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PubMed1995

Associations of physical activity with performance-based and self-reported physical functioning in older men: the Honolulu Heart Program.

OBJECTIVE: To examine the association of self-reported physical activity with performance-based and self-reported physical functioning measured 3 to 5 years later. DESIGN: A population-based, longitudinal study. SETTING: The island of Oahu, Hawaii. PARTICIPANTS: Subjects were 3640 Japanese-American men older than 70 years of age. MEASUREMENTS: Estimated daily energy expenditure evaluated from self-reported engagement in a variety of activities determined from a mail survey in 1988; physical functioning status determined from both self-report and performance-based measures 3 to 5 years later. The effect of physical activity on physical functioning scores was determined through multiple logistic regression and analysis of covariance techniques for subjects who had chronic diseases as well as those in a healthy subsample. RESULTS: For the healthy subsample, those who were highly active in 1988 were more likely to have optimal function for the basic activities of daily living score (odds ratio 2.3; confidence interval (CI) 1.1 to 4.9), home management skills score (odds ratio 1.5; CI 1.1 to 2.1), and physical endurance-type tasks score (odds ratio 1.7; CI 1.2 to 2.4) than subjects classified as low active. A significant linear trend was found additionally across physical activity level for time to walk 10 feet and grip strength (P values < .001). Similar results were found for subjects with chronic diseases; however, most of the benefit of physical activity for this subsample occurred for subjects who were at least physically active at a moderate level. CONCLUSION: Engaging in physical activity is predictive of a high level of physical functioning in older men with and without chronic diseases. Participation in at least moderate physical activity may be sufficient to maintain optimal physical functioning in subjects afflicted with chronic diseases.

Activities of Daily Living↗

PubMed2003

Physical functioning and mortality in older women: an assessment of energy costs and level of difficulty.

OBJECTIVE: We tested the hypothesis that the types of activity and the energy equivalent assigned to each activity affect the relationship between self-reported physical functioning and mortality. METHODS: We analyzed the relationship between physical functioning and cardiovascular and noncardiovascular mortality in 1230 women (median age 70 years) observed for 7.5 years. We evaluated five separate scores of physical functioning that differed in the method of scoring the responses. Cox proportional hazard models included baseline age, self-reported physical functioning, medical morbidity, and assessment of health. RESULTS: For cardiac and noncardiovascular mortality, greater self-reported functioning was associated independently with a decreased hazard of death. The effects of physical functioning were sensitive to the form of the score used; that is, a score based on ordinal responses was associated with a greater reduction in hazard of death difference in survival between high and low function score: Ordinal: -15.2% (95% confidence interval [CI] -25.2--4.0); dichotomous: -11.6% (95%CI -18.9--3.9). CONCLUSION: There is a consistent relationship between functional limitation and all causes of mortality. The association is sensitive to the form of the score. Future physical function scores should be based on ordinal responses to individual items used in the scores.

Aged↗

PubMed1996

Physical function among retirement-aged African American men and women.

Prior attempts to identify factors associated with physical function (here, major lower body movements) among African Americans have been constrained by a narrow range of measures, small sample sizes, or both. The 1992 Health and Retirement Study (HRS) contains a substantial over-sample of African Americans (649 men and 957 women self-respondents aged 51 to 61 years), and detailed measures of high-risk behaviors, disease prevalence and severity, impairment, and physical function. We extend the natural history of disease to the natural history of functional status and model sociodemographic characteristics, high-risk behaviors, disease prevalence and severity, and impairments as direct and indirect influences on physical function in this African American sample. This natural history of functional status model fits the data well for both men (ROC = .88) and women (ROC = .83), although there are gender differences. Slightly over one-half of the women report some difficulty in physical function, compared with one-third of the men. Women also have a higher mean body-mass and report a greater prevalence and severity in 6 of 9 chronic diseases and more pain, but are less likely to smoke or abuse alcohol than men. Importantly, many of the factors with the largest direct and indirect associations with difficulty in physical function among these African American men (alcohol abuse, smoking, body mass, diabetes, heart disease, cerebrovascular disease, arthritis, and pain) and women (alcohol abuse, body mass, arthritis, and respiratory illness) are all potentially preventable or manageable.

