same impairment-based program supplemented with agility and perturbation training will improve patient-reported function on specific functional tasks . Design This study was a secondary analysis of data from a r and omized clinical trial . Setting The study was conducted in the outpatient physical therapy clinic of a large , university-based health center . Participants One hundred eighty-three people with knee OA ( 122 women , 61 men ) participated . Interventions Participants were r and omly assigned to either a group that received agility and perturbation training with st and ard exercise therapy or a group that received only the st and ard exercise . Measurements Specific functional items were taken from the physical function subscale of the Western Ontario and McMasters Universities Osteoarthritis Index , the Lower Extremity Function Scale , and the Activities of Daily Living Scale of the Knee Outcome Survey . Results The probability of self-reported improvement in a variety of specific functional tasks was low following participation in either of the exercise programs . When only participants with moderate to severe difficulty performing specific functional tasks were considered in the analysis , the probability of success improved but was still limited . Limitations The results are generalizable only to self-reported assessment of performance of specific functional tasks . Conclusions Impairment-based exercise may not be enough to make substantial improvement in performance of specific functional tasks .  Task-specific exercise approaches need to be explored for people with knee OA Introduction Pain is the dominant symptom of knee osteoarthritis ( OA ) , and recent evidence suggests factors outside of local joint pathology , such as pain sensitisation , can contribute significantly to the pain experience . It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy . The aims of this study are , first , to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA . Second , we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy . Methods and analysis This is a multicentre prospect i ve cohort study with 140 participants . Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics . A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination , quantitative sensory testing , and vali date d question naires measuring pain and functional capacity . Participants will then undergo physiotherapy treatment . The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria . A principal component analysis will identify measures related to pain sensitisation to include in the predictive model . Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders . Ethics and dissemination This study has been approved by St James ’ Hospital/AMNCH Research Ethics Committee and by the St Vincent 's Healthcare Group Ethics and Medical Research Committee . The results will be presented at international conferences and published in a peer review journal . Trial registration number NCT02310945 OBJECTIVE Clinical tools are needed to identify and target a neuropathic-like phenotype , which may be associated with central sensitization ( CS ) , in osteoarthritis ( OA ) . The modified painDETECT question naire ( mPD-Q ) has face and content validity for identifying neuropathic-like symptoms in knee OA . To further vali date the mPD-Q , this study assessed the unknown relationship between mPD-Q scores and signs of CS on quantitative sensory testing ( QST ) in knee OA . DESIGN 36 Individuals were recruited with chronic , symptomatic , knee OA without other pain/neurological conditions . Reference QST data were obtained from 18 controls/32 eligible knees , enabling identification of sensory abnormalities/CS among case knees . A st and ardized question naire assessed psychological factors ( depressive symptoms and pain catastrophizing ) , and for individual knees , mPD-Q and pain intensity scores . A st and ardized/comprehensive QST protocol was conducted for each knee . QST signs of CS were defined as : mechanical hyperalgesia and /or enhanced temporal summation and /or allodynia . The relationship between the presence of CS ( yes/no ) and a pre-selected mPD-Q score ( ≤12 or > 12 ) , by knees , was assessed using generalized estimating equations . RESULTS Among 57 eligible case knees , 45.6 % had ≥1 sign of CS . Controlling for age , knees with higher mPD-Q scores ( > 12.0 ) had higher odds of having QST signs of CS ( adjusted odds ratio ( OR ) = 5.6 ; 95 % confidence interval ( CI ) , 1.3 - 22.9 ) . This relationship was unaffected by controlling for depression and pain intensity , but was attenuated by pain catastrophizing . CONCLUSIONS Among painful OA knees , higher mPD-Q scores were associated with greater odds of having signs of CS . Thus , the mPD-Q may aid the identification of CS in people with chronic knee OA OBJECTIVE To examine the effects of aerobic and resistance exercise on self-efficacy beliefs in older adults with knee osteoarthritis ( OA ) and to determine whether self-efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions . METHODS Measures of self-efficacy , knee pain , stair climbing performance , and health perceptions were collected prior to r and omization and again at an 18-month followup in older adults with knee OA who were assigned to 1 of 3 treatment conditions : aerobic exercise , resistance training , or health education control .  