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Dynamic weight-bearing assessment of pain in knee osteoarthritis: a reliability and agreement study

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Abstract

Purpose

To evaluate the reliability, agreement and smallest detectable change in a measurement instrument for pain and function in knee osteoarthritis; the Dynamic weight-bearing Assessment of Pain (DAP).

Methods

The sample size was set to 20 persons, recruited from the outpatient osteoarthritis clinic at Frederiksberg Hospital, Copenhagen. Two physiotherapists tested all participants during two visits; at the first visit, one single DAP (including four scores) was conducted by rater one; at the second visit, DAP was conducted by both raters one and two in randomized order with concealed allocation. The time interval was approximately 1.5 h. Measurement error was estimated by standard error of measurement (SEM). The intra- and inter-rater reliability was estimated by Intra-class Correlation Coefficients for agreement based on a two-way ANOVA with random effects (single measures ICC 2.1). Smallest detectable change (SDC) and limits of agreement were calculated.

Results

The pain score showed excellent reliability in terms of ICC (intra-rater 0.93, CI 0.83–0.97, inter-rater 0.91, CI 0.78–0.96), low SEM (intra-rater 0.70, inter-rater 0.86, on a scale from 0 to 10), and acceptable SDC for intra-rater test (1.95). The three knee bend scores all had ICC above 0.50, showing fair-to-good reliability. None of the knee bend scores showed acceptable SEM and SDC.

Conclusions

The reproducibility of the DAP pain score meets the demands for use in clinical practice and research. The total knee bend could be useful for motivational purpose in clinical use. Testing of other psychometric properties of the DAP is pending.

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Acknowledgments

We would like to thank the patients who participated in this study. The Parker Institute is grateful for the financial support received from public and private foundations, companies and private individuals over the years. This study was supported by grants from The Oak Foundation, The Danish Physiotherapy Association and The Danish Rheumatism Association. Financial support was provided from The Parker Institute and Deakin University. The sponsors and funders of the study had no role in the study design, data collection and analysis, interpretation or reporting of this work or the decision to submit the work for publication.

Conflicts of interest

The Parker Institute is supported by a core grant from the Oak Foundation; The Oak Foundation is a group of philanthropic organizations that, since its establishment in 1983, has given grants to not-for-profit organizations around the world. Dr. Christensen reports: I am involved in many health-care initiatives and research that could benefit from wide uptake of this publication (including Cochrane, OMERACT, and the GRADE Working Group). The remaining authors declare that they have no conflict of interests that could influence their work and conclusions in relation to this manuscript.

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Informed consent was obtained from all individual participants included in the study.

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Correspondence to Louise Klokker.

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Klokker, L., Christensen, R., Osborne, R. et al. Dynamic weight-bearing assessment of pain in knee osteoarthritis: a reliability and agreement study. Qual Life Res 24, 2985–2992 (2015). https://doi.org/10.1007/s11136-015-1025-4

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