Background: Osteoarthritis is a common condition with an increasing prevalence and is a common cause of disability. Osteoarthritic pain decreases the quality of life, and simple gait training is used to alleviate it. Knee osteoarthritis limits joint motion in the sagittal and lateral directions. Although many recent studies have activated orthotic research to increase knee joint stabilization, no study has used patellar tendon straps to treat knee osteoarthritis. Objects: This study aimed to determine the effects of patellar tendon straps on kinematic, mechanical, and electromyographic activation in patients with knee osteoarthritis. Methods: Patients with knee osteoarthritis were selected. After creating the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), leg length difference, Q-angle, and thumb side flexion angle of the foot were measured. Kinematic, kinetic, and muscle activation data during walking before and after wearing the orthosis were viewed. Results: After wearing the patellar tendon straps, hip adduction from the terminal stance phase, knee flexion from the terminal swing phase, and ankle plantar flexion angle increased during the pre-swing and initial swing phases. The cadence of spatiotemporal parameters and velocity increased, and step time, stride time, and foot force duration decreased. Conclusion: Based on the results of this study, the increase in plantar flexion after strap wearing is inferred by an increase due to neurological mechanisms, and adduction at the hip joint is inferred by an increase in adduction due to increased velocity. The increase in cadence and velocity and the decrease in gait speed and foot pressure duration may be due to joint stabilization. It can be inferred that joint stabilization is increased by wearing knee straps. Thus, wearing a patellar tendon strap during gait in patients with knee osteoarthritis influences kinematic changes in the sagittal plane of the joint.

Background: Although symmetry of spatio-temporal parameter and center of pressure (COP) shift during walking is associated with knee adduction moment, research on clinical association with knee osteoarthritis (OA)-related knee pain and functional scores is lacking. Objects: The aims were 1) to compare symmetry of gait parameters and COP-shift in patients with unilateral knee OA and pain and matched controls, and 2) to investigate the relationship between symmetry of gait parameters and COP-shift, and clinical measures. Methods: Female subjects (n = 16) had with unilateral radiological knee OA and pain. Healthy controls (n = 15) were age-matched to OA group. Symmetry of foot rotation, step length, stance and swing phase, lateral symmetry of COP and anterior/posterior symmetry of COP during walking was assessed. To assess the clinical variables, pain intensity, pain duration and function using Knee Osteoarthritis Outcome Survey (KOOS) subscales were collected. We compared symmetry between groups using Mann–Whitney U-test or independent t-test. Relationships between clinical measures and symmetry index measured using Spearman’s correlation test. Statistical significance was set at α = 0.05. Results: Knee OA group showed significantly greater values of only lateral symmetry of COP (p < 0.01) than healthy group. Values of lateral symmetry of COP had moderate or strong correlation significantly with the intensity of knee pain, pain duration, and scores of all KOOS subscales (p < 0.01). Conclusion: Patients with unilateral knee OA and pain showed more asymmetry of lateral COP-shift during walking compared with matched healthy controls. In addition, larger asymmetry of lateral COP-shift has the moderate or strong association with worse of knee pain, worse in KOOS scores and longer duration of knee pain. Asymmetry of lateral COP-shift during walking may be one of the characteristics of unilateral knee OA as the compensatory strategy response to unilateral OA of the knee.

