{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:00:17Z","timestamp":1791896417849,"version":"4.3.4"},"reference-count":56,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with or at risk of developing knee osteoarthritis (OA) can acquire a knee flexion contracture (FC). The prevalence, severity, and association of knee FC on OA outcomes such as pain, stiffness, and function are not well described and clinical scales may omit measuring joint range of motion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>(1) To determine if the presence and severity of a knee FC was associated with worse joint pain, stiffness and\/or function and (2) to determine if this association was present in participants with or at risk of knee OA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following a detailed standardized protocol, maximum knee extension was obtained from the baseline physical examination data using a goniometer with the fulcrum over the knee joint line, the upper arm directed towards the greater trochanter and the lower arm directed towards the lateral malleolus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Cross\u2010sectional, using the Osteoarthritis Initiative database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and Participants<\/jats:title><jats:p>Baseline cross\u2010sectional data collected from a prospective outpatient cohort study, recruiting from four academic health care centers in the United States. Three subcohorts were included: those at\u2010risk of OA (n\u2009=\u20095995 knees), those with radiographic OA (n\u2009=\u20092610 knees), and controls (n\u2009=\u200962 knees).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>We categorized knee FCs as none, mild, moderate, or severe. Pain scales included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and numeric pain rating scale; stiffness, the WOMAC stiffness subscale; and function, the WOMAC function subscale and 400\u2010m walk time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants with FC reported overall worse pain, stiffness, and function compared to those without FC in a severity\u2010dependent manner. OA participants' scores showed between 1.8\u2010 and 11.0\u2010fold mean relative worsening versus at\u2010risk participants (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05 for all). Knee FC was independently associated in a severity\u2010dependent manner with all outcomes (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Knee FCs were associated with worse pain, stiffness, and function in a severity\u2010dependent manner in a population with or at risk of knee OA. There was an interaction between OA subcohort and FC severity (<jats:italic>P<\/jats:italic>\u2010for\u2010interaction &lt;.01 for all WOMAC outcomes). Evaluation of the longitudinal effects of contracture on OA and at\u2010risk patient outcomes is necessary.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12497","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T06:16:18Z","timestamp":1600928178000},"page":"954-961","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Knee Flexion Contractures Are Associated with Worse Pain, Stiffness, and Function in Patients with Knee Osteoarthritis: Data from the Osteoarthritis Initiative"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6328-9030","authenticated-orcid":false,"given":"T Mark","family":"Campbell","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Elisabeth Bruy\u00e8re Hospital  Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Ramsay","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute  Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Trudel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Physical and Rehabilitation Medicine The Ottawa Hospital  Ottawa ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1703856114"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.13805"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61729-2"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-014-2692-1"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.332.7542.639"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/39.9.955"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2014.12.001"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2006.11.009"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/000164702320155365"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(00)90213-2"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.140079"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22785"},{"key":"e_1_2_8_14_1","volume-title":"Orthopedic Physical Assessment","author":"Magee DJ","year":"2008"},{"key":"e_1_2_8_15_1","first-page":"648","volume-title":"Joint Contractures","author":"Campbell TM","year":"2015"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.071056"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2009.02.003"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2019.11.018"},{"key":"e_1_2_8_19_1","first-page":"338","article-title":"The prevalence of joint contractures in residents in NHS continuing care","volume":"54","author":"Yip B","year":"1996","journal-title":"Health Bull"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2013.04.039"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2009.04.010"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/BCR.0000000000000149"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20314"},{"key":"e_1_2_8_24_1","first-page":"1833","article-title":"Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy N","year":"1988","journal-title":"J Rheumatol"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-1-17"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-1130(12)80315-2"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200407000-00017"},{"key":"e_1_2_8_28_1","first-page":"Cd007455","article-title":"Stretch for the treatment and prevention of contractures","volume":"1","author":"Harvey LA","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2017.09.018"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.016444"},{"key":"e_1_2_8_31_1","unstructured":"The osteoarthritis initiative \u2010 Protocol for the cohort study. 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