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J Acupunct Res > Volume 30(5); 2013 > Article
Lee, Oh, Yu, Lee, Kim, Lee, and Kim: Development of Oriental Medical Rating Scale of Knee Pain and Validity Assessment※
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Abstract

Objectives:

This study is performed to develop the oriental medical rating scale of knee pain and to assess its validity.

Methods:

250 knee pain patients completed the previously accepted rating scale of knee pain(VAS, WOMAC(pain, function, stiffness), 6 minute walk test(number of steps, distance)) and oriental medical rating scale of knee pain which was developed by Hwang et al at 2012, before and after the 6 weeks acupuncture treatment. Comparing these results, we assessed the validity of oriental medical rating scale.

Results:

Comparing oriental medical rating scale of knee pain before acupuncture treatment with VAS, WOMAC(pain, function, stiffness) and 6 minute walk test(number of steps, distance), oriental medical rating scale showed correlation with VAS, WOMAC(pain, function, stiffness) and showed the highest correlation with WOMAC(function). Comparing the change of oriental medical rating scale of knee pain after 6 weeks of acupuncture treatment with the change of VAS, WOMAC(pain, function, stiffness) and 6 minute walk test(number of steps, distance) after 6 weeks, change of oriental medical rating scale showed correlation with the change of VAS, WOMAC(pain, function, stiffness) and showed the highest correlation with the change of WOMAC(function). Through factor analysis of oriental medical rating scale items, 4 factors(pain, swelling, deformation of the knee, thermal sense of the knee), 17 items were extracted.

Conclusions:

Oriental medical rating scale of knee pain reflected the patient’s pain, functional limitation and stiffness well. And oriental medical rating scale reflected the patient’s functional improvement after the treatment well.

Table 1.
Demographic Data of Participants(n=250)
Variable Min Max
Age(yr) 60.16 ± 8.55 40 79
BMI 24.93 ± 2.84 16.97 30.86
Height(cm) 158.50 ± 7.94 140 186
Weight(kg) 62.77 ± 9.64 45 108
Duration(yr) 6.57 ± 6.42 0.5 40
Gender Male 51 (20.48%)
Female 198 (79.52%)
Part Left 126 (50.4%)
Right 124 (49.6%)

Values are mean ± SD or number(percentage).

Abbreviation BMI : body mass index

Table 2.
Spearman Correlation Coefficients between Oriental Medical Rating Scale of Knee Pain and Other Knee Pain Outcome Measurement
VAS WOMAC pain WOMAC function WOMAC stiffness 6 minute walk test (number of steps) 6 minute walk test (distance)
HAN 0.28** 0.59** 0.66** 0.53** −0.09 −0.10

VAS : visual analogue scale.

WOMAC : Western Ontario and McMaster Universities Osteoarthritis Index.

HAN : oriental medical rating scale of knee pain.

** : p<0.01.

Table 3.
Spearman Correlation Coefficients between Oriental Medical Rating Scale of Knee Pain(Individual Items) and Other Knee Pain Outcome Measurement
VAS WOMAC pain WOMAC function WOMAC stiffness
HAN-M-3 0.55 0.62 0.48
HAN-M-4 0.46
HAN-M-7 0.52 0.58 0.41
HAN-M-9 0.42 0.53 0.55 0.43
HAN-M-23 0.52 0.53 0.47
HAN-E-1 0.55 0.54 0.44
HAN-E-2 0.42
HAN-E-4 0.44
HAN-E-5 0.43 0.55 0.42
HAN-E-6 0.41 0.53 0.41
HAN-E-7 0.45 0.52
HAN-E-8 0.48 0.58 0.51

HAN-M : main questions of oriental medical rating scale of knee pain.

HAN-E : extra questions of oriental medical rating scale of knee pain.

All values : p<0.01, Correlation coefficients values recorded more than 0.4.

Table 4.
Spearman Correlation Coefficients between Oriental Medical Rating Scale of Knee Pain Changes and Other Knee Pain Outcome Measurement Changes
Change of VAS Change of WOMAC pain Change of WOMAC function Change of WOMAC stiffness Change of 6 minute walk test (number of steps) Change of 6 minute walk test (distance)
Change of HAN 0.25** 0.35** 0.49** 0.39** −0.14* −0.15*

VAS : visual analogue scale.

