A Pilot Study to Evaluate the Reliability of Pattern Identification Tool for Knee Osteoarthritis and to Analyze Correlation between Pattern Identification Tool and Knee Range of Motion, Visual Analog Scale and Western Ontario & Mcmaster Universities Osteoarthritis Index

퇴행성 무릎관절염 변증도구의 신뢰도 평가 및 무릎 ROM, VAS, WOMAC과의 상관관계에 대한 탐색적 연구

  • Oh, Seung-Joon (Department of Korean Medicine Rehabilitation, College of Oriental Medicine, Daejeon University) ;
  • Jang, Eunsu (Department of Diagnosis, College of Oriental Medicine, Daejeon University) ;
  • Oh, Young-Seon (Dunsan Korean Medical Hospital, Daejeon University) ;
  • Kang, Wee-chang (Department of Statistics, H-Liberal Arts College, Daejeon University) ;
  • Lee, Eun-Jung (Departments of Oriental Rehabilitation Medicine, College of Korean Medicine, Daejeon University) ;
  • Jung, In Chul (Department of Oriental Neuropsychiatry, College of Oriental Medicine, Daejeon University)
  • 오승준 (대전대학교 한의과대학 한방재활의학과교실) ;
  • 장은수 (대전대학교 한의과대학 진단학교실) ;
  • 오영선 (대전대학교 둔산한방병원) ;
  • 강위창 (대전대학교 리버럴아츠칼리지 통계학과) ;
  • 이은정 (대전대학교 한의과대학 한방재활의학과교실) ;
  • 정인철 (대전대학교 한의과대학 신경정신과학교실)
  • Published : 2019.07.31


Objectives To evaluate the pattern identification tool for knee osteoarthritis and to investigate the relationship between pattern identification tool and knee ROM (range of motion), VAS (visual analog scale) and WOMAC (Western Ontario & McMaster Universities osteoarthritis index). Methods We studied 50 patients who are diagnosed as degenerative osteoarthritis. With one patient dropping out, total of 49 patient went through pattern identification tool. Re-test of the pattern identification tool was implemented after about a week. The reliability was analyzed by calculating ICC (intraclass correlation coefficient). Also, reliability of each pattern identification score was calculated along with influence factor and correlation between knee ROM, VAS and WOMAC. Results Reliability of the pattern identification tool was evaluated as 'poor agreement beyond chance' with ICC value of 0.396. Reliablility of each pattern identification score was calculated and four out of five were measured 'good' with one 'moderate' reliability. Two of inter-item consistency were 'good', two were 'acceptable' and one was 'questionable'. Correlation between each pattern identification and knee ROM showed 'clear negative linear relationship' with two patterns. VAS showed 'clear positivie linear relationship' with all five patterns. WOMAC showed 'positivie linear relationship' with all five patterns. Conclusions According to the results, pattern identification tool for knee osteoarthritis seems to have meaningful relationship with other agnedas. Also, further research is needed to develop the tool.


Supported by : Korea Health Industry Development Institute (KHIDI)