Black or African American↗

PubMed2006

Metabolic syndrome impairs physical function, health-related quality of life, and peripheral circulation in patients with intermittent claudication.

PURPOSE: This study was conducted to (1) examine the effect of metabolic syndrome on intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with peripheral arterial disease (PAD), and (2) determine whether peripheral vascular function was predictive of intermittent claudication and physical function in patients with metabolic syndrome. METHODS: Patients limited by intermittent claudication and who had metabolic syndrome (n = 133) were compared with those without metabolic syndrome (n = 201). Patients were assessed on metabolic syndrome characteristics, PAD-specific measures consisting of ankle/brachial index and claudication distances, physical function measures, health-related quality of life, and calf blood flow and transcutaneous oxygen tension responses after 3 minutes of vascular occlusion. RESULTS: Initial claudication distance (mean +/- SD) was 29% shorter (P = .018) in patients with metabolic syndrome than in the controls (128 +/- 121 meters vs 180 +/- 166 meters), and absolute claudication distance was 22% shorter (P = .025) in those with metabolic syndrome (319 +/- 195 meters vs 409 +/- 255 meters). Furthermore, patients with metabolic syndrome had lower peak oxygen uptake (P = .037), a shorter 6-minute walk distance (P = .027), lower values on six domains of health-related quality of life (P < .05), reduced calf hyperemia (P = .028), and greater calf ischemia (P < .001) after vascular occlusion. In the group with metabolic syndrome, calf ischemia was correlated with initial claudication distance (r = 0.30, P = .004), absolute claudication distance (r = 0.40, P < .001), and peak oxygen uptake (r = 0.52, P < .001). CONCLUSION: Metabolic syndrome worsens intermittent claudication, physical function, health-related quality of life, and peripheral circulation in patients with PAD. Calf ischemia in those with metabolic syndrome was predictive of intermittent claudication and physical function. The additive burden of metabolic syndrome thus places patients who are limited by intermittent claudication at an even greater risk for living a functionally dependent lifestyle. Aggressive risk-factor modification designed to treat components of metabolic syndrome should be evaluated for efficacy in modifying physical and vascular function in patients with intermittent claudication.

Aged↗

PubMed2002

Physical functional performance in persons using a manual wheelchair.

STUDY DESIGN: Descriptive study. OBJECTIVES: To develop a performance-based physical functional measure for people using a manual wheelchair, and to evaluate the feasibility and reliability of the administration of the new procedure. BACKGROUND: Most performance-based measures of physical function focus on balance and ambulation impairments. Recent developments of performance measures fail to produce a valid and reliable performance-based measure to quantify physical function in people who must rely on upper-body function to mobilize. METHODS: Eighteen adults (ages 18 to 67 years) who used a nonmotorized wheelchair participated in this study. Volunteers performed selected tasks from the Continuous Scale Physical Functional Performance (CS-PFP) test, modified for persons using a wheelchair. Outcome measures included scores on the Wheelchair Physical Functional Performance (WC-PFP) test and the Sickness Impact Profile (SIP) questionnaire. RESULTS: Participants had substantial disability (mean total SIP > 20). Total and domain scores of the WC-PFP had no ceiling or floor effects and were reproducible with intraclass correlation coefficients ranging from 0.87 to 0.96. Poorer self-rated health was correlated with poorer performance in the upper-body domain of the WC-PFP (r = -0.45). Those reporting disability in bathing and dressing using the SIP had significantly lower WC-PFP scores, indicating that the WC-PFP had construct validity. A significant correlation was not found between WC-PFP and the ambulation and mobility domains of the SIP. CONCLUSION: The WC-PFP provides a reliable and quantifiable measure of mobility in persons who use a manual wheelchair.

