Department of Orthopaedics, Royal Perth Hospital, Wellington Street, Perth, WA, 6000, Australia.
School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3705-3712. doi: 10.1007/s00167-019-05505-3. Epub 2019 Apr 9.
No quantitative test exists to reliably assess kneeling tolerance before and after surgery. The aim of this study was to validate a kneeling test, designed to quantify kneeling tolerance.
A total of 179 participants (324 knees) were enrolled into the study, including 124 asymptomatic knees, 98 with osteoarthritis (OA), 85 following total knee arthroplasty (TKA) and 17 following anterior cruciate ligament reconstruction (ACLR). Patients were asked to kneel on a custom-built platform on a soft, firm and hard surface, at both 90° and 110° of knee flexion. A kneeling score of 0-100 was established for 90° and 110° with 100 being a complete absence of pain or discomfort. A linear mixed model with random intercept was used to estimate differences between conditions (healthy, OA, ACLR and TKA). Pearson's correlation coefficient was used to test the strength of the association between the kneeling test and the forgotten joint score (FJS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Test-retest reliability was estimated by the intraclass correlation coefficient (ICC).
The kneeling test demonstrated good discriminative validity with differences at 110° between asymptomatic knees and knees with OA (difference = - 42, p < 0.001), following ACLR (- 12, p = 0.013) and TKA (- 26, p < 0.001). Similar differences were observed at 90. The kneeling test demonstrated construct validity, with a moderately strong correlation observed between the kneeling test and the FJS and the WOMAC at 90° (FJS 0.474 [95%CI: 0.357, 0.577], WOMAC - 0.503 [- 0.389, - 0.602]) and 110° (FJS 0.579 [95% CI: 0.479, 0.665], WOMAC - 0.648 [- 0.560, - 0.722]). The ICC for the kneeling test at 90° and 110° was 0.843 (95% CI: 0.745, 0.905) and 0.926 (95% CI: 0.877, 0.956), respectively.
The kneeling test is a valid technique to quantitatively determine kneeling tolerance. It can aid in the assessment and modification of current surgical techniques to improve patient outcomes.
III.
目前尚无可靠的定量试验来评估手术前后的跪姿耐受力。本研究的目的是验证一种跪姿试验，旨在量化跪姿耐受力。
共有 179 名参与者（324 个膝关节）纳入研究，包括 124 例无症状膝关节、98 例骨关节炎（OA）患者、85 例全膝关节置换术（TKA）后患者和 17 例前交叉韧带重建（ACLR）后患者。患者被要求在一个定制的平台上以 90°和 110°的膝关节弯曲度跪在软、硬两种表面上。90°和 110°的跪姿评分为 0-100 分，100 分为完全无痛或无不适。采用具有随机截距的线性混合模型来估计健康、OA、ACLR 和 TKA 之间的条件差异。Pearson 相关系数用于测试跪姿试验与遗忘关节评分（FJS）和西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分之间的关联强度。通过组内相关系数（ICC）估计测试-再测试的可靠性。
110°时，无症状膝关节与 OA 膝关节（差异=-42，p<0.001）、ACLR 后膝关节（差异=-12，p=0.013）和 TKA 后膝关节（差异=-26，p<0.001）之间的跪姿试验差异具有良好的判别效度。在 90°时也观察到类似的差异。跪姿试验具有结构效度，90°和 110°时，跪姿试验与 FJS 和 WOMAC 之间具有中度强相关性（FJS 0.474 [95%CI: 0.357, 0.577]，WOMAC -0.503 [-0.389, -0.602]）和 110°（FJS 0.579 [95%CI: 0.479, 0.665]，WOMAC -0.648 [-0.560, -0.722]）。90°和 110°时的跪姿试验 ICC 分别为 0.843（95%CI: 0.745, 0.905）和 0.926（95%CI: 0.877, 0.956）。
跪姿试验是一种定量测定跪姿耐受力的有效技术。它可以帮助评估和修改当前的手术技术，以改善患者的治疗效果。
III 级。
