Thresholds in the Relationship of Quadriceps Strength With Functional Limitations in Women With Knee Osteoarthritis

Arthritis Care Res (Hoboken). 2019 Sep;71(9):1186-1193. doi: 10.1002/acr.23740. Epub 2019 Aug 6.


Objective: To investigate thresholds of strength below which individuals with knee osteoarthritis (OA) may have more difficulty carrying out physical functions of daily life. Individuals below such thresholds might benefit more from strengthening interventions than those with greater strength.

Methods: We studied individuals with symptomatic OA at baseline in the Multicenter Osteoarthritis Study who had knee extensor strength measured isokinetically at 60º/second. Participants underwent a 20-meter walk test and a sit-to-stand test and answered questions from the Western Ontario and McMaster Universities Osteoarthritis Index. Physical function results were plotted against measures of quadriceps strength (Nm) (and as strength:body weight) for the worst knee. Loess technique was used to examine inflection points. Nonlinear relationships were examined in piecewise linear regression models. Differences were tested using linear and logistic regression models.

Results: The study had 834 participants (65.8% women). The mean ± SD age of the participants was 62.9 ± 7.9 years. In women, there were thresholds of strength below which the slope of strength versus function was steeper: walking speed (<58 Nm), chair stand time (<32 Nm), and the McMaster Universities Osteoarthritis Index functions of rising from a chair and getting on/off the toilet (<38 Nm). We found no thresholds in men. Loess analyses using strength:weight showed similar results.

Conclusion: In individuals with symptomatic knee OA, thresholds in the strength function relationship may help identify individuals, especially women, at the brink of disability insofar as strength and capacity for daily tasks. In those with low strength, small increments in strength may be associated with improvement in function and greater ease with common daily life, emphasizing the importance of preventing loss of strength.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Aged
  • Anaerobic Threshold
  • Body Mass Index
  • Cohort Studies
  • Disability Evaluation*
  • Female
  • Humans
  • Iowa
  • Linear Models
  • Logistic Models
  • Middle Aged
  • Muscle Strength / physiology*
  • Osteoarthritis, Knee / diagnosis*
  • Osteoarthritis, Knee / epidemiology
  • Physical Examination / methods
  • Prognosis
  • Prospective Studies
  • Quadriceps Muscle / physiopathology*
  • Range of Motion, Articular / physiology*
  • Risk Assessment
  • Severity of Illness Index
  • Walk Test