Disability, Physical Impairments, and Poor Quality of Life, Rather Than Radiographic Changes, Are Related to Symptoms in Individuals With Ankle Osteoarthritis: A Cross-sectional Laboratory Study
Munira Al Mahrouqi, Bill Vicenzino, D. Macdonald, Michelle Smith
Abstract
Objective To compare physical and patient-reported outcomes between (1) individuals with symptomatic radiographic ankle osteoarthritis (OA) and asymptomatic individuals, and (2) asymptomatic individuals with and without radiographic ankle OA. Design Cross-sectional study. Methods Ninety-six volunteers (31 symptomatic individuals with radiographic ankle OA, 41 asymptomatic individuals with radiographic ankle OA, and 24 asymptomatic individuals without radiographic ankle OA) completed a survey on quality of life (QoL), function, pain, disability, kinesiophobia, ankle instability, and physical activity, and undertook physical assessments of ankle muscle strength, heel-raise endurance, dorsiflexion range of motion (ROM), and ambulatory function. Results Symptomatic individuals with radiographic ankle OA reported greater pain (standardized mean difference [SMD], 1.70; 95% confidence interval [CI]: 1.18, 2.23), disability (SMD, 1.44; 95% CI: 0.93, 1.95), and instability (SMD, −3.92; 95% CI: −4.68, −3.17), and lower patient-reported function (SMD, −2.10; 95% CI: −2.66, −1.54) and QoL (SMD, −0.98; 95% CI: −1.47, −0.50), than asymptomatic individuals. Muscle strength (all SMDs, −0.73 or greater), heel-raise endurance (SMD, −0.71; 95% CI: −1.16, −0.25), dorsiflexion ROM (SMD, −1.54; 95% CI: −2.02, −1.06), and ambulatory function (all SMDs, 0.57 or greater) were significantly impaired in symptomatic individuals with radiographic ankle OA compared to asymptomatic individuals. Most patient-reported and physical outcomes were similar between asymptomatic individuals with and without radiographic ankle OA. Conclusion Individuals with symptomatic radiographic ankle OA had poorer physical outcomes, function, and QoL compared to asymptomatic individuals with and without radiographic ankle OA. This suggests that disability in ankle OA is related to symptoms rather than to radiographic evidence of degeneration. J Orthop Sports Phys Ther 2020;50(12):711–722. doi:10.2519/jospt.2020.9376