All analyses were conducted on the intention-to-treat principle . RESULTS Both exercise treatments increased self-efficacy for stair climbing in comparison to the health education control group . Both knee pain and self-efficacy mediated the effect of the treatments on stair climb time , whereas only knee pain mediated health perceptions . CONCLUSIONS The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee . Moreover , these variables mediate the effects that such programs have on disability and health perceptions Background Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis ( OA ) . Strengthening the hip abductor and adductor muscles may influence joint loading and /or OA-related symptoms , but no study has evaluated these hypotheses directly . The aim of this r and omised , single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA . Methods / Design 88 participants with painful , radiographically confirmed medial compartment knee OA and varus alignment will be recruited from the community and r and omly allocated to a hip strengthening or control group using concealed allocation stratified by disease severity . The hip strengthening group will perform 6 exercises to strengthen the hip abductor and adductor muscles at home 5 times per week for 12 weeks . They will consult with a physiotherapist on 7 occasions to be taught the exercises and progress exercise resistance . The control group will be requested to continue with their usual care . Blinded follow up assessment will be conducted at 12 weeks after r and omisation . The primary outcome measure is the change in the peak external knee adduction moment measured during walking . Question naires will assess changes in pain and physical function as well as overall perceived rating of change . An intention-to-treat analysis will be performed using linear regression modelling and adjusting for baseline outcome values and other demographic characteristics . Discussion Results from this trial will contribute to the evidence regarding the effect of hip strengthening on knee loads and symptoms in people with medial compartment knee OA . If shown to reduce the knee adduction moment , hip strengthening has the potential to slow disease progression . Trial Registration Australia New Zeal and Clinical Trials Registry Abstract Background Self-management has become increasingly popular in the management of chronic diseases . There are many different self-management models . Meta analyses of arthritis self-management have concluded that it is difficult to recommend any one program in preference to another due to inconsistencies in the study design s used to evaluate different programs . The Stanford Arthritis Self-Management Program ( ASMP ) , most commonly delivered by trained lay leaders , is a generic program widely used for people with rheumatological disorders . We have developed a more specific program expressly for people with osteoarthritis of the knee ( OAKP ) . It includes information design ed to be delivered by health professionals and results in improvements in pain , function and quality of life . Aim : To determine whether , for people with osteoarthritis ( OA ) of the knee , the OAKP implemented in a primary health care setting can achieve and maintain clinical ly meaningful improvements in more participants than ASMP delivered in the same environment . Methods / Design The effectiveness of the programs will be compared in a single-blind r and omized study . Participants : 146 participants with established OA knee will be recruited . Volunteers with coexistent inflammatory joint disease or serious co-morbidities will be excluded . Interventions : Participants will be r and omised into either  OAKP or ASMP groups and followed for 6 months . Measurements : Assessment s will be immediately before and after the intervention and at 6 months . Primary outcome measures will be WOMAC and SF-36 question naires and a VAS for pain . Secondary outcomes will include balance , tested using a timed single leg balance test and a timed step test and self-efficacy . Data will be analysed using repeated measures ANOVA . Discussion With an aging population the health care costs for people with arthritis are ever increasing . Although cost analysis is beyond the scope of this study , it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders . Consequently it is critical to examine the relative effectiveness of the primary care management strategies available for OA.Trial Registration This study is registered with the Australian New Zeal and Clinical Trials Registry : OBJECTIVES To examine the objective physical function of the lower extremities , to measure the properties of quadriceps femoris muscle ( QFM ) , and to assess subjective disabilities in men with knee osteoarthritis ( OA ) and to compare the results with those obtained from age- and sex-matched control subjects . DESIGN Cross-sectional study . SETTING Rehabilitation clinic in a university hospital . PARTICIPANTS Male volunteers ( n=54 ) ( age range , 50 - 69y ) with knee OA and r and omly selected healthy , age- and sex-matched control subjects ( n=53 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Physical function evaluated with a test battery including the QFM composition measurement , the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and the R AND 36-Item Short-Form Health Survey , version 1.0 .  