본 연구는 퇴행성 무릎 관절염을 가진 노인여성을 대상으로 12주간의 노르딕 워킹을 통해 신체 기능과 관절염 통증 정도의 개선에 어떠한 효과를 미치는지 규명하는데 목적이 있다. 본 연구의 대상자는 퇴행성관절염으로 진단받은 노인여성 16명(나이: 73.00±3.70year, 신장: 154.30±4.07cm)을 대상으로 무선배정 된 노르딕 워킹 운동그룹(n=9)과 통제그룹(n=7)으로 나누었다. 운동 그룹은 노르딕 스틱을 이용하여 12주간 주 3회, 1회 30분 노르딕 워킹 운동을 실시하였고, 운동 강도는 HRR의 40-60%로 설정하였다. 통제그룹은 동일한 기간 동안 일상생활을 유지하도록 하였다. 종속변인으로 신체조성(체중, 체지방률, 근골격량)과 근력과 유연성(상·하지 근력, 상·하지 유연성), 균형능력(정적균 형, 동적균형) 및 통증정도를 측정하였다. 이러한 지표들의 측정은 운동프로그램을 진행하기 전과 후로 나누어 2번 측정하였다. 자료처리는 SPSS-PC version 25.0을 이용하여 실험집단과 통계집단간의 생리학적 특성 비교를 위해 독립표본 t-test를 사용하였으며, 노르딕 워킹 운동그룹과 통제그룹의 그룹 간, 시기간의 변화를 알아보기 위해 2x2 반복측정 이원배치분산분석을 사용하였다. 연구 결과는 첫째, 12주간의 노르딕 워킹을 통해 신체조성 기능에서 체지방률은 운동 처치 후에 감소하는 결과가 나타났으며(p=.004), 집단 간과 시기 간의 상호작용에서도 감소하는 결과가 나타났다(p=.003). 골격근량은 운동처치 후에 증가하는 결과가 나타났으며(p=.018), 집단 간과 시기 간의 상호작용에서도 증가하는 결과가 나타났다(p=.005). 둘째, 근력과 유연성은 상지근력과 하지유연성에서 집단 간과 시기 간 상호작용에서 증가하는 결과가 나타났으며(p=.009)(p=036), 하지근력에서는 운동집단과 통제집단 간 개선 효과가 나타났다(p=.006). 또한, 상지유연성은 운동처치 후에 증가하는 결과가 나타났다(p=.020). 셋째, 균형능력 요인은 정적균형에서 운동처치 후 개선 효과가 나타났으며(p=.016), 동적균형에서는 차이가 나타나지 않았다(p>.05). 넷째, 통증정도는 운동처치 후 개선 효과가 나타났으며(p=.022), 운동집단과 통제집단 간에 개선 효과도 나타났다(p=.013). 결론적으로 12주간의 노르딕 워킹은 퇴행성 무릎 관절염을 가진 노인여성의 신체조성과 근력과 유연성 에 긍정적인 영향을 미치는 것으로 나타났다. 따라서 노르딕 워킹은 퇴행성 무릎 관절염을 가진 노인여성 에게 신체조성과 안정성, 균형성을 높여 주였으며, 무릎 관절의 통증을 낮춰주어 재활 운동 기능 개선에 효과적인 운동방법이라고 사료된다.

Background: Knee osteoarthritis (OA) causes not only pain during walking but also walking disorders. Therefore, intervention for older patients with OA is important. Objective: To study investigated the effects of kinesio taping (KT) on pain and walking ability in elderly persons with knee OA. Design: One group, pre-post design Methods: This study enrolled 12 community-dwelling elderly people with knee OA. KT was applied on the surrounding structures, including the patellar and bilateral lateral ligaments. Assessment was made using the visual analog scale and GAITRite system to measure pain and walking ability during KT and non- KT conditions. Results: In this study, compared to the non-KT condition, the KT condition showed a significant improvement in walking ability and pain reduction during walking (velocity, cadence, step length, and stride length) (p < 0.05). Conclusion: This study demonstrated that knee KT has a positive effect on pain reduction and walking ability of the elderly with OA.

Background: Knee osteoarthritis (OA) diagnosis using Kellgren-Lawrence scores is commonly used to help decision-making during assessment of the severity of OA with assessment of pain, function and muscle strength. The association between Kellgren-Lawrence scores and functional/clinical outcomes remains controversial in patients with knee OA. Objects: The purpose of this study was to examine the relationships between Kellgren-Lawrence scores and knee pain associated with OA, function during daily living and sports activities, quality of life, and knee muscle strength in patients with knee OA. Methods: We recruited 66 patients with tibiofemoral knee OA and determined knee joint Kellgren-Lawrence scores using standing anteroposterior radiographs. Self-reported knee pain, daily living function, sports/recreation function, and quality of life were measured using the knee injury and OA outcome score (KOOS). Knee extensors and flexors were assessed using a handheld dynamometer. We performed Spearman’s rank correlation analyses to evaluate the relationships between Kellgren-Lawrence and KOOS scores or muscle strength. Results: Kellgren-Lawrence scores were significantly negatively correlated with KOOS scores for knee pain, daily living function, sports/recreation function, and quality of life. Statistically significant negative correlations were found between Kellgren-Lawrence scores and knee extensor strength but not flexor strength. Conclusion: Higher Kellgren-Lawrence scores were associated with more severe knee pain and lower levels of function in daily living and sports/recreation, quality of life, and knee extensor strength in patients with knee OA. Therefore, we conclude that knee OA assessment via self-reported KOOS and knee extensor strength may be a cost-effective alternative to radiological exams.

