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a Rheumatology Unit, City Hospital,
Nottingham NG5 1PB, b Department of Public Health Medicine and Epidemiology,
Queens Medical Centre, Nottingham
Correspondence to: Dr O'Reilly.
Accepted for publication 27 July 1998
OBJECTIVES
(1) To determine the importance of
quadriceps strength, structural change, and psychological status in
terms of knee pain in the community. (2) To determine the relative
importance of quadriceps function, structural change, and psychological
status with respect to disability in subjects with knee pain.
METHODS300 men and women with pain and 300 controls without pain (aged 40-79) were seen. Isometric quadriceps
strength (MVC) was measured and muscle activation was assessed by
twitch superimposition. Disability (Western Ontario McMaster
Osteoarthritis Index (WOMAC)) and anxiety and depression were assessed
(Hospital Anxiety and Depression Index (HAD)). Radiographs were
obtained of the tibiofemoral and patellofemoral joints and total
score for osteophyte, narrowing, and sclerosis calculated for each knee.
RESULTSSubjects with knee pain had lower
voluntary quadriceps strength than those without pain (p<0.005).
Quadriceps activation was also lower (p<0.005), but did not fully
explain the reduction in strength. When analysed by multiple logistic
regression: quadriceps strength (odds ratio 18.8, CI 4.8, 74.1 for MVC
10 kgF); depression (odds ratio 2.4, CI 1.0, 5.5 for HAD score
8);
and radiographic change (odds ratio 4.1, CI 1.9, 8.6 for radiographic
score 4) were independently associated with pain. In those with knee
pain, disability was independently associated with quadriceps strength (odds ratio 8.2, CI 1.5, 44.4 for MVC 10 kgF) and depression (odds
ratio 6.2, CI 2.1, 18.0 for HAD score8); but not with radiographic score.
CONCLUSIONSQuadriceps strength is strongly
associated with knee pain and disability in the community, even when
activation and psychological factors are taken into account. This has
important therapeutic implications.
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