Abstract
Segal NA, Yack HJ, Brubaker M, Torner JC, Wallace R. Association of dynamic joint
power with functional limitations in older adults with symptomatic knee osteoarthritis.
Objectives
To determine which lower-limb joint moments and powers characterize the level of gait
performance of older adults with symptomatic knee osteoarthritis (OA).
Design
Cross-sectional observational study.
Setting
University motion analysis laboratory.
Participants
Community-dwelling adults (N=60; 27 men, 33 women; age 50–79y) with symptomatic knee
OA.
Interventions
Not applicable.
Main Outcome Measures
Physical function was measured using the long-distance corridor walk, the Short Physical
Performance Battery, and the Late Life Function and Disability Instrument (LLFDI Function).
Joint moments and power were estimated using an inverse dynamics solution after 3-dimensional
computerized motion analysis.
Results
Subjects aged 64.2±7.4 years were recruited. Ranges (mean ± SD) for the 400-m walk
time and the LLFDI Advanced Lower-Limb Function score were 215.3 to 536.8 (304.1±62.3)
seconds and 31.5 to 100 (57.0±14.9) points, respectively. In women, hip abductor moment
(loading response), hip abductor power (midstance), eccentric hamstring moment (terminal
stance), and power (terminal swing) accounted for 41%, 31%, 14%, and 48% of the variance
in the 400-m walk time, respectively (model R2=.61, P<.003). In men, plantar flexor and hip flexor power (preswing) accounted for 19% and
24% of the variance in the 400-m walk time, respectively (model R2=.32, P=.025).
Conclusions
There is evidence that men and women with higher mobility function tend to rely more
on an ankle strategy rather than a hip strategy for gait. In higher functioning men,
higher knee extensor and flexor strength may contribute to an ankle strategy, whereas
hip abductor weakness may bias women with lower mobility function to minimize loading
across the knee via use of a hip strategy. These parameters may serve as foci for
rehabilitation interventions aimed at reducing mobility limitations.
Key Words
List of Abbreviations:
LLFDI (Late Life Function and Disability Instrument), MOST (Multicenter Osteoarthritis Study), OA (osteoarthritis), SPPB (Short Physical Performance Battery), WOMAC (Western Ontario McMasters Knee Osteoarthritis Index)To read this article in full you will need to make a payment
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References
- Self-reported causes of physical disability in older people: the Cardiovascular Health Study.J Am Geriatr Soc. 1994; 42: 1035-1044
- Disability in older adults: evidence regarding significance, etiology, and risk.J Am Geriatr Soc. 1997; 45: 92-100
- The contribution of osteoarthritis to disability: preliminary data from the Women's Health and Aging Study.J Rheumatol Suppl. 1995; 43: 16-18
- Difficulty and dependence: two components of the disability continuum among community-living older persons.Ann Intern Med. 1998; 128: 96-101
- Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.N Engl J Med. 1995; 332: 556-561
- Preclinical mobility disability predicts incident mobility disability in older women.J Gerontol A Biol Sci Med Sci. 2000; 55: M43-M52
- Predicting the risk of mobility difficulty in older women with screening nomograms: the Women's Health and Aging Study II.Arch Intern Med. 2000; 160: 2525-2533
- Biomechanical gait analysis of the diseased knee joint.Clin Orthop. 1977; : 246-255
- Isometric muscle force measurement for clinicians treating patients with osteoarthritis of the knee.Arthritis Rheum. 2003; 49: 29-35
- Knee osteoarthritis compromises early mobility function: the Women's Health and Aging Study II.J Rheumatol. 2003; 30: 114-120
- Age-related declines in knee extensor strength and physical performance in healthy Hispanic and Caucasian women.J Gerontol A Biol Sci Med Sci. 2000; 55: B563-B569
- Maximal isometric strength and mobility among 75-year-old men and women.Age Ageing. 1994; 23: 132-137
- Mechanical energy transfer during gait in relation to strength impairment and pathology in elderly women.Clin Biomech (Bristol, Avon). 2001; 16: 324-333
- Age causes a redistribution of joint torques and powers during gait.J Appl Physiol. 2000; 88: 1804-1811
- Rehabilitation effects on compensatory gait mechanics in people with arthritis and strength impairment.Arthritis Rheum. 2003; 49: 248-254
