Evaluation and Standardization of the Knee Examination (ESKE)
Introduction:
The knee examination is an important component of the assessment of persons with knee osteoarthritis both in a clinical setting and in research. The knee examination can be conducted using different assessments including examination for joint fluid, tenderness, bony swelling, walking, alignment (how straight the leg is), joint grinding, muscle strength, instability and range of movement. 
In addition, different techniques can be employed for these assessments. There is little information on how reliable or comparable the findings of a knee examination are among different examiners. If the knee examination is to be used in research studies, it is important to understand which assessments and techniques are most reliable and to use only those that are reliable, so that the results of a research study can be incorporated by other researchers or in a clinical setting. The objective of this study was to determine which knee examination techniques can be assessed reliably by expert rheumatologists in subjects with symptomatic knee osteoarthritis.
Project Methodology:
Six subjects with mild to severe knee osteoarthritis were each examined by 6 rheumatologists experienced in the assessment of osteoarthritis. Subjects were examined in random order prior to and following standardization of techniques. Standardization of techniques was achieved during a meeting of the six participating rheumatologists which entailed identification of differences in findings from the pre-standardization assessments, discussion of examination techniques to elucidate reasons for the variability in findings and demonstration of knee examinations on a healthy volunteer. The reliability of findings among rheumatologists was measured for each of 42 knee examination manoeuvres.
Participant Recruitment:
Six subjects (3 males, 3 females), 44 to 74 years old, with knee osteoarthritis who had previously participated in research and had indicated an interest in further research were recruited for this study.
Relevance For People With Arthritis:
A standardized knee examination is important for the accurate and reliable assessment of persons with knee osteoarthritis. The results from this study will allow for the selective use of only those knee examination techniques that are of good reliability. These findings will be applied in a subsequent study that aims to develop a tool for the diagnosis of early knee osteoarthritis (MoDEKO study). In general, the diagnostic accuracy and evaluation of progression of osteoarthritis will be enhanced by such standardized assessments both in clinical practice and in a research setting. The investigators for the National Institutes of Health Osteoarthritis Initiative have expressed an interest in the standardized knee examination and have adapted some examination manoeuvres for inclusion into their osteoarthritis initiative.
Results:
After standardization of techniques, 30 of 42 knee examination manoeuvres were reliably assessed. Reliable assessments included different manoeuvres for joint fluid, tenderness, bony swelling, walking, alignment (how straight the leg is), joint grinding, muscle strength and range of movement. There was poor agreement among the 6 rheumatologists on the findings of joint instability and hence instability could not be assessed reliably.
Consumer Involvement:
Consumers were involved with participation in this study.
Time Frame:
October 2001 - September 2002.
Funding Agency:
Canadian Institutes of Health Research and Canadian Arthritis Network.
Publications / Presentations
This work was presented at the Osteoarthritis Research Society International World Congress, Sydney , Australia , in September 2002 and is published in Arthritis and Rheumatism 2004;50:458-68.
Project Team Members:
Principal Investigators
Jolanda Cibere MD, PhD
Research Scientist, ARC
John M. Esdaile MD, MPH
Scientific Director, ARC
Co-Investigators
Jacek Kopec MD, PhD
Research Scientist, ARC
Kam Shojania MD
Clinical Trialist, ARC
Joel Singer MD, PhD
Anona Thorne MSc
Hubert Wong PhD
Andrew Chalmers MD
A. Robin Poole PhD, DSc
Nicholas Bellamy MD, MSc
Paul Peloso MD, MSc
Study Coordinator
Kelly J. McGorm BN, MPH
Research Co-ordinator, ARC
Other Institutions Involved
University of British Columbia
Vancouver, BC Canada
Centre for Health & Evaluation Outcome Sciences
Vancouver, BC Canada
Vancouver Hospital & Health Sciences Centre
Vancouver, BC Canada
Centre of National Research on Disability and Rehabilitation Medicine (CONROD)
University of Queensland
Brisbane Australia
University of Iowa
Iowa City, USA