In knee OA , strong evidence was found that avoidance of activities is associated with activity limitations via muscle weakness ( mediation by muscle weakness ) , strong evidence was found for an association between muscle weakness and activity limitations , and weak evidence was found that pain and psychological distress are associated with muscle weakness via avoidance of activities ( mediation by avoidance ) .
In hip OA , weak evidence was found for mediation by muscle weakness ; and strong evidence was found for an association between muscle weakness and activity limitations .
The avoidance model in patients with knee and hip osteoarthritis ( OA ) hypothesizes that pain and psychological distress lead to avoidance of activities , and thereby to muscle weakness and activity limitations .
This paper systematic ally review s the scientific evidence for the validity of this avoidance model .
Predicting the course of functional limitation among older adults with knee pain: do local signs, symptoms and radiographs add anything to general indicators?
Objective : To determine the additional prognostic value of clinical history , physical examination and x-ray findings to a previously derived simple generic model ( age , body mass index , anxiety and pain severity ) in a cohort of older adults with knee pain . Methods : Prospect i ve cohort study in community-dwelling adults in North Staffordshire . 621 participants ( aged ⩾50 years ) reporting knee pain who attended a research clinic at recruitment and were followed up by postal question naire at 18 months . Poor functional outcome was measured by the Physical Functioning Scale of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) at 18-month follow-up defined in 60 % of participants . Results : Three clinical history variables ( bilateral knee pain , duration of morning stiffness and inactivity gelling ) were independently associated with poor outcome . The addition of the “ clinical history ” model to the “ generic ” model led to a statistical improvement in model fit ( likelihood ratio ( LR ) = 24.84 , p = 0.001 ) . Two physical examination variables ( knee tender point count and single-leg balance ) were independently associated with poor outcome but did not lead to a significant improvement when added to the “ clinical history and generic ” model ( LR = 6.34 , p = 0.50 ) . Functional outcome was significantly associated with severity of knee radiographic osteoarthritis ( OA ) , but did not lead to any improvement in fit when added to the “ generic , clinical history and physical examination ” model ( LR = 1.86 , p = 0.39 ) . Conclusions : Clinical history , physical examination and severity of radiographic knee OA are of limited value over generic factors when trying to predict which older adults with knee pain will experience progressive or persistent functional difficulties
In knee OA , strong evidence was found that avoidance of activities is associated with activity limitations via muscle weakness ( mediation by muscle weakness ) , strong evidence was found for an association between muscle weakness and activity limitations , and weak evidence was found that pain and psychological distress are associated with muscle weakness via avoidance of activities ( mediation by avoidance ) .
In hip OA , weak evidence was found for mediation by muscle weakness ; and strong evidence was found for an association between muscle weakness and activity limitations .
The avoidance model in patients with knee and hip osteoarthritis ( OA ) hypothesizes that pain and psychological distress lead to avoidance of activities , and thereby to muscle weakness and activity limitations .
This paper systematic ally review s the scientific evidence for the validity of this avoidance model .