Activities of Daily Living↗

PubMed2005

Thyroid hormone concentrations, disease, physical function, and mortality in elderly men.

CONTEXT: Physiological changes in thyroid hormone concentrations might be related to changes in the overall physical function in the elderly. OBJECTIVE: We determined to what extent thyroid hormone concentrations are related to physical function and mortality in elderly men. DESIGN: A longitudinal population study (the Zoetermeer study) was conducted. Mortality was registered in the subsequent 4 yr. PARTICIPANTS: Four hundred three independently and ambulatory living men (aged 73-94 yr) participated. MAIN OUTCOME MEASURES: The study examined the association between serum thyroid hormones and parameters of physical function as well as the association with mortality. METHODS: TSH, free T4 (FT4) total T4, T3, rT3, and T4-binding globulin were measured. Physical function was estimated by the number of problems in activities of daily living, a measure of physical performance score (PPS), leg extensor strength and grip strength, bone density, and body composition. RESULTS: Serum rT3 increased significantly with age and the presence of disease. Sixty-three men met the biochemical criteria for the low T3 syndrome (decreased serum T3 and increased serum rT3). This was associated with a lower PPS, independent of disease. Furthermore, higher serum FT4 (within the normal range of healthy adults) and rT3 (above the normal range of healthy adults) were related with a lower grip strength and PPS, independent of age and disease. Isolated low T3 was associated with a better PPS and a higher lean body mass. Low FT4 was related to a decreased risk of 4-yr mortality. CONCLUSIONS: In a population of independently living elderly men, higher FT4 and rT3 concentrations are associated with a lower physical function. High serum rT3 may result from a decreased peripheral metabolism of thyroid hormones due to the aging process itself and/or disease and may reflect a catabolic state. Low serum FT4 is associated with a better 4-yr survival; this may reflect an adaptive mechanism to prevent excessive catabolism.

Activities of Daily Living↗

PubMed1993

Self report functional disability scores and the use of devices: two distinct aspects of physical function in rheumatoid arthritis.

OBJECTIVES: Self report scores of physical disability and the use of devices or assistance in performing activities are sometimes integrated in one index of physical function, although they are aimed at measuring different dimensions of physical disability. The properties of both parameters were evaluated in two groups of patients with rheumatoid arthritis (RA). METHODS: A group of patients with RA of recent onset was compared with a group with established disease on four parameters of disability: use of devices, use of personal assistance, and scores on a validated Dutch version of the Health Assessment Questionnaire Disability Index, with and without integrating the use of devices or assistance. Correlation coefficients among disability parameters were calculated. In multiple regression analysis the influence of disease duration on the disability parameters was determined after disease activity, psychological wellbeing, and demographical characteristics had been controlled. RESULTS: Functional disability scores were mainly related to inflammatory activity and psychological wellbeing, whereas the uses of devices had a strong relation with disease duration, independent of current disease activity. Integrating these parameters of disability yielded a parameter that was still mainly associated with disease activity. CONCLUSION: Self report scores of functional disability and the use of devices represent distinct dimensions of physical function in RA. Integrating both parameters into one measure of physical disability does not provide an index adequately reflecting both dimensions. The use of both parameters to measure outcome in long term clinical studies is recommended.

Activities of Daily Living↗

PubMed2005

Back pain and decline in lower extremity physical function among community-dwelling older persons.

