Limits...
Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials.

Henriksen M, Creaby MW, Lund H, Juhl C, Christensen R - BMJ Open (2014)

Bottom Line: There were very serious limitations associated with the methodological quality of the included studies.No RCTs were found to confirm or refute the findings from the cohort studies.CRD42012003253.

View Article: PubMed Central - PubMed

Affiliation: The Parker Institute, Copenhagen University Hospitals Bispebjerg and Frederiksberg, Copenhagen, Denmark.

No MeSH data available.


Related in: MedlinePlus

The mean baseline knee adduction moment (KAM) knee joint load exposures in patients with and without structural disease progression from the four individual cohorts. Note the overlap between progressors and non-progressors in the different studies. Error bars: 95% CI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4120424&req=5

BMJOPEN2014005368F3: The mean baseline knee adduction moment (KAM) knee joint load exposures in patients with and without structural disease progression from the four individual cohorts. Note the overlap between progressors and non-progressors in the different studies. Error bars: 95% CI.

Mentions: The non-significant combined OR indicates no association between knee joint load during walking and structural disease progression. Thus, a score of 0 in the Strength of Association criterion was assigned. The associations were not consistently replicated (50%), resulting in a score of 0 in the Consistency criterion. This finding was further supported by the heterogeneity between the studies (I2=77%; figure 2), and the discrepancies between baseline peak KAM magnitudes among progressors and non-progressors across the cohorts (figure 3). Temporal correctness was accepted in one cohort.30 After requesting for additional information from the authors of one cohort study,31 we discovered that the article reported only part of the study. The additional information retrieved35 showed that the study consisted of three measurements taken every 18 months. Joint space and Kellgren-Lawrence grades (X-rays) were recorded at all three time points, whereas the KAM was obtained at time points 2 and 3 (18 and 36 months). KAM at time point 2 (18 months) was associated with structural disease progression from 18 to 36 months and structural disease progression from time points 1 to 2 (baseline to 18 months) was associated with increased KAM from 18 to 36 months.35 Thus, temporal correctness cannot be assigned to the observed associations in this study, and the overall Temporality criterion was not satisfied (a 0 score). Biological Gradient was investigated in one cohort29 that showed no positive association between baseline peak KAM and loss of medial tibial cartilage volume over 12 months, resulting in a score of 0. Consequently, the causation score based on the included cohort studies was 0 for the association between peak KAM during walking and structural disease progression in patients with knee OA (table 3).


Is there a causal link between knee loading and knee osteoarthritis progression? A systematic review and meta-analysis of cohort studies and randomised trials.

Henriksen M, Creaby MW, Lund H, Juhl C, Christensen R - BMJ Open (2014)

The mean baseline knee adduction moment (KAM) knee joint load exposures in patients with and without structural disease progression from the four individual cohorts. Note the overlap between progressors and non-progressors in the different studies. Error bars: 95% CI.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4120424&req=5

BMJOPEN2014005368F3: The mean baseline knee adduction moment (KAM) knee joint load exposures in patients with and without structural disease progression from the four individual cohorts. Note the overlap between progressors and non-progressors in the different studies. Error bars: 95% CI.
Mentions: The non-significant combined OR indicates no association between knee joint load during walking and structural disease progression. Thus, a score of 0 in the Strength of Association criterion was assigned. The associations were not consistently replicated (50%), resulting in a score of 0 in the Consistency criterion. This finding was further supported by the heterogeneity between the studies (I2=77%; figure 2), and the discrepancies between baseline peak KAM magnitudes among progressors and non-progressors across the cohorts (figure 3). Temporal correctness was accepted in one cohort.30 After requesting for additional information from the authors of one cohort study,31 we discovered that the article reported only part of the study. The additional information retrieved35 showed that the study consisted of three measurements taken every 18 months. Joint space and Kellgren-Lawrence grades (X-rays) were recorded at all three time points, whereas the KAM was obtained at time points 2 and 3 (18 and 36 months). KAM at time point 2 (18 months) was associated with structural disease progression from 18 to 36 months and structural disease progression from time points 1 to 2 (baseline to 18 months) was associated with increased KAM from 18 to 36 months.35 Thus, temporal correctness cannot be assigned to the observed associations in this study, and the overall Temporality criterion was not satisfied (a 0 score). Biological Gradient was investigated in one cohort29 that showed no positive association between baseline peak KAM and loss of medial tibial cartilage volume over 12 months, resulting in a score of 0. Consequently, the causation score based on the included cohort studies was 0 for the association between peak KAM during walking and structural disease progression in patients with knee OA (table 3).

Bottom Line: There were very serious limitations associated with the methodological quality of the included studies.No RCTs were found to confirm or refute the findings from the cohort studies.CRD42012003253.

View Article: PubMed Central - PubMed

Affiliation: The Parker Institute, Copenhagen University Hospitals Bispebjerg and Frederiksberg, Copenhagen, Denmark.

No MeSH data available.


Related in: MedlinePlus