University of Oulu

W.M. Oo, J.M. Linklater, M. Daniel, S. Saarakkala, J. Samuels, P.G. Conaghan, H.I. Keen, L.A. Deveza, D.J. Hunter, Clinimetrics of ultrasound pathologies in osteoarthritis: systematic literature review and meta-analysis, Osteoarthritis and Cartilage, Volume 26, Issue 5, 2018, Pages 601-611, ISSN 1063-4584,

Clinimetrics of ultrasound pathologies in osteoarthritis : systematic literature review and meta-analysis

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Author: Oo, W. M.1; Linklater, J. M.2; Daniel, M.1;
Organizations: 1Rheumatology Department, Royal North Shore Hospital, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
2Department of Musculoskeletal Imaging, Castlereagh Sports Imaging, St. Leonards, Sydney, Australia
3Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
4Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
5Division of Rheumatology, Centre for Musculoskeletal Care, NYU Langone Medical Centre, New York, USA
6Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
7NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom
8School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: Elsevier, 2018
Publish Date: 2020-04-06


Objective: The aims of this study were to systematically review clinimetrics of commonly assessed ultrasound pathologies in knee, hip and hand osteoarthritis (OA), and to conduct a meta-analysis for each clinimetric.

Methods: Medline, Embase, and Cochrane Library databases were searched from their inceptions to September 2016. According to the Outcome Measures in Rheumatology (OMERACT) Instrument Selection Algorithm, data extraction focused on ultrasound technical features and performance metrics. Methodological quality was assessed with modified 19-item Downs and Black score and 11-item Quality Appraisal of Diagnostic Reliability (QAREL) score. Separate meta-analyses were performed for clinimetrics: (1) inter-rater/intra-rater reliability; (2) construct validity; (3) criteria validity; and (4) internal/external responsiveness. Statistical Package for the Social Sciences (SPSS), Excel and Comprehensive Meta-analysis were used.

Result: Our search identified 1126 records; of these, 100 were eligible, including a total of 8542 patients and 32,373 joints. The average Downs and Black score was 13.01, and average QAREL was 5.93. The stratified meta-analysis was performed only for knee OA, which demonstrated moderate to substantial reliability [minimum kappa > 0.44(0.15,0.74), minimum intraclass correlation coefficient (ICC) > 0.82(0.73—0.89)], weak construct validity against pain (r = 0.12 to 0.27), function (r = 0.15 to 0.23), and blood biomarkers (r = 0.01 to 0.21), but weak to strong correlation with plain radiography (r = 0.13 to 0.60), strong association with Magnetic Resonance Imaging (MRI) [minimum r = 0.60(0.52,0.67)] and strong discrimination against symptomatic patients (OR = 3.08 to 7.46). There was strong criterion validity against cartilage histology [r = 0.66(−0.05,0.93)], and small to moderate internal [standardized mean difference(SMD) = 0.20 to 0.58] and external (r = 0.35 to 0.43) responsiveness to interventions.

Conclusion: Ultrasound demonstrated strong criterion validity with cartilage histology, poor to strong correlation with patient findings and MRI, moderate reliability, and low responsiveness to interventions.

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Series: Osteoarthritis and cartilage
ISSN: 1063-4584
ISSN-E: 1522-9653
ISSN-L: 1063-4584
Volume: 26
Issue: 5
Pages: 601 - 611
DOI: 10.1016/j.joca.2018.01.021
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3126 Surgery, anesthesiology, intensive care, radiology
Funding: WMO is supported for his PhD project by a Presidential Scholarship of Myanmar. PGC is supported in part by the National Institute for Health Research (NIHR) Leeds Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. DJH is supported by a National Health and Medical Research Council (NHMRC) Practitioner. Fellowship.
Copyright information: © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license