背景：在社區的年老長者裡，退化性關節病變是骨科臨床常見的一種疾病，當中又以退化性膝關節炎最為常見且影響最多。WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) 膝關節功能量表是目前臨床上最常又來評估退化性膝關節的評分工具，主要包含了疼痛，關節僵硬及身體功能。 此研究的目的主要是嘗試去尋找影響社區能獨立活動之高齡者膝關節疼痛的因子, 並藉此來提醒預防退化性膝關節炎的惡化。
目的：這篇研究的主要目標: 1) 比較不同膝關節評分參數群之高齡者功能性體能的差異2) 尋找會影響膝關節評分參數的相關因子 3)從相關因子裡找出最具影響力的關鍵因子。
方法：這篇研究收錄了98位社區老人 (平均年齡: 72.44 ± 10.54歲)，並依據主訴膝關節量表的分數分為3組：健康組 (分數: 0)，輕度不適 (分數: 1~10) 及中度不適 (分數 > 10)。測量與比較三組間可能影響退化性膝關節炎的因子包括：身高體重指數、美國的風濕病醫學會(American College of Rheumatology, ACR)疼痛評估分數、視覺疼痛量表、下肢肌力、下肢膝關節活動度、單腳站立的時間、30秒起坐的次數、2分鐘登階。並同時收錄了社區高齡者膝蓋的X光片，以做為臨床指標參考。採用獨立樣本單因子共變數分析針對組間的差異作分析比較，皮爾森積差相關（pearson’s correlation coefficient）及多元逐步迴歸（stepwise multiple regression）找出最有決定力的因子。
結果：經過變異數分析結果顯示：身體質量指數，美國的風濕病醫學會疼痛指數 (ACR)、視覺疼痛量表、上肢肌力、起坐時間及單腳站立的時間與退化性膝關節炎程度在三組間均有顯著差異有關係(P<.05)。下肢肌力，膝關節活動度及2分鐘登階則無明顯的差異。其中起坐及視覺疼痛量表在退化性膝關節炎的嚴重度上扮演重要的角色。
結論：根據研究的結果分析，起坐困難及主觀性的膝關節疼痛在惡化性的膝關節指數扮演決定性的角色，特別是針對體重過重的長者而言。因此，當健康的族群發現自己膝蓋痛，起坐困難，建議盡早進行系統性的核心肌群及多關節的下肢肌力訓練，不僅只限於股四頭肌的訓練。

Background and Purpose: Degenerative joint disease, especially knee osteoarthritis (OA), is common among all the problems presented in outpatient Orthopedic departments and the main cause of disability in elderly adults. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is one of the most common clinical knee scores used for evaluating and scoring of systemic knee function (pain, stiffness, and physical function). The purpose of this study is to determine differences in knee functions in various pain groups and also to determine what factors may affect WOMAC scores for the purpose of preventing knee osteoarthritis. Our objectives were 1) to compare muscle strength, pain, ROM, and senior functional fitness over different knee joint scores, 2) to investigate the relationship between factors correlated with knee OA effects on the knee joint score, and 3) to attempt to find some key factors related to lowering of knee OA scores.
Materials and Methods: 98 community-dwelling elder adults (mean age: 72.44 ± 10.54 years) were divided into a normal group (Nor: N=39), a mildly disabled group (Mild, N=47), and a moderately disabled group (Mod, N=12) group using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index examination. A score of 0 represented healthy people; 1~10 represented a mildly disabled knee, and a score higher than 10 was set to represent a moderately disabled knee. Various knee OA factors were collected, including body mass index (BMI), American College of Rheumatology (ACR) score, the visual analogue scale (VAS), individualized lower limbs quadriceps muscle power, individualized knee range of motion (ROM), chair sit-and-reach test, standing on one leg (balance), 30 seconds chair-to-stand (lower extremity muscle strength), agility and dynamic balance (eight-foot up-and-go), and aerobic endurance (two-minute step). Basic knee X-rays were collected for further radiographic correlation with clinical symptoms. A one-way ANCOVA, the Pearson’s correlation coefficient, and a stepwise multiple regression were used to determine the plasticity of the WOMAC score grading and the associated factors.
Results: There were significant correlations with the OA Index (WOMAC) for lower muscle strength (30- second chair-to-stand) and VAS scores among these three groups after the one-way ANCOVA test, and no significant correlations for BMI, ACR, VAS, balance with single leg stand test, or upper muscle strength (30-second arm curl and grip). The results showed the major impact factors came from the chair stand (p=.001) after the stepwise regression. There were no obvious effects on knee range of motion (ROM), lower leg Quadriceps muscle strength, the chair sit and reach test, seated up and go test, or the 2 minutes step test.
Discussions and Conclusion: Based on the clinical data, we found that difficulty with lower muscle strength (30-second chair-to-stand) and subjective knee pain play important roles in deteriorated WOMAC scores, especially in the case of overweight individuals. Conclusion: When a healthy individual is suffering from knee pain and has difficulty standing up, earlier muscle training with multi-joint lower limb exercise and adequate pain control are necessary. It can be concluded that a preventative approach is better than a treatment approach to this issue.

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