Background: Knee osteoarthritis (OA) is a single most arthritic disease. Knee joint space width (JSW) is commonly used for grading severity of knee OA. However, previous studies did not established criterion validity and test-retest reliability of ultrasound (US) image for measuring JSW. Objects: The aim of this study was to establish criterion validity and test-retest reliability of US measurement of medial and lateral knee JSW. Methods: Twenty-nine subjects with knee OA were participated. The US and X-ray were used to measure knee JSW. One sample Kolmogorov-Smirnov test was used to confirm the data normal distribution. Pearson correlation coefficient and ICC were used to calculated and establish criterion validity and test-retest reliability, respectively. Results: US measurement of medial and lateral knee JSW was highly correlated with radiographic imaging measure (r=.714 and .704, respectively). Test-retest reliabilities of medial and lateral knee JSW were excellent correlated (ICC=.959 for medial side and .988 for lateral side, respectively). Conclusion: US may be valid tool to measure knee JSW.

This study aimed to identify the effects of kinesio taping (KT) applied in a proprioceptive neuromuscular facilitation (PNF) pattern on the pain, weight-bearing distribution (WBD), and walking ability of knee osteoarthritis (KOA) patients. Thirty women with KOA were randomly allocated to a control group (n=15) with KT at the quadriceps only, and a PNF pattern group (n=15) with KT at the quadriceps and gastrocnemius muscle. Pain intensity was measured using a visual analogue scale during walking. In addition, WBD, and walking ability were measured before and 30 minutes after KT application. The VAS significantly reduced in both groups after the intervention (p<.05). WBD (p<.05, ES=.32) and walking ability (p<.05, ES=.38) showed a significant change in the PNF pattern group, and in the inter-group comparison, the PNF pattern group showed a significant difference compared to the control groups. These results demonstrate that KT application with PNF pattern effectively attenuate the pain and improves WBD and walking ability in KOA patients.

The purpose of this study was to identify the effects of mechanical traction applied to the knee joint on pain, knee range of motion (ROM), timed up and go (TUG) and Western Ontario and MacMaster Universities Osteoarthritis (WOMAC) in patients with knee osteoarthritis (KOA) of Kellgren-Lawrence radiological rating scale Ⅱ or Ⅲ. Twenty three patients participated in the experiment for a period of four weeks. After baseline assessment, the patients with KOA were randomized into two groups: the traction group (n1=12), which received traction with general physical therapy; and the control group (n2=11), which received general physical therapy only on unilateral knee joints. Patients received interventions once a day, three times a week, for four weeks. Wilcoxon signed-rank test was used to analyze the change of dependent variances within the group during pre and post intervention. Mann-Whitney U test was used to analyze the change of dependent variances as TUG and passive ROM between the two groups. Analysis of covariance was used to analyze the change of dependent variances as numeric pain rating scale (NPRS) and WOMAC score between the two groups. In Wilcoxon signed-rank test, the traction group improved significantly with regard to NPRS (p<.01), passive knee flexion ROM (p<.01), passive knee extension (p<.05), TUG (p<.01) and WOMAC scores (p<.01) after intervention for four weeks, but not for the control group. In the Mann-Whitney U test and analysis of covariance, no significant difference was seen among all the dependent variances after intervention for four weeks between the two groups. These outcomes suggest that further studies should be carried out to determine the effects of mechanical traction prior to using it for the treatment of patients with knee osteoarthritis.

The purpose of this study was to analyze and compare the effect of resistance exercise and balance exercise on proprioception and WOMAC index of patients with degenerative knee osteoarthritis. A total of 40 subjects participated in this study. The subjects were diagnosed with degenerative knee osteoarthritis and all were more than 60 years old. They were divided into three groups. Group Ⅰ(n=8) was trained with resistance exercise, Group Ⅱ(n=6) was trained with balance exercise and GroupⅢ(n=6) was trained with range of motion as a control. The results of this study were as follows. It was significantly indicated that the resistance exercise group and balance exercise group elicited error-reduction on proprioception goal-angle (p<.05). There was a statistically significant difference on proprioception between resistance exercise group and control(range of motion) group. There was a statistically significant reduction on WOMAC index between resistance exercise group and balance exercise group (p<.05) and on the WOMAC index between resistance exercise group and range of motion group(p<.05). In conclusion, resistance exercise and balance exercise are effective on degenerative knee osteoarthritis and resistance exercise is the most effective for improving proprioception and WOMAC index. More research on the intervention according to the degree of degenerative knee osteoarthritis is needed.