RESULTS Knee OA patients had 13 % to 26 % poorer ( P range , .050-.001 ) physical function and muscle strength compared with the controls . There were also significant differences in QFM composition . WOMAC ( P range , .050-.001 ) and muscle strength ( P<.001 ) associated with physical function tests , but subjective pain correlated with neither physical function nor muscle strength in knee OA patients . The radiographic knee OA grade did not have any significant effect on physical function , but passive knee motion , knee extension strength , and WOMAC were related to the severity of the disease ( P<.05 ) . CONCLUSIONS The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls . The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease . The results highlight the effect of QFM strength on physical function as well as the importance of patient 's subjective and objective physical function when deciding on knee OA treatment policy STUDY DESIGN An experimental laboratory study with a repeated- measures crossover design . BACKGROUND Treatment effects of joint mobilization may occur in part by decreasing excitability of central nociceptive pathways . Impaired conditioned pain modulation ( CPM ) has been found experimentally in persons with knee and hip osteoarthritis , indicating impaired inhibition of central nociceptive pathways . We hypothesized increased effectiveness of CPM following application of joint mobilization , determined via measures of deep tissue hyperalgesia . OBJECTIVE To examine the effect of joint mobilization on impaired CPM . METHODS An examination of 40 individuals with moderate/severe knee osteoarthritis identified 29 ( 73 % ) with impaired CPM . The subjects were r and omized to receive 6 minutes of knee joint mobilization ( intervention ) or manual cutaneous input only , 1 week apart . Deep tissue hyperalgesia was examined via pressure pain thresholds bilaterally at the knee medial joint line and the h and at baseline , postintervention , and post-CPM testing . Further , vibration perception threshold was measured at the medial knee epicondyle at baseline and post-CPM testing . RESULTS Joint mobilization , but not cutaneous input intervention , result ed in a global increase in pressure pain threshold , indicated by diminished hyperalgesic responses to pressure stimulus . Further , CPM was significantly enhanced following joint mobilization . Diminished baseline vibration perception threshold acuity was enhanced following joint mobilization at the knee that received intervention , but not at the contralateral knee . Resting pain was also significantly lower following the joint intervention . CONCLUSION Conditioned pain modulation was enhanced following joint mobilization , demonstrated by a global decrease in deep tissue pressure sensitivity . Joint mobilization may act via enhancement of descending pain mechanisms in patients with painful knee osteoarthritis OBJECTIVE To determine , in subjects with knee pain but no radiographic changes of tibiofemoral or patellofemoral compartment osteoarthritis ( OA ) , whether mean body weight , quadriceps and hamstring strength , lower extremity muscle mass , depression scores , and perceptions of their general health status differed from those of subjects with symptomatic knee OA . METHODS Subjects were 25 women and 10 men with knee pain and radiographic evidence of OA at the baseline examination , and 21 women and 16 men who had knee pain at the baseline examination but no radiographic evidence of knee OA at either baseline examination or followup evaluation performed , on average , 31 months later . These individuals were a subset of a cohort of 462 independently living elderly individuals recruited by telephone interview after r and om selection through r and om digit dialing of households in central Indiana . Data from an additional 134 subjects who had neither knee pain nor radiographic changes of OA at either the baseline or followup examination were analyzed for comparison . Lower extremity muscle strength was measured by isokinetic dynamometry , lean tissue ( i.e. , muscle ) mass in the lower extremities by dual x-ray absorptiometry , depression by Center for Epidemiology Depression ( CES-D ) scale . knee pain by Western Ontario McMaster University OA instrument , and perceived general health status by the Medical Outcome Survey Short Form-36 . RESULTS In contrast to those with symptomatic knee OA , those who had knee pain but no radiographic evidence of OA were less obese , had hamstring as well as quadriceps weakness , and had CES-D scores high enough to qualify for a diagnosis of clinical depression . CONCLUSION Among subjects with knee pain but no OA-- and among women in this subset , in particular -- knee pain may be a manifestation of depression . rather than of joint disease Background Knee osteoarthritis ( OA ) is a prevalent chronic musculoskeletal condition with no cure . Pain is the primary symptom and results from a complex interaction between structural changes , physical impairments and psychological factors . Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population . There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training ( PCST ) particularly in other chronic pain conditions . Though typically provided separately , there are symptom , re source and personnel advantages of exercise and PCST being delivered together by a single healthcare professional . Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management . No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population . The primary aim of this multisite r and omised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA . Methods / design This will be an assessor-blinded , 3-arm r and omised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice . Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and r and omized into one of three groups : exercise alone , PCST alone , or integrated PCST and exercise .  R and omisation will be stratified by city ( Melbourne or Brisbane ) and gender . Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale . Secondary outcomes include global rating of change , muscle strength , functional performance , physical activity levels , health related quality of life and psychological factors . Measurements will be taken at baseline and immediately following the intervention ( 12 weeks ) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects . Specific assessment of adherence to the treatment program will also be made at weeks 22 and 42 . Relative cost-effectiveness will be determined from health service usage and outcome data . Discussion The findings from this r and omised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone . Trial registration Australian New Zeal and Clinical Trials Registry reference number : BACKGROUND Osteoarthritis ( OA ) of the knee is associated with a number of physical and psychological impairments . Unfortunately , very few treatment strategies are capable of addressing both types of impairments concurrently . We performed a pilot , r and omized controlled , proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training ( PCST ) . METHODS Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were r and omized to receive either 10 weeks of physiotherapist supervised exercises ( lower limb strengthening and walking ) combined with non-directive counseling ( NDC ) or the same exercise program delivered concurrently with PCST . Primary outcomes included self-reported pain and pain coping , while secondary outcomes included self efficacy and self-reported physical function . RESULTS Ten participants were r and omized to each group and both groups exhibited significant improvements in isometric knee strength , self-reported knee pain and physical function , self efficacy for control of pain management and other arthritis symptoms . Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking . No between-group differences existed in any outcome ( 0.07 < p < 0.98 ) . Based on our findings , 63 participants per group would be needed for future large-scale studies using similar outcome measures and design . CONCLUSIONS Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA . LEVEL OF EVIDENCE Level II Clinical Trials Registry number : ACTRN12609000623291 STUDY DESIGN R and omized , double-blind , placebo-controlled study . OBJECTIVES To examine the short-term therapeutic effects of monochromatic infrared energy ( MIRE ) on participants with knee osteoarthritis ( OA ) . Patients were assessed according to the International Classification of Functioning , Disability and Health . BACKGROUND MIRE is commonly used in therapy for patients with peripheral neuropathies . However , research has not focused intensively on the therapeutic effects of MIRE in patients with knee OA . METHODS This study enrolled 73 participants with knee OA . Participants received six 40-minute sessions of active or placebo MIRE treatment ( 890-nm wavelength ; power , 6.24 W ; energy density , 2.08 J/cm2/min ; total energy , 83.2 J/cm2 ) over the knee joints for 2 weeks . International Classification of Functioning , Disability and Health-related outcomes were collected weekly over 4 weeks using the Knee injury and Osteoarthritis Outcome Score , Lysholm Knee Scale , Hospital Anxiety and Depression Scale , Multidimensional Fatigue Inventory , Chronic Pain Grade question naire , World Health Organization Quality of Life-brief version , and OA Quality of Life Question naire . Data were analyzed by repeated- measures analysis of variance . RESULTS No