BACKGROUND: Little is known regarding the longitudinal effects of back pain on physical function among older persons. We sought to determine whether back pain leading to activity restriction (i.e., restricting back pain) is associated with decline in lower extremity physical function among community-dwelling older persons. METHODS: In this prospective study with an 18-month follow-up period, participants (N = 659) were aged 70 years or older and independent in bathing, dressing, transferring, and walking at baseline. Restricting back pain, defined as staying in bed for at least one-half day or cutting down on one's usual activities due to back pain, was ascertained during monthly telephone interviews. Lower extremity physical function was assessed using three timed, performance-based tests (rapid gait, chair stands, and foot taps) at baseline and 18 months. Decline in lower extremity physical function was defined as an increase in timed scores on these tests between the baseline and 18-month assessments. RESULTS: The mean (standard deviation) number of months with restricting back pain was 1.3 (2.3); 364 (55%) participants reported 0 months, 209 (32%) reported 1-3 months, and 86 (13%) reported 4 or more months. After adjustment for baseline performance score and other covariates, the number of months with restricting back pain was independently associated with worsening rapid gait (p <.001), chair stand (p =.030), and foot tap (p <.001) performance. The deleterious effects of the "exposure" were limited to participants with 4 months of restricting back pain. CONCLUSIONS: Restricting back pain is independently associated with decline in lower extremity physical function among community-dwelling older persons. Treatment of restricting back pain may help to decrease functional decline in this population.

Aged↗

PubMed2006

Cardiorespiratory fitness in relation to self-reported physical function in cancer patients after chemotherapy.

AIM: The aim of this study was to estimate the association between objective cardiorespiratory fitness (CRF) and subjective self-reported physical function, taking into account the influence of mental distress. We hypothesized an association between these parameters, since they might be thought to measure parts of the same phenomenon. METHODS: Approximately 1 month after discontinuation of all primary treatment, 90 cancer patients aged 18-50 years treated with chemotherapy were surveyed. CRF was determined by the Astrand-Ryhming indirect cycle ergometer test, which indicate peak VO2 in mL x kg(-1) x min(-1) (predicted VO2max). Self-reported physical function was assessed by The European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). The relation between VO2max and self-reported physical function was estimated by multiple linear regression. Mental distress (assessed by The Hospital Anxiety and Depression scale), age, gender, body mass index (BMI), time from treatment to physical test and diagnoses were included as potential confounders. RESULTS: There was no association between predicted VO2max and self-reported physical function. Mental distress was negatively associated with self-reported physical function (P<0.001), but is not associated with predicted VO2max. CONCLUSIONS: The results suggest that predicted VO2max does not reflect self-reported physical function and vice versa in cancer patients after chemotherapy. If information about cardiac and/or pulmonary status is required, direct or indirect measures of VO2max should be used.

Adolescent↗

PubMed1999

Improving physical functioning in the elderly dialysis patient: relevance of physical therapy.

Compromised physical functioning is characteristic of medically complicated patients on dialysis, but many of these deficits can be addressed by rehabilitation. This article describes the benefits and limitations of a 3-month physical therapy pilot program at an inner-city hemodialysis clinic. Program results indicate the difficulties in keeping patients participating in such a program, but, for those patients who did regularly participate, on-site physical therapy consultation was valuable in assisting staff to identify exercise regimens that were consistent with individual patients' needs and addressed their functional difficulties.

Activities of Daily Living↗

PubMed2006

Use of peak oxygen consumption in predicting physical function and quality of life in COPD patients.

OBJECTIVE: To determine whether peak oxygen consumption (Vo(2)peak) adds to the power of FEV(1) in predicting physical function and quality of life in COPD patients. DESIGN: Single-center cross-sectional study. METHODS: Subjects included 291 COPD patients who completed pulmonary function testing, a graded exercise test, a 6-min walk, and stair climb test to assess physical function; a questionnaire assessing self-reported physical function; and a disease-specific, health-related quality-of-life questionnaire. Hierarchical multiple regression analysis was used to determine the contribution of Vo(2)peak in predicting physical function and quality of life after accounting for FEV(1). RESULTS: After accounting for FEV(1), Vo(2)peak added significantly to the prediction of 6-min walk distance (R(2) increased by 0.395 [p < 0.005]); stair climb time (R(2) increased by 0.262 [p < 0.005]); self-reported function (R(2) increased by 0.109 [p < 0.005]); and health-related quality-of-life domain of mastery (R(2) increased by 0.044 [p < 0.005]). Only Vo(2)peak was found to significantly predict the health-related quality-of-life domain of fatigue (R(2) = 0.094 [p < 0.005]). CONCLUSION: After controlling for FEV(1), Vo(2)peak adds significantly to the prediction of physical function and health-related quality-of-life domain of mastery in COPD patients. These results provide additional support for the use of Vo(2)peak in the multidimensional assessment of COPD patients.