WOMAC : Western Ontario and McMaster Universities Osteoarthritis Index.

HAN : Oriental medical rating scale of knee pain

* : p<0.05.

** : p<0.01.

Table 5.
Spearman Correlation Coefficients between Oriental Medical Rating Scale of Knee Pain Changes(Individual Items) and Other Knee Pain Outcome Measurement Changes
VAS WOMAC pain WOMAC function
HAN-M-3 0.42 0.43
HAN-M-4 0.41
HAN-M-9 0.40 0.45 0.45
HAN-E-8 0.42

HAN-M : main questions of oriental medical rating scale of knee pain.

HAN-E : extra questions of oriental medical rating scale of knee pain.

All values : p<0.01, correlation coefficients values recorded more than 0.4.

Table 6.
Extracted Items of Oriental Medical Rating Scale of Knee Pain Which are Related to Effect of Acupuncture Treatment based on Simple Linear Regression
Item β Standard error of β t p-value R2
WOMAC pain change HAN-M-3 0.471 0.2362 1.99* 0.0476 0.0185
HAN-M-4 0.802 0.2444 3.28** 0.0012 0.0485
HAN-M-7 0.627 0.2449 2.56* 0.0111 0.0301
HAN-M-9 0.762 0.2432 3.13** 0.002 0.0444
HAN-M-23 0.520 0.2892 1.8 0.0735 0.0151
HAN-E-1 0.598 0.2552 2.34* 0.0201 0.0254
HAN-E-2 0.650 0.2409 2.7* 0.0075 0.0334
HAN-E-4 0.627 0.2517 2.49* 0.0134 0.0286
HAN-E-5 0.331 0.2211 1.5 0.1363 0.0105
HAN-E-6 0.435 0.2349 1.85 0.0652 0.016
HAN-E-7 0.640 0.2339 2.74** 0.0068 0.0342
HAN-E-8 0.388 0.2365 1.64 0.1026 0.0126
HAN-B-5 0.188 0.2359 0.8 0.4268 0.003
HAN-B-6 0.102 0.2861 0.36 0.7216 0.0006
HAN-B-7 0.268 0.2816 0.95 0.3421 0.0043
HAN-B-11 0.427 0.2192 1.95 0.0526 0.0177
HAN-B-14 −0.066 0.2343 −0.28 0.7788 0.0004
WOMAC function change HAN-M-3 1.968 0.7562 2.6** 0.0099 0.0312
HAN-M-4 2.865 0.7841 3.65** 0.0003 0.0598
HAN-M-7 2.391 0.7845 3.05** 0.0026 0.0424
HAN-M-9 2.962 0.7753 3.82** 0.0002 0.065
HAN-M-23 2.014 0.9285 2.17* 0.0312 0.0219
HAN-E-1 1.937 0.8229 2.35* 0.0195 0.0257
HAN-E-2 2.204 0.7750 2.84** 0.0049 0.0371
HAN-E-4 2.389 0.8060 2.96** 0.0034 0.0401
HAN-E-5 1.444 0.7091 2.04* 0.043 0.0194
HAN-E-6 2.596 0.7426 3.5** 0.0006 0.055
HAN-E-7 2.704 0.7445 3.63** 0.0004 0.0591
HAN-E-8 1.846 0.7563 2.44* 0.0155 0.0276
HAN-B-5 −0.082 0.7659 −0.11 0.9148 0.0001
HAN-B-6 −0.035 0.9232 −0.04 0.9697 0.0000
HAN-B-7 0.923 0.9082 1.02 0.3109 0.0049
HAN-B-11 1.623 0.7071 2.3* 0.0227 0.0245
HAN-B-14 −1.064 0.7517 −1.42 0.1583 0.0095
WOMAC stiffness change HAN-M-3 0.171 0.1060 1.61 0.1081 0.0122
HAN-M-4 0.270 0.1107 2.44* 0.0154 0.0276
HAN-M-7 0.218 0.1103 1.98* 0.0496 0.0182
HAN-M-9 0.323 0.1090 2.96** 0.0034 0.0401
HAN-M-23 0.157 0.1299 1.21 0.2275 0.0069
HAN-E-1 0.160 0.1152 1.39 0.1656 0.0091
HAN-E-2 0.220 0.1086 2.03* 0.0435 0.0193
HAN-E-4 0.269 0.1127 2.39* 0.0178 0.0264
HAN-E-5 0.142 0.0989 1.44 0.1524 0.0097
HAN-E-6 0.154 0.1055 1.46 0.1448 0.0101
HAN-E-7 0.267 0.1049 2.54* 0.0118 0.0298
HAN-E-8 0.294 0.1045 2.81** 0.0053 0.0364
HAN-B-5 0.129 0.1059 1.22 0.2242 0.007
HAN-B-6 0.184 0.1275 1.44 0.1504 0.0098
HAN-B-7 0.135 0.1260 1.07 0.2858 0.0054
HAN-B-11 0.211 0.0983 2.15* 0.0327 0.0215
HAN-B-14 0.042 0.1048 0.4 0.6898 0.0008