The purpose of this study was to examine the validity and reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-VA3.0 in patients with hip and knee osteoarthritis (OA). The sample consisted of 301 patients who had received treatments at the physical therapy units of 5 medical institutions in Andong City in june 2006. Questionnaires on the WOMAC were recruited by 12 physical therapists. The internal structure and reliability of the scales were evaluated by means of item-internal consistency (Cronbach's alpha coefficient: ), item-discriminant validity, and Pearson's relation coefficient. To explore construct validity, we conducted a principal component factor analysis with varimax rotation analysis. The criterion for factor extraction was an eigenvalue >1.0. The average age of the patients was 62.1 years. All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficients of .81, .91, and .80, respectively. The internal consistency reliability of item-each scale were also internally consistent with Cronbach's coefficient of .89 (Pearson's correlation coefficient: .71~.84), .93 (.89~.91), and .96 (.67~.91), respectively. However, high correlation was found among 3 items (.66~.83, .66~.67, and .67~.83), so the item-discriminant validity was low ( coefficient: .81, .91, .80, respectively). The construct validity by factor analysis was low because it was not consistent With WOMAC-VA3.0. In conclusion, the results reported here confirm the reliability of the WOMAC in patients with OA of the hip and knee. The collection of information on the hip and knee osteoarthritis using this instrument was acceptable to patients. A further prospective multi-center study will be necessary to prove the construct validity.

The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is a valid and widely used instrument for the assessment of osteoarthritis patients. In this study, data was obtained from the out-patients with painful osteoarthritis of the knee. One hundred-three out-patients were interviewed by physical therapists. In an exploratory way, a Korean version of the KWOMAC was analyzed for unidimensionality, item separation, and item difficulty using the Winsteps programs. Ninety-five patients with osteoarthritis of the knee over 65 years were analyzed for Rash analysis. In the analysis several functional items poorly fit to the model. These items included "heavy domestic duties" and "standing". In the pain domain, one item ("at night while in bed") did not fit the model. In the stiffness domain one item ("after sitting, lying, or resting later in the day") did not fit the model. Although 4 items from the 3 domains (pain, stiffness, function domain) do not fit well, the KWOMAC domains were confirmed by Rasch analysis. Thus the KWOMAC needs to be further examined before it can be used to properly determine the health status of the elderly with OA.

The quadriceps-angle (Q-angle) and the ratio of hamstring/quadriceps (H/Q) are important for the stability of the knee and for protection from excessive stress. The aim of this study was to examine the association between Q-angle and H/Q ratio with and without knee osteoarthritis. We compared knee osteoarthritis patients with symptom-free women. The mean age of the patients in the arthritis group (25 women, osteoarthritis) was 59.7 years. The non-arthritis group consisted of 25 women with a mean age of 55.2 years. Of the 25 women with osteoarthritis, 5 had the condition in their left knee, 5 had it in their right knee, and 15 had it on both sides. There was no significant difference in the knee Q-angle of the left and right knees of the arthritis group and the non-arthritis-group (p>.05). The strength of all the muscles around the involved right knee in the arthritis group was significantly weaker than that of the non-arthritis group (p<.05). However, in the left knee, only the strength of the knee extensors and internal rotators was significantly weaker than that of the non-arthritis group (p<.05). The Q-angle was not associated with the H/Q ratio and internal rotators/external rotators ratio of the involved knee in the arthritis group (p>.05). Neither was the Q-angle associated with the pain level of an involved knee in the arthritis group (p>.05). The knee pain was not associated with the H/Q ratio of the involved knee in the arthritis group (p>.05). The Q-angle was not associated with the ratio of H/Q and pain level of the involved knee in the osteoarthritis women.

The purpose of this study was to examine the effect of the angle of a wedged insole on knee varus torque during walking. Fifteen healthy subjects were recruited. Knee varus torque was measured using three-dimensional motion analysis (Elite). Knee varus torque was normalized to gait cycle (0%: initial contact; 100%: ipsilateral initial contact) and stance phase (0%: initial contact; 100%: ipsilateral toe off). The average peaks of knee varus torque during the stance phase of the gait cycle according to the different insole angles (10 or 15 degrees) were compared using one-way ANOVA with repeated measures. The results showed that in the early stance phase, the average peak knee varus torque increased significantly for both the medial 10 and 15 degree wedged insole conditions and decreased significantly for both the lateral 10 and 15 degree wedged insole conditions as compared with no insole (p<.05). However, there were no significant differences between the 10 and 15 degree wedged insole conditions with either the medial or lateral wedged insole (p>.05). In the late stance phase, the average peak knee varus torque increased significantly for the medial 10 and 15 degree wedged insole conditions (p<.05), but not for the lateral 10 and 15 degree wedged insole conditions as compared with no insole (p>.05). We suggest that these results may be beneficial for manufacturing foot orthotic devices, such as wedged insoles, to control medial and lateral compartment forces in the knee varus-valgus deformity. Further studies of the effects of wedged insole angle on knee varus torque in patients with medial-lateral knee osteoarthritis are needed.