statistically significant differences were found for the interaction of group by time for Knee injury and Osteoarthritis Outcome Score scores , including pain , other symptoms , function in daily living , function in sport and recreation , and knee-related quality of life . Scores on the Lysholm Knee Scale , Hospital Anxiety and Depression Scale , Multidimensional Fatigue Inventory , Chronic Pain Grade question naire , World Health Organization Quality of Life-brief version , and OA Quality of Life Question naire also showed no significant differences between the 2 groups at any of the 4 follow-up assessment s. CONCLUSION Short-term MIRE therapy provided no beneficial effects to body functions , activities , participation , and quality of life in patients with knee OA The WOMAC Osteoarthritis Index and Lequesne Algofunctional Index have not been translated and vali date d for Iranian patients with osteoarthritis ( OA ) of the knee or hip . The aim of this study was to vali date the Persian form of WOMAC OA Index and Lequesne Algofunctional Index and to assess their test – retest reliability and convergent validity . Forward/backward translations and consensus panels were conducted to obtain the Persian versions of WOMAC OA Index and Lequesne Algofunctional Index .  A non-probability sample of 116 patients with knee/hip osteoarthritis was asked to complete the WOMAC OA Index and Lequesne Algofunctional Index as well as Medical Outcomes Study —20-Item Short Form ( SF-20 ) question naires , a visual analogue scales ( VAS ) of pain and demographic information form . Internal consistency ( using Cronbach ’s alpha ) and convergent validity ( by examining the Pearson ’s correlation coefficients ) were evaluated to determine the psychometric properties of the question naires . In order to evaluate test – retest reliability , 20 r and omly selected patients completed the question naires , on a second occasion , 7–10 days later . Cronbach ’s alpha coefficients and intraclass correlation coefficients for the WOMAC OA Index and Algofunctional Index subscales ranged from 0.63 to 0.94 and from 0.53 to 0.96 , respectively . Statistically significant correlations were found between WOMAC OA Index , Algofunctional Index and SF-20 subscales and VAS for pain . The Persian version of WOMAC demonstrated a more acceptable validity , internal consistency and reliability compared with the Lequesne Algofunctional Index . However , both indices are valid and reliable instruments for evaluating the OA severity of knee/hip in Iran OBJECTIVES The study aim ed to compare the psychological and physical characteristics of older adults with knee osteoarthritis ( OA ) vs those of adults with chronic low back pain ( CLBP ) and to identify psychological and physical predictors of function as measured by gait speed . DESIGN Secondary data analysis . METHOD AND PATIENTS Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate r and omized controlled trials were selected for this study . MEASURES Inclusion criteria for both trials included age > or = 65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months .  Psychological constructs ( catastrophizing , fear avoidance , self-efficacy , depression , affective distress ) and physical measures ( comorbid medical conditions , pain duration , pain severity , pain related interference , self-rated health ) were obtained . RESULTS Subjects with CLBP had slower gait ( 0.88 m/s vs 0.96 m/s , P = 0.002 ) and more comorbid conditions than subjects with knee pain ( mean 3.36 vs 1.97 , P < 0.001 ) . All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory-Affective Distress score . Self-efficacy , pain severity , and medical comorbidity burden were associated with slower gait regardless of the location of the pain . CONCLUSIONS Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed . These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans
Results The FreKAQ-J had acceptable internal consistency , unidimensionality , good test-retest reliability , and was functional on the category rating scale .
The FreKAQ-J was significantly correlated with pain in motion , disability , pain-related catastrophizing , fear of movement , and anxiety symptomatology .
Conclusions We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA .
Background Recent systematic review s have demonstrated that pain associated with knee osteoarthritis ( OA ) is a complex phenomenon that involves various contributors .
People with knee OA exhibit symptoms of impaired body-perception , including reduced tactile acuity , impairments in limb laterality recognition , and de grade d proprioceptive acuity .
The Fremantle Back Awareness Question naire ( FreBAQ ) was developed to assess body-perception specific to the back in people with chronic low back pain .
The aim of this study was to develop and assess the psychometric properties of a knee-specific version of the FreBAQ-J ( FreKAQ-J ) , determine whether people with knee pain experience perceptual impairments and investigate the relationship between disturbed self-perception and clinical status .