Long-term Outcomes of Knee OA in the OAI Cohort

OAI 队列中膝关节 OA 的长期结果

• 批准号: 9125680
• 负责人: REBECCA D JACKSON
• 金额: $ 99.23万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9125680
• 关键词: Address; Aging; Arthralgia; Clinic Visits; Clinical; Clinical Course of Disease; Cohort Studies; Comorbidity; Consequentialism; Data; Degenerative polyarthritis; Development; Disease; Disease Progression; Event; Gait speed; Goals; Health; Heterogeneity; Intervention; Investigation; Knee; Knee Injuries; Knee Osteoarthritis; Knowledge; Leg; Longitudinal Studies; Measures; Mental Depression; Musculoskeletal; Natural History; Obesity; Observational Study; Outcome; Outcome Assessment; Pain; Participant; Pathology; Patients; Performance; Persons; Phenotype; Phonation; Physical Performance; Physical activity; Population; Prevention; Prevention strategy; Probability; Psychosocial Factor; Quality of life; Research Personnel; Risk; Risk Factors; Scientific Inquiry; Severities; Severity of illness; Source; Stratification; Symptoms; Telephone; Time; clinical imaging; clinically significant; cohort; comorbid depression; coping; cost; design; disability; effective therapy; follow-up; illness length; improved outcome; knee pain; knee replacement arthroplasty; minimal risk; outcome forecast; outcome prediction; psychosocial; public health relevance; standardize measure

 DESCRIPTION (provided by applicant): Knee osteoarthritis (OA) is a major cause of pain, functional limitation and disability and among the most costly musculoskeletal conditions. A burgeoning population with knee OA and poor clinical outcomes in the absence of effective treatments are key drivers of the soaring rates and costs of knee replacement. Knee OA pathology and clinical outcomes typically unfold over decades and have a highly varied time course. It is a priority to understand the range of factors that contribute to poor and good outcomes in knee OA, but there are critical gaps in knowledge about the long-term course of the disease and its determinants. It is sensible to target prevention and treatment on those most at risk for poor outcomes. However, there is a paucity of longitudinal studies long enough (≥10 years) with frequent assessment using standardized measures to capture the full trajectory, range and variability of outcomes and investigate their determinants. In addition, investigation of these questions is hampered by baseline heterogeneity in knee OA severity and impact, which can be a source of imprecision and bias in observational studies of disease prognosis. Started in 2002, the OAI is a unique cohort study of 4796 persons with or at risk for knee OA that has uniform, rich clinical and imaging data from annual assessments and has been followed comprehensively for up to 8 years with good retention. We now propose to continue assessment of outcomes of knee OA for up to 15 years after baseline, primarily by phone and mail, an efficient and less burdensome approach that will yield more complete follow-up than clinic visits alone in this aging cohort. A brief clinic visit in a subset of participants will enale us to study performance measures of function as a long-term outcome. Our goal is to take advantage of this unprecedented opportunity for long-term follow-up to describe the full trajectory and probability of outcomes at different stages of disease, to identify vulnerable and protected phenotypes in its long-term course and investigate potentially modifiable predictors of these outcomes. Outcomes will span a range of health domains, including: knee-OA related (pain, functional limitation and performance, OA global impact, knee replacement), disability/participation and general health. The extended follow-up provides the opportunity for an analysis design that reduces the risk of common sources of bias and imprecision in studies of disease prognosis by allowing the use of changes from baseline to year 4 to define "inception events," such as the transition to more advanced stages of knee pain or structural OA or the development of favorable and unfavorable trajectories of risk factors (knee OA-related, physical performance, general health and psychosocial variables). These changes will then be evaluated for their association with subsequent outcomes occurring from year 5 to year 15 in analyses conditioned on a range of baseline knee OA-related and other covariates with a minimal risk of collider stratification bias. Using this approach we will investigate questions that can inform emerging strategies for prevention and treatment that are focused on improving outcomes in persons with knee OA. These include describing the probabilities of both poor and good long-term outcomes at different stages of knee pain and structural OA, comparing outcomes in those with recent transitions to more advanced stages with those whose course has been stable, and identifying the modifiable determinants of long-term outcomes at different stages of disease and whether these differ by stage, thus suggesting the need for tailored interventions to improve outcomes.

 描述(申请人提供)：膝骨性关节炎(OA)是疼痛、功能受限和残疾的主要原因，也是最昂贵的肌肉骨骼疾病之一。膝关节骨性关节炎患者的数量迅速增加，在缺乏有效治疗的情况下，临床结果很差，这是膝关节置换术的发病率和费用飙升的主要原因。膝骨性关节炎的病理和临床结果通常在几十年内展开，并具有高度不同的时间进程。了解导致膝骨性关节炎预后良好和不良的各种因素是当务之急，但对该病的长期病程及其决定因素的认识存在严重差距。明智的做法是将预防和治疗的目标对准那些面临不良后果风险最高的人群。然而，缺乏足够长的纵向研究(≥10年)，经常使用标准化措施进行评估，以捕捉结果的全部轨迹、范围和可变性，并调查其决定因素。此外，还调查了 这些问题受到膝骨性关节炎严重程度和影响的基线异质性的阻碍，这可能是疾病预后观察性研究中不精确和偏差的来源。OAI始于2002年，是一项独特的队列研究，涵盖了4796名膝骨性关节炎患者或有膝骨性关节炎风险的人，该研究拥有统一的、丰富的临床和影像数据，来自年度评估，并已被全面跟踪长达8年，保留良好。我们现在建议在基线后的15年内继续评估膝骨性关节炎的结果，主要是通过电话和邮件，这是一种有效且负担较轻的方法，在这一老龄化队列中，比起单独的临床访问，将产生更全面的随访。对一部分参与者进行简短的临床访问将使我们能够研究作为长期结果的功能表现测量。我们的目标是利用这一史无前例的长期随访机会，描述疾病不同阶段结果的完整轨迹和概率，识别长期过程中脆弱和受保护的表型，并研究这些结果的潜在可修改预测因素。结果将涉及一系列健康领域，包括：与膝骨性关节炎相关的(疼痛、功能限制和表现、膝骨性关节炎的全球影响、膝关节置换)、残疾/参与和一般健康。延长的随访为分析设计提供了机会，通过允许使用从基线到第4年的变化来定义“初始事件”，例如过渡到更高级的膝关节疼痛或结构性骨关节炎，或发展有利和不利的风险因素(与膝关节骨关节炎相关的、身体表现、一般健康和心理社会变量)，从而减少疾病预后研究中常见的偏倚和不精确来源的风险。然后，这些变化将在一系列基线膝关节骨关节炎相关变量和其他协变量的条件下进行评估，以确定它们与第5年至第15年发生的后续结果的相关性，并将碰撞分层偏差的风险降至最低。使用这种方法，我们将调查一些问题，这些问题可以为新的预防和治疗战略提供信息，这些战略的重点是改善膝骨性关节炎患者的预后。这些措施包括描述膝关节疼痛和结构性骨关节炎不同阶段长期结果差和好的概率，比较最近过渡到更晚期阶段的结果与病程稳定的结果，确定不同疾病阶段长期结果的可改变决定因素以及这些因素是否因阶段不同而不同，从而表明需要量身定做的干预措施来改善结果。