Activities of Daily Living↗

PubMed2006

Explanations of socioeconomic differences in changes in physical function in older adults: results from the Longitudinal Aging Study Amsterdam.

BACKGROUND: This study examines the association between socioeconomic status and changes in physical function in younger- (aged 55-70 years) and older-old (aged 70-85 years) adults and seeks to determine the relative contribution of diseases, behavioral, and psychosocial factors in explaining this association. METHODS: Data were from 2,366 men and women, aged 55-85 years, participating in the Longitudinal Aging Study Amsterdam (LASA). Two indicators of socioeconomic status were used: education and income. Physical function was measured by self-reported physical ability over nine years of follow-up. RESULTS: In older adults, low socioeconomic status was related to a poorer level of physical function during nine years of follow-up. In subjects who were between 55 and 70 years old, there was an additional significant socioeconomic-differential decline in physical function, while socioeconomic differentials did not further widen in subjects 70 years and older. Behavioral factors, mainly BMI and physical activity, largely explained the socioeconomic differences in physical function in the youngest age group, while psychosocial factors reduced socioeconomic status differences most in the oldest age group. CONCLUSION: The findings indicate age-specificity of both the pattern of socioeconomic status differences in function in older persons and the mechanisms underlying these associations.

Activities of Daily Living↗

PubMed2005

The impact of anemia on energy and physical functioning in individuals with AIDS.

BACKGROUND: To our knowledge, the relationship between changes in hemoglobin level and energy and physical functioning in the anemic and "normal" ranges of hemoglobin among individuals with AIDS has not been well characterized. METHODS: In a multicenter, prospective, cohort study involving 19 clinics in the United States, 1406 individuals, 13 years and older, with AIDS were administered the Medical Outcomes Study HIV [human immunodeficiency virus] Health Survey (MOS-HIV) at baseline and at 3- to 6-month follow-up visits. Energy and physical functioning scores were the main outcomes. RESULTS: At baseline, a higher hemoglobin level was associated with a higher energy score and a higher physical functioning score (P < .001 for both), after adjusting for CD4 lymphocyte count, sex, age, education, and HIV risk factor. In longitudinal analyses, increases in hemoglobin were associated with increases in energy and physical functioning scores (P < .001 for both), after adjusting for CD4 lymphocyte count, sex, age, education, and HIV risk factor. Changes in the energy scales were, on average, 1.5 and 2.3 scale points per 1-g/dL change in hemoglobin level in the normal and anemic ranges, respectively. For the physical functioning scale, average changes were 2.7 and 2.6 scale points per 1-g/dL change in hemoglobin level in the normal and anemic ranges, respectively. CONCLUSIONS: Higher levels of hemoglobin are associated with better quality of life among individuals with AIDS. Changes in hemoglobin level within the conventional normal range of hemoglobin are also significantly associated with changes in quality of life.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Assessment of unidimensionality of physical functioning in patients receiving therapy in acute, orthopedic outpatient centers.

Physical functioning is a common construct of interest for patients receiving rehabilitation. This report describes the assessment of hierarchial structure, unidimensionality and reproducibility of item calibrations along the continuum of physical functioning defined by the PF-10 of the MOS SF-36. Three new questions specific to patients with upper extremity impairments were added, and item calibrations were compared across several groups of patients with different musculoskeletal impairments. Reproducibility of item calibrations over testing times was supported. Item order was dependent on impairment in a clinically logical pattern. Construct validity of the physical functioning scale was supported and improved with the new questions for patients with upper extremity impairments as well as for patients with some lower level extremity impairments.