HAN-M : main questions of oriental medical rating scale of knee pain

HAN-E : extra questions of oriental medical rating scale of knee pain

HAN-B : systemic symptom questions of oriental medical rating scale of knee pain

* : p<0.05.

** : p<0.01.

Table 7.
Factor Loadings of Oriental Medical Rating Scale of Knee Pain Items
Factor 1 Factor 2 Factor 3 Factor 4
HAN-E-1 0.75554
HAN-M-9 0.74795
HAN-M-7 0.72445
HAN-M-23 0.72006
HAN-E-8 0.65028
HAN-M-3 0.64707
HAN-M-8 0.7859
HAN-M-10 0.74942
HAN-M4 0.71238
HAN-M-11 0.69605
HAN-B-7 0.78878
HAN-B-6 0.78248
HAN-M-19 0.55551
HAN-M-18 0.52504
HAN-B-11 0.84175
HAN-E-3 0.82932
HAN-E-4 0.57394
Eigen value 8.37 1.70 1.41 1.19
Cronbach α 0.870611 0.811698 0.777524 0.792534

HAN-M : main questions of oriental medical rating scale of knee pain.

HAN-E : extra questions of oriental medical rating scale of knee pain.

HAN-B : systemic symptom questions of oriental medical rating scale of knee pain.

Explorative principal components analysis(PCA) with varimax rotation produced a four-factor solution.

Items selected based on a four-factor analysis in samples from 250 people, 50 questions.

Organized into subcategories : factor 1(pain), factor 2(swelling), factor 3(deformation of the knee) and factor 4(thermal sense of the knee).

Items with communalities below 0.50 and negative impacts on the reliability were not adopted.

Table 8.
Final Extracted 17 Items of Oriental Medical Rating Scale of Knee Pain
Factors Items
Factor 1 HAN-M-3 Do you feel stretch and pain in your knee?
HAN-M-7 Do the pain of your knee is too strong to walk?
HAN-M-9 Do you feel very intense pain in your knee?
HAN-M-23 Do you feel weakly continued pain in your knee?
HAN-E-1 Do the pain of your knee is unbearably severe?
HAN-E-8 Do you have difficulty in walking because of heavy legs?
Factor 2 HAN-M-4 Do your knee is swollen and burning red?
HAN-M-8 Do your knee is swollen?
HAN-M-10 Do your knee and around the knee are soft when you press them?
HAN-M-11 Do the skin of your knee and around the knee are changed in dark red color?
Factor 3 HAN-M-18 (Comparing to the healthy contralateral knee or previous time) Do your knee bone came out a little?
HAN-M-19 (Comparing to the healthy contralateral knee or previous time) Do your knee shape is changed such as becoming thicker?
HAN-B-6 Do you suffer from shortness of breath?
HAN-B-7 Do you feel heaviness on you heart?
Factor 4 HAN-E-3 Do you feel cold in your knee?
HAN-E-4 Do you fell dullness in your knee and around the knee?
HAN-B-11 Do you feel cold in your knee or waist?

HAN-M : main questions of oriental medical rating scale of knee pain.

HAN-E : extra questions of oriental medical rating scale of knee pain.

HAN-B : systemic symptom questions of oriental medical rating scale of knee pain.

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