interactive Journal of Medical Research
A general medical journal, focusing on innovation in health and medical research
i-JMR is a general medical journal with a focus on innovation in health, health care, and medicine - through new medical techniques and innovative ideas and/or research, including - but not limited to - technology, clinical informatics, or groundbreaking research.
Published by JMIR Publications, publisher of JMIR, the leading eHealth/mHealth journal (Impact Factor 2014: 3.4), i-JMR is a JMIR "sister journal" which features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs.
i-JMR is indexed in PubMed and archived in PubMed Central.
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Latest Submissions Open for Peer-Review:View All Open Peer Review Articles
Relationship of buckling and knee injury to pain exacerbation in knee osteoarthritis: a web-based case-crossover study
Date Submitted: Dec 29, 2015
Open Peer Review Period: Jan 22, 2016 - Mar 18, 2016
Background: Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care...
Background: Knee osteoarthritis (OA) is the most frequent cause of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognised antecedent to disability and eventually joint replacement. There is evidence that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Objective: We examined whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. Methods: We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the internet. Participants were asked to log onto the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control-periods) - a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experience an isolated incident of knee pain exacerbation (case-periods). The case-period questionnaires were only available for those individuals who qualified as having a pain exacerbation based on the difference in knee pain level compared to the mildest intensity level of pain reported previously at the baseline visit (≥2 point increase on the numerical rating scale (NRS)). Participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. Same questions were asked for case-period and control-period online visits. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. Results: There were 157 participants (66% women, mean age: 62 years, mean BMI 29.5 kg/m2) included in the analysis. Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio (OR) 10.2; 95% CI: 5.4, 19.3) compared with no injury. An event of knee buckling was associated with experiencing a pain exacerbation (OR 4.0; 95% CI: 2.6, 6.2) compared with no buckling and the association increased with a greater number of buckling events (for ≥ 6 buckling events, OR 20.1; 95%CI: 3.7, 110). Conclusions: Knee injury and buckling are associated with knee pain exacerbation. Reducing the likelihood of these mechanical events through avoidance of particular activities and/or appropriate rehabilitation programs may decrease the risk of pain exacerbation.