  1. The Korean Orthiopaedic Association. Orthopaedics. 7th ed. Seoul:ChoiSin Medical Publishing Co. 2013.
  2. The Statistics Korea. [Most frequent diseases in patients older than 65 (2016_Korean Medicine)] Korean. [Internet] 2016 [cited 2018 Sep 16]. Available from:
  3. Cha WS, Oh JH, Park HJ, Ahn SW, Hong SY, Kim NI. Historical difference between traditional Korean medicine and traditional Chinese Medicine. Neurological Research in Autism Spectrum Disorders. 2007;29(1):5-9.
  4. Kim H, Lee HS, Lee EJ, Park JH, Kang WC, Jung IC. Correlation between instrument on pattern identification for depression and psychological tests by statistical analysis. Journal of oriental neuropsychiatry. 2016;27(3):131-46.
  5. Park EJ, Baek SE, Kang BK, Yoo JE, Jung IC. A correlation study of pattern identification instrument and biomarkers for polycystic ovary syndrome. Journal of Korean Obsterics and Gynecology. 2018;31(3):33-49.
  6. Jung IC, Kang WC, Kim KK. Seo BN. Guidelines for the reliability and validity of the instrument on pattern identifications for Hwa-byung. Journal of Oriental Neuropsychiatry. 2013;24(4):331-42.
  7. Kim JB, Kim JH, Son CG, Kang WC, Cho JH. Development of Instrument of pattern identification for functional dyspepsia. Journal of Physiology & Pathology in Korean Medicine. 2012;24(6):1094-8.
  8. Lee EH, Jung IC, Choi WC. Preliminary study to develop the instrument on pattern identifications for depression. Journal of Oriental Neuropsychiatry. 2013;24(4):435-50.
  9. Ko SG, Song YK, Ahn MY, Lim HH. Development of questionnaire for pattern identification of chronic low back pain by Delphi method. Journal of Oriental Rehabilitation Medicine. 2013;23(4):143-58.
  10. Kim MK, Heo JE, Park SM, Lee IS, Kim BH, Kang YK, Choi HN. Comparative study of normal person and traffic accident patient by DSOM. Journal of Physiology & Pathology in Korean Medicine. 2009;23(1):245-50.
  11. Jeon DH. Lee EJ, So HW, Hwang MS, Yoo JE, Park YC, Jung IC, Oh MS. Preliminary study to develop the instrument on pattern identifications knee osteoarthritis. Journal of Oriental Rehabilitation Medicine. 2017;27(3):77-91.
  12. Johannes MG, David FH, Bernard J, Henrik B, Karlmeinrad G. WOMAC, EQ-5D and knee society score thresholds for treatment succes after total knee arthroplasty. J Arthroplasty. 2015;30:2154-8.
  13. Rehabilitation Medicine of Korean Medicine. Oriental rehabilitation medicine. 3rd ed. Seoul:Koonja publishing. 2011.
  14. Kim HA. Clinical investigation of osteoarthritis. Journal of Rheumatic Diseases. 2000;7(3):205-11.
  15. Park KH, Park O, Yu CW, Shin SH, Kim YB, Jung HJ, Kim WJ, Kim MJ, Park SC. Clinical presentation and risk factors for prosthetic joint related infections. J Korean Soc Chemother. 1999;17(3):211-20.
  16. Motsis EK, Paschos N, Pakos EE, Georgoulos AD. Review article: patellar instability after total knee arthroplasty. Journal of Orthopaedic Surgery. 2009;17(3):351-7.
  17. Kwon SH, Lee JH, Kim KK. Accuracy of lower extremity alignment in total knee arthroplasty using navigation system. Journal of the Korean Orthopaedic Association. 2009;44(6):599-603.
  18. Seo BK, Ryu SR, Lee SS, Huh JE, Baek YH, Lee JD, Choi DY, Cho YJ, Kim NJ, Park DS. Systemic review: herbal medicines in the treatment of osteoarthritis in Pubmed and Chinmed and Chinese Medical Journals. Journal of Acupuncture Research. 2004;21(3):265-82.
  19. Gu JH, Kim ES, Park YC, Jung IC, Lee EJ. A systematic review of bee venom acupuncture for knee osteoarthritis. Journal of Oriental Rehabilitation Medicine. 2017;27(3):47-60.
  20. Kim EJ, Lee SD, Jung CY, Yoon EH, Jang MG, Nam DW, Kim HW, Lee EY, Kim KH, Lee GM, Lee JD, Kim KS. Review of randomized controlled trials on ideal acupuncture treatment for degenerative knee osteoarthritis. The Acupuncture. 2009;4:125-45.
  21. Na WM, Lee SY, Jang EH, Kim SC, Moon HC, Kim SM, Yoon CH, Jun BH. A study on pain relief effects and allergic responses for the osteoarthritis of the knee joint between sweet bee venom and bee venom pharmacopuncture. Journal of Pharmacopuncture. 2007;10(2):47-55.
  22. Byun H, Kim SW, Ahn JH, Kim YS, Seo JC, Choi SM, Park JE, Kawakita K, Sumiya E, Lee SD. Individualized acupuncture versus standardized acupuncture in symptomatic treatment of osteoarthritis of the knee-a randomized controlled trial. The Acupuncture. 2007;24(8):183-95.
  23. Jung HC, Jeong SH. A clinical study of knee joint osteoarthritis patients on the effect of Korean traditional medicine treatment with acupuncture, cupping, physical therapy and Ganghwalijetong-yeum(Qianghuochutong-yin): case series. The Journal of the Society of Korean Medicine Diagnostics. 2015;19(2):125-32.
  24. Kim SC, Lim JA, Lee JD, Lee SK, Lee SY, Moon HC, Choi SM, Chung YH. A pilot study of acupuncture treatment for the osteoarthritis of the knee joint on the EBM (Evidence Basement Medicine). The Acupuncture. 2006;23(2):187-215.
  25. Park IS, Jung CY, Jang MK, Kang MS, Lee SW, Kim EJ, Lee SD, Kim KS. A randomized clinical trial of local acupoints compared with distal acupoints in degenerative osteoarthritis on knee. The Acupuncture. 2008;25:227-42.
  26. Park EJ, Shin JC, Na GH, Lee DH, Han SG, Yoon YC, Chae WS, Sho MR. Study on clinical effects of cervus elaphus herval-acupuncture on osteoarthritis in knee joint. The Acupuncture. 2004;21(4):275-86.
  27. Seo BK, Ryu SR, Kang JW, Woo HS, Lee JD, Choi DY, Kim KS, Lee DI, Lee YH, Lee SH. Effects of Jetongdan on the quality of life in patients with osteoarthritis of knee. The Acupuncture. 2005;22(12):219-28.
  28. Song JY, Kim MJ, Sung WS, Kim PK, Goo BH, Kwak HU, Kim JH, Kim DH, Park YC, Seo BK, Baek YH, Choi DY, Lee JD, Park DS. Efficacy and safety of herb medication according to cold-heat tendency of knee osteoarthritis patients. The Acupuncture. 2012;5(10):97-108.
  29. Lee HJ, Park JO, Oh MS. Anti-inflammation and anti-oxidation effects of Gamikyejakjimo-tang, herbal acupuncture on pathologic factor and MIA-induced osteoarthritis rat. J Korean Med Rehabil. 2015;4(10):1-20.
  30. Song TJ. Validity and reliability. Seoul:Hakjisa. 2007.
  31. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.
  32. Fleiss J. Statistical methods for rates and proportions. 3rd ed. New York:John Wiley. 2003.
  33. Koo T and Li M. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155-63.
  34. George D, Mallery P. SPSS for Windows step by step: A simple guide and reference. 11.0 update. 4th ed. Boston:Allyn & Bacon. 2003.
  35. Kim YY, Jang ES. Test-retest reliability of brief KS-15 -Korean Sasang constitutional diagnostic questionnaire-. Journal of Physiology & Pathology in Korean Medicine. 2016;30(3):177-83.