Original article| Volume 94, ISSUE 2, P332-339, February 2013

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Assistive Walking Device Use and Knee Osteoarthritis: Results From the Health, Aging and Body Composition Study (Health ABC Study)

Published:October 08, 2012DOI:



      To identify factors that predicted incident use of assistive walking devices (AWDs) and to explore whether AWD use was associated with changes in osteoarthritis of the knee.


      Prospective cohort study.




      Older adults (N=2639) in the Health, Aging and Body Composition (Health ABC) Study including a subset of 874 patients with prevalent knee pain.


      Not applicable.

      Main Outcome Measures

      Incident use of AWDs, mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores, and the frequency of joint space narrowing on knee radiographs over a 3-year time period.


      AWD use was initiated by 9% of the entire Health ABC cohort and 12% of the knee pain subset. Factors that predicted use in both groups were age ≥73 (entire cohort: odds ratio [OR]=2.07; 95% confidence interval [CI], 1.43–3.01; knee pain subset: OR=1.87; 95% CI, 1.16–3.03), black race (entire cohort: OR=2.95; 95% CI, 2.09–4.16; knee pain subset: OR=3.21; 95% CI, 2.01–5.11), and lower balance ratios (entire cohort: OR=3.18; 95% CI, 2.21–4.59; knee pain subset: OR=3.77; 95% CI, 2.34–6.07). Mean WOMAC pain scores decreased slightly over time in both AWD and non-AWD users. Twenty percent of non-AWD users and 28% of AWD users had radiographic progression in joint space narrowing of the tibiofemoral joint in at least 1 knee. Fourteen percent of non-AWD users and 12% of AWD users had radiographic progression in joint space narrowing in the patellofemoral joint in at least 1 knee.


      AWDs are frequently used by older adults. Knee pain and balance problems are significant reasons why older adults initiate use of an AWD. In an exploratory analysis, there was no consistent relation between the use or nonuse of an AWD and WOMAC pain scores or knee joint space narrowing progression. Further studies of the relation of use of AWDs to changes in knee osteoarthritis are needed.


      List of abbreviations:

