Knee osteoarthritis (OA), a chronic progressive disease, is a common complaint in adults over age 45. Indeed, osteoarthritis is the most common joint disorder in many countries, affecting for example 13.9% of adults 25 years and older and 33.6% of people 65 years and older in the United States. The challenge for clinicians is the multifactorial nature of the disease and understanding the everyday mechanical factors that affect it. While various guidelines are available for treatment guidance, every patient’s management needs to be individualized, which can be time-consuming. Furthermore, assessment tools that have been validated for conservative care are lacking.
Now, recently published results from a randomized, controlled clinical trial have demonstrated that use of a new technology for assessing knee joint movement—knee kinesiography—in patients with osteoarthritis can help reduce pain, improve patient quality of life, and may even reduce the need for surgery.
Canadian researchers were testing the KneeKG™ (Emovi Inc., Canada), a medical device that enables healthcare professionals to accurately assess patients’ knees in 3D while the patient is moving and weight-bearing. The trial findings indicate that integrating data from the device’s objective biomechanical evaluation into the management of patients with knee osteoarthritis, can significantly reduce patients’ pain while improving their function and satisfaction levels.
About the Trial
In the cluster randomized controlled trial, which was published in Postgraduate Medicine, primary care clinics were randomized into three groups, as outlined in Figure 1. Primary outcomes were scores on the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and overall score.
For the knee kinesiography exam, trained technicians monitored the patients using the KneeKG validated marker attachment brace while they walked on a treadmill at a self-selected speed (Figure 2). Per previous works, the brace captures 3D knee kinematics with accuracy of coronal and axial rotation measurements established at 0.4° and 2.3° respectively; its reliability (intra- and inter-raters) achieved intra-class coefficients of 0.88 to 0.94 for measuring 3D knee kinematics. The KneeKG software automatically identifies presence of mechanical markers known to be risk factors of knee OA progression, such as varus thrust or offset toward internal tibial rotation. Clinicians in the 2 intervention groups received a report that summarized each patient’s musculoskeletal assessment and the objective mechanical markers identified and recommended personalized treatments (eg, mechanical interventions, specific sports activities) plus a personalized home-based exercise program targeting the identified mechanical knee deficiencies.
Of the 894 patients referred from 87 clinics, 515 participated, and 449 (87.2%) completed the study. At the 6-month follow-up appointments, patients in Group 2 and Group 3, the KneeKG groups, reported statistically significant improvement on the KOOS overall score (Group 2: +5.5; Group 3: +5.05) and on symptoms, pain, and activities of daily living subscales (all P<.001). The study also demonstrated higher levels of patient engagement in Groups 2 and 3 as they reported significantly higher satisfaction levels with global care (both P < 0.01). Group 3-CMM+KneeKG+Education showed statistically significant improvements in objective functional tests as well as greater global impression of change in pain, function, quality of life, and global condition (all P < 0.05).
Figure 1. The care pathway for each of the intervention groups.
In discussing the results, the authors noted that this technology represents a validated tool that can provide quantitative information on biomechanical markers and misalignment issues that can be recognized and corrected through therapy and exercise. In addition, the authors noted that Group 3 had a significantly larger number of patients who were more adherent to the therapeutic recommendations and suggested that the addition of education and supervision contributed to improvement in objective function as well as the perceived global impression of change.
The authors also noted that while satisfaction was significantly higher in the 2 intervention groups, dissatisfaction in the control group was nearly 25%, with 1 in 4 patients reporting that they felt their knee OA “had not been taken care of.” The authors speculated that the higher levels of satisfaction in the intervention groups may be the result of “enhanced patient understanding of the causes of their symptoms facilitated by the KneeKG results.
These findings also appear to demonstrate that this technology may enhance clinicians’ capability and knowledge base to immediately pinpoint functional deficits that correlate to the patient’s knee pain. Recognition of the specific deficit would enable the healthcare provider to determine the most appropriate patient specific care to achieve better outcomes and restore optimal knee function, which could potentially delay the need for knee replacement as suggested by a previous study.
In addition to improving patient quality of life with the reduction of symptoms and pain, the authors concluded the addition of this kind of technology to current medical management of knee OA would provide support for clinical decision-making when creating a conservative treatment plan.
Source: Cagnin A, Choinière M, Bureau NJ, et al. A multi-arm cluster randomized clinical trial of the use of knee kinesiography in the management of osteoarthritis patients in a primary care setting, Postgraduate Medicine. 2019;DOI: 10.1080/00325481.2019.1665457.