Reliability of the Kellgren and Lawrence radiographic scale and its association with pain intensity
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Introduction: The Kellgren and Lawrence radiographic scale is the proposed gold standard for classification of osteoarthritis in the clinical and research environment, however, there is no report on the intra-evaluating reproducibility of the Kellgren and Lawrence radiographic classification scale and the association of severity degree with intensity of pain in patients.Methodology: This study involved a cross-sectional cut-off design of reproducibility in which the association between the degree of severity of OA according to radiographic criteria and the intensity of pain was explored. The population consisted of people with a medical diagnosis of OA of the knee (tibiofemoral) aged between 40 and 75 years old, with X-rays of no more than 6 months of age, who were recruited from patients in private orthopaedic practice and from the university community of the Industrial University of Santander. Patients who met the selection criteria and who agreed to participate were given an x-ray and evaluated in their quality by a 25 year old orthopaedic doctor with knee experience. The assessment of pain intensity and function was evaluated once, while the x-rays were evaluated twice between 8-15 day assessments. The X-rays were evaluated in physics, masked and randomly organized in each evaluation, and the data obtained were analyzed in the stata 12 statistical software. Intra evaluation reproducibility was calculated using Cohen's Kappa coefficient, which compared the rating of the same evaluator. The result for CCI and Kappa was interpreted according to the classification of Landis and Koch values between 0.81-1.00 almost perfect agreement, 0.61-0.80 considerable, 0.41-0.60 moderate, 0.21-0.40 just, 0.00-0.20 mild and <0.00 poor 172. The correlation between severity grade and clinical variables of pain intensity and function was determined by the Spearman correlation.Results: Intraevaluating reproducibility was good and the association of the severity degree scale determined by the radiographic scale and intensity of pain at rest, palpation and at the end of functional activities was very low, 0.3, -0.07 and 0.1, none of the above with statistical significance.