      AWD (assistive walking device), BMI (body mass index), Health ABC (Health, Aging and Body Composition), JSN (joint space narrowing), NSAID (nonsteroidal anti-inflammatory drug), OA (osteoarthritis), PF (patellofemoral), TF (tibiofemoral), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
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        • Guccione A.A.
        • Felson D.T.
        • Anderson J.J.
        • et al.
        The effects of specific medical conditions on the functional limitations of elders in the Framingham Study.
        Am J Public Health. 1994; 84: 351-358
        • Wolff J.
        • Agree E.
        • Kasper J.
        Wheelchairs, walkers, and canes: what does medical pay for, and who benefits?.
        Health Affairs. 2005; 24: 1140-1149
        • Van der Esch M.
        • Heijmans M.
        • Dekker J.
        Factors contributing to possession and use of walking aids among persons with rheumatoid arthritis and osteoarthritis.
        Arthritis Rheum. 2003; 49: 838-842
        • Shrier I.
        • Feldman D.E.
        • Gaudet M.C.
        • et al.
        Conservative non-pharmacological treatment options are not frequently used in the management of hip osteoarthritis.
        J Sci Med Sport. 2006; 9: 81-86
        • Bateni H.
        • Maki B.E.
        Assistive devices for balance and mobility: benefits, demands, and adverse consequences.
        Arch Phys Med Rehabil. 2005; 86: 134-145
        • Salminen A.L.
        • Brandt A.
        • Samuelsson K.
        • Toytari O.
        • Malmivaara A.
        Mobility devices to promote activity and participation: a systematic review.
        J Rehabil Med. 2009; 41: 697-706
        • Van Hook F.W.
        • Demonbreun D.
        • Weiss B.D.
        Ambulatory devices for chronic gait disorders in the elderly.
        Am Fam Physician. 2003; 67: 1717-1724
        • Hunter D.J.
        • Zhang Y.Q.
        • Niu J.B.
        • et al.
        Patella malalignment, pain and patellofemoral progression: the Health ABC Study.
        Osteoarthritis Cartilage. 2007; 15: 1120-1127
        • Haringsma R.
        • Engels G.I.
        • Beekman A.T.
        • Spinhoven P.
        The criterion validity of the Center for Epidemiological Studies Depression Scale (CES-D) in a sample of self-referred elders with depressive symptomatology.
        Int J Geriatr Psychiatry. 2004; 19: 558-563
        • Taylor H.L.
        • Jacobs Jr., D.R.
        • Schucker B.
        • Knudsen J.
        • Leon A.S.
        • Debacker G.
        A questionnaire for the assessment of leisure time physical activities.
        J Chronic Dis. 1978; 31: 741-755
        • Guralnik J.M.
        • Simonsick E.M.
        • Ferrucci L.
        • et al.
        A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.
        J Gerontol. 1994; 49: M85-M94
        • Pahor M.
        • Chrischilles E.A.
        • Guralnik J.M.
        • Brown S.L.
        • Wallace R.B.
        • Carbonin P.
        Drug data coding and analysis in epidemiologic studies.
        Eur J Epidemiol. 1994; 10: 405-411
        • Peterfy C.
        • Li J.
        • Zaim S.
        • et al.
        Comparison of fixed-flexion positioning with fluroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility.
        Skeletal Radiol. 2003; 32: 343-344
        • Felson D.T.
        • McAlindon T.E.
        • Anderson J.J.
        • et al.
        Defining radiographic osteoarthritis for the whole knee.
        Osteoarthritis Cartilage. 1997; 5: 241-250
        • Altman R.
        • Asch E.
        • Bloch D.
        • et al.
        Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association.
        Arthritis Rheum. 1986; 29: 1039-1049
        • Bellamy N.
        WOMAC osteoarthritis index, a user's guide.
        Univ of Western Ontario, London1995
        • Resnik L.
        • Allen S.
        Racial and ethnic differences in use of assistive devices for mobility: effect modification by age.
        J Aging Health. 2006; 18: 106-124
        • Skinner J.
        • Weinstein J.N.
        • Sporer S.M.
        • Wennberg J.E.
        Racial, ethnic, and geographic disparities in rates of knee arthroplasty among Medicare patients.
        N Engl J Med. 2003; 349: 1350-1359
        • Ibrahim S.A.
        • Siminoff L.A.
        • Burant C.J.
        • Kwoh C.K.
        Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients.
        Arthritis Rheum. 2001; 45: 340-345
        • Shrier I.
        • Feldman D.E.
        • Gaudet M.C.
        • et al.
        Conservative non-pharmacological treatment options are not frequently used in the management of hip osteoarthritis.
        J Sci Med Sport. 2006; 9: 81-86
        • Dean E.
        • Ross J.
        Relationships among cane fitting, function, and falls.
        Phys Ther. 1993; 73: 494-500
        • Satariano W.A.
        • DeLorenze G.N.
        • Reed D.
        • Schneider E.L.
        Imbalance in an older population: an epidemiological analysis.
        J Aging Health. 1996; 8: 334-358
        • Kumar R.
        • Roe M.C.
        • Scremin O.U.
        Methods for estimating the proper length of a cane.
        Arch Phys Med Rehabil. 1995; 76: 1173-1175
        • Chan G.N.
        • Smith A.W.
        • Kirtley C.
        • Tsang W.W.
        Changes in knee moments with contralateral versus ipsilateral cane usage in females with knee osteoarthritis.
        Clin Biomech (Bristol, Avon). 2005; 20: 396-404
        • Richards S.
        • Cristian A.
        The role of the physical therapist in the care of the older adult.
        Clin Geriatr Med. 2006; 22 (viii): 269-279
        • Tanamas S.
        • Hanna F.S.
        • Cicuttini F.M.
        • Wluka A.E.
        • Berry P.
        • Urquhart D.M.
        Does knee malalignment increase the risk of development and progression of knee osteoarthritis? A systematic review.
        Arthritis Rheum. 2009; 61: 459-467