Activities of Daily Living↗

PubMed2003

Physical function and health-related quality of life of Spanish patients with ankylosing spondylitis.

OBJECTIVE: To determine the physical function and the quality of life (QOL) of Spanish patients with ankylosing spondylitis (AS), and to study the reliability of the Spanish version of the Bath Ankylosing Spondylitis Functional Index (BASFI). METHODS: Clinimetric variables, including Spanish BASFI (test-retest), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), QOL instruments (Short Form 36 [SF-36] and European Quality of Life Questionnaire [EuroQol]), Bath Ankylosing Spondylitis Metrology Index (BASMI), and chest expansion, were assessed. RESULTS: A total of 92 patients were included: 69 males (75%), age (mean +/- SD) 40.7 +/- 9.1 years, and disease duration 11 +/- 7.8 years. The scores (mean +/- SD) were (from 0 the best to 10 the worst): BASFI 4.3 +/- 2.4; BASDAI 4.5 +/- 2.2; global SF-36 5.5 +/- 2.1; SF-36 physical function 3.8 +/- 2.5; SF-36 physical scale 4.9 +/- 2.7; SF-36 mental scale 3.7 +/- 2.7; SF-36 physical role limitations 5.6 +/- 4.4; SF-36 general health 5.5 +/- 2.1; SF-36 pain 5.4 +/-2.8; SF-36 vitality 5.1 +/- 2; EuroQoL rating scale 3.9+/-2.1; EuroQol health profile (from 0 the best to 2 the worst) 0.6 +/- 0.4; and BASMI 4.7 +/- 1.6. Significant association was found between BASFI and SF-36 physical function domain (r = 0.75, R(2) = 0.56, P < 0.0001). BASFI Cronbach's alpha was 0.92, Spearman's rho = 0.91, P < 0.0001. CONCLUSIONS: Physical function and QOL are deteriorated in AS. The physical domain is more impaired than the mental one. The SF-36 and the health profile of the EuroQol may be used as generic instruments to measure health-related QOL. Spanish BASFI index is a reliable instrument.

Adult↗

PubMed2026

DNA methylation signatures in skeletal muscle associated with physical function in healthy older adults.

Despite the substantial variability in physical function among older adults, the molecular mechanisms remain poorly characterized, particularly within skeletal muscle. This study aimed to determine the patterns of DNA methylation in skeletal muscle associated with physical function in healthy older adults. We analyzed DNA methylation (EPIC v2 array; 875,554 CpG sites) in skeletal muscle from 92 healthy older adults (median age 74; 62% female). Associations were examined across five phenotypes: Short Physical Performance Battery (SPPB), 6-min walk test (6MWT), handgrip strength, perceived disability (PAT-D), and lifestyle health (modified Life's Essential 8). Linear regression models adjusted for age, sex, race, BMI, and muscle fiber composition. Genomic inflation corrected via the BACON method (FDR < 0.05). Gene set enrichment analysis was performed on suggestive hits (FDR < 0.1). We identified significant differentially methylated probes (DMPs) and regions (DMRs) across all phenotypes: SPPB (70 DMPs, 22 DMRs), 6MWT (16 DMPs, 566 DMRs), handgrip strength (2 DMRs), PAT-D (19 DMPs, 1 DMR), and lifestyle health (2 DMPs). DMRs largely overlapped promoters. Identified genes overlapped known musculoskeletal and neurological GWAS hits, including RUNX2 and FOXL1 (bone mineral density), IGFBP3 (muscle mass), and NEK1 and SHANK1 (neurological function). Enrichment analysis revealed that 6MWT-associated genes relate to nervous and skeletal system development, while handgrip-associated genes involve cytoskeletal dynamics and protein assembly. Epigenetic variation in aging skeletal muscle is associated with physical function. The enrichment of pathways related to nervous and musculoskeletal development suggests specific epigenetic mechanisms underlying functional decline, offering potential targets for intervention in older adults.

