Original article
Decrease of Muscle Strength Is Associated With Increase of Activity Limitations in Early Knee Osteoarthritis: 3-Year Results From the Cohort Hip and Cohort Knee Study

https://doi.org/10.1016/j.apmr.2014.06.007Get rights and content

Abstract

Objective

To determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity.

Design

A longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders.

Setting

A rehabilitation and rheumatology center.

Participants

Subjects (N=146) with early symptomatic knee OA from the CHECK study.

Interventions

Not applicable.

Main Outcome Measures

Muscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test.

Results

A total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures (B=−1.12, B=−5.83, and B=−1.25, respectively). Proprioception and laxity did not moderate this association.

Conclusions

In patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. Further well-designed experimental studies are indicated to establish the causal role of muscle weakness in activity limitations.

Section snippets

Study design

Of 1002 participants in the Cohort Hip and Cohort Knee (CHECK) cohort, the participants (n=151) in Reade, Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands, who reported knee symptoms at the second year were assessed for muscle strength, proprioception, laxity, and performance-based activity limitations and were included in the present 3-year follow-up study.9 Measurements performed at the second (t0) and fifth (t1) years of the CHECK study were used in the present study

Study population

Of 151 participants, 5 underwent total knee or total hip replacement during the 3-year follow-up. These 5 participants were excluded, leaving 146 participants for analysis. The 146 participants did not differ in age, sex, body mass index, K & L grade, pain, and WOMAC-pf compared with the total CHECK population. To be included in the analysis, participants had to have complete data at t0 and t1.

Missing data

For the WOMAC-pf, the number of participants with missing data at t1 (fifth year) was 9. These 9

Discussion

We evaluated the association between change in muscle strength and change in activity limitations among participants with early symptomatic knee OA over 3 years. The main finding was that a decrease in muscle strength was associated with an increase in activity limitations over time, independent of age, sex, change in pain, and radiographic severity. Both proprioception and laxity at t0 did not moderate this association. These results are in line with muscle weakness' playing an important role

Conclusions

Overall, we conclude that although changes in muscle strength and activity limitations over a 3-year period are small, a decrease in muscle strength is associated with an increase in activity limitations in patients with early knee OA. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. To establish the causal role of muscle weakness in activity limitations, further well-designed experimental studies are indicated.

Suppliers

  • a.

    Enraf-Nonius BV, Vareseweg 127, PO Box 12080, NL-3004 GB Rotterdam, The Netherlands.

  • b.

    IBM Corp, 1 New Orchard Rd, Armonk, NY 10504-1722.

Acknowledgments

CHECK is led by a steering committee composed of 16 members with expertise in different fields of OA. It is chaired by J.W.J. Bijlsma, PhD, and coordinated by J. Wesseling, MSc. The following institutions are involved: Erasmus Medical Center Rotterdam; Kennemer Gasthuis Haarlem; Leiden University Medical Center; Maastricht University Medical Center; Martini Hospital Groningen/Allied Health Care Center for Rheumatology and Rehabilitation Groningen; Medical Spectrum Twente

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    Supported by the Dutch Arthritis Association. The sponsor of the study was not involved in study design, data collection, data analysis, interpretation of data, and writing of the report.

    Disclosures: none.

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