L Sheehy1, E Culham2, L McLean3, J Niu4, J Lynch5, N A Segal6, J A Singh7, M Nevitt8, T D V Cooke9. 1. Bruyère Research Institute, Ottawa, ON, Canada; School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada. Electronic address: lsheehy@bruyere.org. 2. School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. Electronic address: elsie.culham@queensu.ca. 3. School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada. Electronic address: mcleanl@queensu.ca. 4. Boston University School of Medicine, Boston, MA, USA. Electronic address: niujp@bu.edu. 5. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. Electronic address: JLynch@psg.ucsf.edu. 6. Department of Rehabilitation Medicine, University of Kansas, Kansas City, KS, USA; Department of Epidemiology, University of Iowa, Iowa City, IA, USA. Electronic address: neil-segal@uiowa.edu. 7. Department of Medicine at School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; Medicine Service, VA Medical Center, Birmingham, AL, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. Electronic address: jasvinder.md@gmail.com. 8. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. Electronic address: MNevitt@psg.ucsf.edu. 9. School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada. Electronic address: derek@cookes.ca.
Abstract
OBJECTIVES: The purpose of this study was to assess the concurrent validity and sensitivity to change of three knee osteoarthritis (OA) grading scales. The Kellgren-Lawrence (KL) and the Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) grading scales are well-established. The third scale, the compartmental grading scale for OA (CG) is a novel scale which grades JSN, femoral osteophytes, tibial erosion and subluxation to create a total score. METHODS: One sample of 72 posteroanterior (PA) fixed-flexion radiographs displaying mild to moderate knee OA was selected from the Multicenter Osteoarthritis Study (MOST) to study validity. A second sample of 75 radiograph pairs, which showed an increase in OA severity over 30 months, was selected to study sensitivity to change. The three radiographic grading scales were applied to each radiograph in both samples. Spearman's rank correlation coefficients were used to correlate the radiographic grades and the change in grades over 30 months with a Whole-organ Magnetic Resonance Imaging Score (WORMS)-based composite score which included five articular features of knee OA. RESULTS: Correlations between the KL, OARSI JSN and CG grading scales and the magnetic resonance image (MRI)-based score were 0.836, 0.840 and 0.773 (P < 0.0001) respectively while correlations between change in the radiographic grading scales and change in the MRI-based score were 0.501, 0.525 and 0.492 (P < 0.0001). CONCLUSIONS: All three radiographic grading scales showed high validity and are suitable to assess knee OA severity. They showed moderate sensitivity to change; therefore caution should be taken when using ordinal radiographic grading scales to monitor knee OA over time.
OBJECTIVES: The purpose of this study was to assess the concurrent validity and sensitivity to change of three knee osteoarthritis (OA) grading scales. The Kellgren-Lawrence (KL) and the Osteoarthritis Research Society International (OARSI) joint space narrowing (JSN) grading scales are well-established. The third scale, the compartmental grading scale for OA (CG) is a novel scale which grades JSN, femoral osteophytes, tibial erosion and subluxation to create a total score. METHODS: One sample of 72 posteroanterior (PA) fixed-flexion radiographs displaying mild to moderate knee OA was selected from the Multicenter Osteoarthritis Study (MOST) to study validity. A second sample of 75 radiograph pairs, which showed an increase in OA severity over 30 months, was selected to study sensitivity to change. The three radiographic grading scales were applied to each radiograph in both samples. Spearman's rank correlation coefficients were used to correlate the radiographic grades and the change in grades over 30 months with a Whole-organ Magnetic Resonance Imaging Score (WORMS)-based composite score which included five articular features of knee OA. RESULTS: Correlations between the KL, OARSI JSN and CG grading scales and the magnetic resonance image (MRI)-based score were 0.836, 0.840 and 0.773 (P < 0.0001) respectively while correlations between change in the radiographic grading scales and change in the MRI-based score were 0.501, 0.525 and 0.492 (P < 0.0001). CONCLUSIONS: All three radiographic grading scales showed high validity and are suitable to assess knee OA severity. They showed moderate sensitivity to change; therefore caution should be taken when using ordinal radiographic grading scales to monitor knee OA over time.
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