Reliability of the Knee Examination in Osteoarthritis: Effect of Standardization

Cibere, J., Bellamy, N., Thorne, A., Esdaile, J. M., McGorm, K. J., Chalmers, A., Huang, S., Peloso, P., Shojania, K., Singer, J., Wong, H. and Kopec, J. (2004) Reliability of the Knee Examination in Osteoarthritis: Effect of Standardization. Arthritis and Rheumatism, 50 2: 458-468. doi:10.1002/art.20025

Author Cibere, J.
Bellamy, N.
Thorne, A.
Esdaile, J. M.
McGorm, K. J.
Chalmers, A.
Huang, S.
Peloso, P.
Shojania, K.
Singer, J.
Wong, H.
Kopec, J.
Title Reliability of the Knee Examination in Osteoarthritis: Effect of Standardization
Journal name Arthritis and Rheumatism   Check publisher's open access policy
ISSN 0004-3591
Publication date 2004-01-01
Sub-type Article (original research)
DOI 10.1002/art.20025
Volume 50
Issue 2
Start page 458
End page 468
Total pages 11
Editor D. S. Pisetsky
Place of publication Hoboken, U.S.A.
Publisher John Wiley & Sons
Language eng
Subject C1
321028 Rheumatology and Arthritis
730306 Evaluation of health outcomes
Abstract Objective. To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization. Methods. Forty-two physical signs and techniques were evaluated using a 6 X 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. For those signs with dichotomous scales, agreement among the rheumatologists was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), while for the signs with continuous and ordinal scales, a reliability coefficient (R-c) was calculated using analysis of variance. A PABAK of >0.60 and an Re of >0.80 were considered to indicate adequate reliability. Results. Adequate poststandardization reliability was achieved for 30 of 42 physical signs/techniques (71%). The most highly reliable signs identified by physical examination of the OA knee included alignment by goniometer (R-c = 0.99), bony swelling (R-c = 0.97), general passive crepitus (R-c = 0.96), gait by inspection (PABAK = 0.78), effusion bulge sign (R-c = 0.97), quadriceps atrophy (R. = 0.97), medial tibiofemoral tenderness (R-c = 0.94), lateral tibiofemoral tenderness (R-c = 0.85), patellofemoral tenderness by grind test (R-c = 0.94), and flexion contracture (R-c = 0.95). The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK = 0.14), medial instability at 30degrees flexion (PABAK = 0.02), and lateral instability at 30degrees flexion (PABAK = 0.34) were the only 3 signs that were highly unreliable. Conclusion. With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.
Keyword Rheumatology
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2005 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 78 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 78 times in Scopus Article | Citations
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Created: Wed, 15 Aug 2007, 13:10:28 EST