DNA methylation↗

PubMed2001

Determinants of levels and changes of physical functioning in chronically ill persons: results from the GLOBE Study.

STUDY OBJECTIVE: Declines in physical functioning are a common result of chronic illness, but relatively little is known about factors not directly related to severity of disease that influence the occurrence of disability among chronically ill persons. The aim of this study was to assess the effect of a large number of potential determinants (sociodemographic factors, health related behaviour, structural living conditions, and psychosocial factors). DESIGN: Longitudinal study of levels and changes of physical functioning among persons suffering from four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic low back pain). In 1991, persons suffering from one or more of these diseases were identified in a general population survey. Self reported disabilities, using a subset of the OECD disability indicator, were measured six times between 1991 and 1997. These data were analysed using generalised estimating equations, relating determinants measured in 1991 to disability between 1991 and 1997, and controlling for a number of potential confounders (age, gender, year of measurement, and type and severity of chronic disease). SETTING: Region of Eindhoven (south eastern Netherlands). PARTICIPANTS: 1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain. MAIN RESULTS: In a "repeated prevalence" model, statistically significant (p<0.05) and strong associations were found between most of the determinants and the prevalence of disabilities. In a "longitudinal change" model, statistically significant (p<0.05) predictors of unfavourable changes in physical functioning were low income and excessive alcohol consumption, while we also found indications for effects of marital status, degree of urbanisation, smoking, and external locus of control. CONCLUSIONS: Other factors than characteristics of the underlying disease have an important influence on levels and changes of physical functioning among chronically ill persons. Reduction of the prevalence of disabilities in the population not only depends on medical interventions, but may also require social interventions, health education, and psychological interventions among chronically ill persons.

Activities of Daily Living↗

PubMed2004

Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function.

OBJECTIVE: To report the prevalence and relationship of self-reported knee instability to physical function in a sample of subjects with knee osteoarthritis (OA), and to discuss the implications of these observations for rehabilitation. METHODS: Subjects were 105 individuals (80 females) with knee OA who rated their knee instability severity on a 6-point numeric scale in response to the query "To what degree does giving way, buckling, or shifting of the knee affect your level of daily activity?" A principal component analysis was used to combine The Western Ontario and McMaster Universities pain, stiffness, and physical function subscale scores, and the Timed Get Up and Go Test score into a principal component score for physical function (PCPF). Other variables that could affect the PCPF such as age, sex, years with knee OA, radiographic severity of knee OA, knee pain, knee motion, and quadriceps strength were also recorded. The prevalence of self-reported knee instability was determined by calculating the proportion of subjects who reported each severity level of knee instability. Hierarchical regression analysis was performed to determine if the level of self-reported knee instability could predict the PCPF, even after accounting for the effects of the other variables. RESULTS: Sixty-three percent of the subjects reported knee instability during activities of daily living, and 44% reported that instability affects their ability to function. The severity of self-reported knee instability was associated with the PCPF (eta2=0.40, P <0.001), and after controlling for all other independent variables, significantly increased the prediction of the PCPF (r2=0.56, r2 change=0.05; P <0.001). CONCLUSION: The results indicate that a substantial proportion of individuals with knee OA report episodes of knee instability during activities of daily living, and instability affects physical function beyond that which can be explained by contributions from other impairments such as knee pain, range of motion, and quadriceps strength. Knee instability is a problem that should be specifically addressed in rehabilitation programs and may require interventions beyond those that address pain, joint motion, and muscular strength, to maximize the effectiveness of rehabilitation for individuals with knee OA.

Activities of Daily Living↗