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Am J Phys Med Rehabil. 2018 Feb;97(2):96-103. doi: 10.1097/PHM.0000000000000802.

Could Activity Modifications Indicate Physical Decline Among Adults With Symptomatic Knee Osteoarthritis?

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From the Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, Massachusetts (ACL, WFH, JBD, XH, CW); Department of Physical Medicine and Rehabilitation, Tufts Medical Center, Boston, Massachusetts (RMB); Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts (LLP); and Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts (LLP).



Mobility activity modifications indicate early functional losses that act as precursors to future declines among community-dwelling older adults. However, there is scarce evidence on whether activity modifications indicate poorer physical health among adults with symptomatic osteoarthritis, a major cause of disability. Our purpose was to investigate whether patient-reported mobility activity modifications indicated poorer physical health among adults with symptomatic knee osteoarthritis.


Secondary cross-sectional analysis of randomized trial data was performed. Preclinical Disability Questionnaire was used to group participants into the following three categories: difficulty, modified, and no difficulty walking/stair climbing. Kruskal Wallis and χ tests were used to compare clinical factors across groups.


Among 121 participants (median age = 60 yrs; 73% female; 60% white), less than 10% had modified walking/stair climbing. Compared with those with no walking difficulty, participants with modified walking had significantly less balance (P = 0.01) and global health (P = 0.01) as well as greater knee pain (P = 0.05) and physical disability (P = 0.04). Those with modified stair climbing had significantly smaller walking distances (P = 0.03) compared with those with no difficulty stair climbing.


Activity modifications may signal early impairments in physical health among people with symptomatic knee osteoarthritis. If confirmed, patient-reported activity modifications may enhance symptom evaluation in osteoarthritis and enable a better understanding of the disablement process.

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