- Osteoarthosis and disk degeneration in an urban population.Ann Rheum Dis. 1958; 17: 388-396
- Late Life Function and Disability Instrument: I. Development and evaluation of the disability component.J Gerontol A Biol Sci Med Sci. 2002; 57: M209-M216
- Validation of the Late-Life Function and Disability Instrument.J Am Geriatr Soc. 2004; 52: 1554-1559
- Measuring disability and function in older women: psychometric properties of the Late-Life Function and Disability Instrument.J Gerontol A Biol Sci Med Sci. 2005; 60: 901-909
- Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Pain. 2002; 100: 55-64
- Comparison of WOMAC with SF-36 for OA of the knee or hip.Ann Rheum Dis. 2002; 61: 182-183
- Validation of a modified Thai version of the Western Ontario and McMaster (WOMAC) osteoarthritis index for knee osteoarthritis.Clin Rheumatol. 2007; 26: 1641-1645
- WOMAC osteoarthritis index.Scand J Rheumatol. 1999; 28: 210-215
- The Physical Activity Scale for the Elderly (PASE): evidence for validity.J Clin Epidemiol. 1999; 52: 643-651
- The Physical Activity Scale for the Elderly (PASE): development and evaluation.J Clin Epidemiol. 1993; 46: 153-162
- Validation of the PASE in older adults with knee pain and physical disability.Med Sci Sports Exerc. 1999; 31: 627-633
- Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability.JAMA. 2006; 295: 2018-2026
- Measuring fitness in healthy older adults: the Health ABC Long Distance Corridor Walk.J Am Geriatr Soc. 2001; 49: 1544-1548
- Measures of physical performance and risk for progressive and catastrophic disability: results from the Women's Health and Aging Study.J Gerontol A Biol Sci Med Sci. 2005; 60: 74-79
- Muscle mass is more strongly related to hip bone mineral density than is quadriceps strength or lower activity level in adults over age 50 year.J Clin Densitom. 2008; 11: 503-510
- Techniques of manual examination.in: 6th ed. WB Saunders, Philadelphia1995: 11-26 (p 169-201.)
- Normative values for isometric muscle force measurements obtained with hand-held dynamometers.Phys Ther. 1996; 76: 248-259
- Effects of strength training on strength development and joint position sense in functionally unstable ankles.J Athl Train. 1998; 33: 310-314
- Do female gait patterns differ from male gait patterns in knee osteoarthritis?.in: Proceedings of the 2008 World Congress on Osteoarthritis. September 18-21, 2008: 125 (Rome, Italy.)
- Effect of leg muscle contraction velocity on functional performance in older men and women.J Am Geriatr Soc. 2005; 53: 467-471
- Gender differences exist in osteoarthritic gait.Clin Biomech (Bristol, Avon). 2007; 22: 400-409
- Gait characteristics of patients with knee osteoarthritis.J Biomech. 2001; 34: 907-915
- Discriminating age and disability effects in locomotion: neuromuscular adaptations in musculoskeletal pathology.J Appl Physiol. 2004; 96: 149-160
- Biomechanical changes at the hip, knee, and ankle joints during gait are associated with knee osteoarthritis severity.J Orthop Res. 2008; 26: 332-341
- The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis.Curr Opin Rheumatol. 2006; 18: 514-518
- Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking.Arthritis Rheum. 2005; 52: 2835-2844
- Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression.Arthritis Rheum. 2005; 52: 3515-3519
- The effect of walking speed on lower-extremity joint powers among elderly adults who exhibit low physical performance.Arch Phys Med Rehabil. 2005; 86: 2177-2183
- Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels.J Biomech. 2008; 41: 868-876
- The relationship between ankle plantar flexor muscle moments and knee compressive forces in subjects with and without pain.Clin Biomech (Bristol, Avon). 2000; 15: 522-527
- Thrust during ambulation and the progression of knee osteoarthritis.Arthritis Rheum. 2004; 50: 3897-3903
- Compensatory gait mechanics in patients with unilateral knee arthritis.J Rheumatol. 2002; 29: 2410-2419
Article info
Footnotes
Supported by a 2006 Dennis W. Jahnigen Career Development Scholars Award through the American Geriatrics Society and by the following NIH/NIA grants: U01-AG-18832, U01-AG-18820, U01-AG-18947, and U01-AG-19069.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2009 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
