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Related Experiment Videos

Confounding pain and function: the WOMAC's failure to accurately predict lower extremity function.

Paul Stratford1, Deborah Kennedy1,2,3, Hance Clarke4

  • 1School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.

Arthroplasty Today
|December 21, 2018
PubMed
Summary
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The Western Ontario and McMaster Universities Osteoarthritis Index physical function (WOMAC-PF) score does not accurately reflect changes in lower extremity function after total knee arthroplasty (TKA). A conversion formula can adjust WOMAC-PF scores using the Lower Extremity Functional Scale (LEFS).

Area of Science:

  • Orthopedics and Rehabilitation
  • Biomedical Engineering
  • Clinical Outcomes Assessment

Background:

  • The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has limitations in distinguishing pain and function assessments.
  • The Lower Extremity Functional Scale (LEFS) offers a more distinct assessment of function compared to WOMAC.
  • The WOMAC physical function (WOMAC-PF) subscale's ability to assess lower extremity mobility post-total knee arthroplasty (TKA) requires further investigation.

Purpose of the Study:

  • To evaluate the WOMAC-PF's accuracy in assessing lower extremity mobility following TKA.
  • To establish a relationship between pre- and post-TKA WOMAC-PF and LEFS scores.
  • To account for the bias introduced by WOMAC pain scores on WOMAC-PF assessments.

Main Methods:

Keywords:
Knee arthroplastyOutcome measuresPatient-reported

Related Experiment Videos

  • Administration of WOMAC, LEFS, and Timed-up-and-go measures at baseline, 4 days, 6 weeks, and 3 months post-TKA.
  • Paired t-tests to compare pre-TKA and 4-day post-TKA values for WOMAC-PF and LEFS.
  • Generalized estimating equation (GEE) analysis to assess the relationship between WOMAC-PF and LEFS scores over time.

Main Results:

  • Significant reductions in lower extremity function (LEFS, Timed-up-and-go) and pain were observed post-TKA (P < .001).
  • No significant change in WOMAC-PF scores was detected (P = .61), indicating limited sensitivity to functional improvements.
  • GEE analysis revealed a consistent linear relationship between WOMAC-PF and LEFS scores across all measurement occasions.

Conclusions:

  • Findings confirm the WOMAC-PF's inadequacy in validly assessing functional changes after TKA, consistent with prior research.
  • GEE analysis provides coefficients to convert LEFS scores to WOMAC-PF scores, correcting for pre- and post-TKA assessment bias.
  • This conversion method enhances the utility of WOMAC-PF scores in clinical practice and research for TKA outcomes.