Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial

BACKGROUND: Conventional radiography is commonly used to diagnose knee osteoarthritis (OA), but also to guide clinical decision-making, despite a well-established discordance between radiographic severity and patient symptoms. The incidence and progression of OA is driven, in part, by biomechanical...

Descripción completa

Detalles Bibliográficos
Autores principales: Bensalma, Fatima, Hagemeister, Nicola, Cagnin, Alix, Ouakrim, Youssef, Bureau, Nathalie J., Choinière, Manon, Mezghani, Neila
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533576/
https://www.ncbi.nlm.nih.gov/pubmed/36199051
http://dx.doi.org/10.1186/s12891-022-05845-1
_version_ 1784802375558496256
author Bensalma, Fatima
Hagemeister, Nicola
Cagnin, Alix
Ouakrim, Youssef
Bureau, Nathalie J.
Choinière, Manon
Mezghani, Neila
author_facet Bensalma, Fatima
Hagemeister, Nicola
Cagnin, Alix
Ouakrim, Youssef
Bureau, Nathalie J.
Choinière, Manon
Mezghani, Neila
author_sort Bensalma, Fatima
collection PubMed
description BACKGROUND: Conventional radiography is commonly used to diagnose knee osteoarthritis (OA), but also to guide clinical decision-making, despite a well-established discordance between radiographic severity and patient symptoms. The incidence and progression of OA is driven, in part, by biomechanical markers. Therefore, these dynamic markers may be a good metric of functional status and actionable targets for clinicians when developing conservative treatment plans. The aim of this study was to assess the associations between biomechanical markers and self-reported knee function compared to radiographic severity. METHODS: This was a secondary analysis of data from a randomized controlled trial (RCT) conducted in primary care clinics with knee OA participants. Correlation coefficients (canonical (ρ) and structural (Corr)) were assessed between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and both, radiographic OA severity using the Kellgren-Lawrence grade, and three-dimensional biomechanical markers quantified by a knee kinesiography exam. Significant differences between coefficients were assessed using Fischer’s z-transformation method to compare correlations from dependent samples. RESULTS: KOOS and biomechanical data were significantly more associated than KOOS and X-ray grading (ρ: 0.41 vs 0.20; p < 0.001). Structural correlation (Corr) between KOOS and X-ray grade was 0.202 (4% of variance explained), while individual biomechanical markers, such as the flexion during loading, explained up to 14% of KOOS variance (i.e., Corr(2)). Biomechanical markers showed the strongest associations with Pain and Activity of Daily Living KOOS subscales (both > 36% variance explained), while X-ray grading was most associated with Symptoms subscale (21% explained; all p ≤ 0.001). CONCLUSIONS: Knee biomechanical markers are associated with patient-reported knee function to a greater extent than X-ray grading, but both provide complementary information in the assessment of OA patients. Understanding how dynamic markers relate to function compared to radiographic severity is a valuable step towards precision medicine, allowing clinicians to refine and tailor therapeutic measures by prioritizing and targeting modifiable biomechanical markers linked to pain and function. TRIAL REGISTRATION: Original RCT was approved by the Research Ethics Boards of École de technologie supérieure (H20150505) and Centre hospitalier de l’Université de Montréal (CHUM-CE.14.339), first registered at https://www.isrctn.com/ (ID-ISRCTN16152290) on May 27, 2015.
format Online
Article
Text
id pubmed-9533576
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-95335762022-10-06 Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial Bensalma, Fatima Hagemeister, Nicola Cagnin, Alix Ouakrim, Youssef Bureau, Nathalie J. Choinière, Manon Mezghani, Neila BMC Musculoskelet Disord Research BACKGROUND: Conventional radiography is commonly used to diagnose knee osteoarthritis (OA), but also to guide clinical decision-making, despite a well-established discordance between radiographic severity and patient symptoms. The incidence and progression of OA is driven, in part, by biomechanical markers. Therefore, these dynamic markers may be a good metric of functional status and actionable targets for clinicians when developing conservative treatment plans. The aim of this study was to assess the associations between biomechanical markers and self-reported knee function compared to radiographic severity. METHODS: This was a secondary analysis of data from a randomized controlled trial (RCT) conducted in primary care clinics with knee OA participants. Correlation coefficients (canonical (ρ) and structural (Corr)) were assessed between the Knee Injury and Osteoarthritis Outcome Score (KOOS) and both, radiographic OA severity using the Kellgren-Lawrence grade, and three-dimensional biomechanical markers quantified by a knee kinesiography exam. Significant differences between coefficients were assessed using Fischer’s z-transformation method to compare correlations from dependent samples. RESULTS: KOOS and biomechanical data were significantly more associated than KOOS and X-ray grading (ρ: 0.41 vs 0.20; p < 0.001). Structural correlation (Corr) between KOOS and X-ray grade was 0.202 (4% of variance explained), while individual biomechanical markers, such as the flexion during loading, explained up to 14% of KOOS variance (i.e., Corr(2)). Biomechanical markers showed the strongest associations with Pain and Activity of Daily Living KOOS subscales (both > 36% variance explained), while X-ray grading was most associated with Symptoms subscale (21% explained; all p ≤ 0.001). CONCLUSIONS: Knee biomechanical markers are associated with patient-reported knee function to a greater extent than X-ray grading, but both provide complementary information in the assessment of OA patients. Understanding how dynamic markers relate to function compared to radiographic severity is a valuable step towards precision medicine, allowing clinicians to refine and tailor therapeutic measures by prioritizing and targeting modifiable biomechanical markers linked to pain and function. TRIAL REGISTRATION: Original RCT was approved by the Research Ethics Boards of École de technologie supérieure (H20150505) and Centre hospitalier de l’Université de Montréal (CHUM-CE.14.339), first registered at https://www.isrctn.com/ (ID-ISRCTN16152290) on May 27, 2015. BioMed Central 2022-10-05 /pmc/articles/PMC9533576/ /pubmed/36199051 http://dx.doi.org/10.1186/s12891-022-05845-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Bensalma, Fatima
Hagemeister, Nicola
Cagnin, Alix
Ouakrim, Youssef
Bureau, Nathalie J.
Choinière, Manon
Mezghani, Neila
Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
title Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
title_full Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
title_fullStr Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
title_full_unstemmed Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
title_short Biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
title_sort biomechanical markers associations with pain, symptoms, and disability compared to radiographic severity in knee osteoarthritis patients: a secondary analysis from a cluster randomized controlled trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9533576/
https://www.ncbi.nlm.nih.gov/pubmed/36199051
http://dx.doi.org/10.1186/s12891-022-05845-1
work_keys_str_mv AT bensalmafatima biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial
AT hagemeisternicola biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial
AT cagninalix biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial
AT ouakrimyoussef biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial
AT bureaunathaliej biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial
AT choinieremanon biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial
AT mezghanineila biomechanicalmarkersassociationswithpainsymptomsanddisabilitycomparedtoradiographicseverityinkneeosteoarthritispatientsasecondaryanalysisfromaclusterrandomizedcontrolledtrial