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（由适用提供）：膝盖骨关节炎（OA）是疼痛，功能限制和残疾以及最昂贵的肌肉骨骼疾病的主要原因。在没有有效治疗的情况下，有膝盖OA和临床结果不佳的水伤人群是膝盖替代的飙升率和成本的关键驱动力。膝盖OA病理学和临床结果通常数十年来展开，并具有高度不同的时间过程。要了解导致膝盖OA差和良好结果的因素范围是优先考虑的，但是了解疾病的长期过程及其决定的差距很大。它对预防和治疗最有可能发生不良预后的人敏感。但是，使用标准措施捕获完整的轨迹，结果的范围和变异性并调查其确定词的纵向研究很少（≥10年）经常进行评估。另外，调查 这些问题受到膝关节严重程度和影响的基线异质性的阻碍，这可能是疾病进展的观察性研究的影响和偏见的根源。 OAI始于2002年，是一项独特的队列研究，对有4796人的膝盖OA风险或有风险，其膝盖OA具有统一，丰富的临床和成像数据，并从年度评估中进行了详尽的遵循，最多持续了8年，并保留了良好的保留率。现在，我们建议在基线后长达15年，通过电话和邮件，一种有效且较少的朴素方法，继续评估膝关节OA的结局长达15年，该方法将产生比单独的临床访问更完整的随访。在一部分参与者中进行简短的诊所访问将使我们能够将功能的绩效指标作为长期结果。我们的目标是利用这种前所未有的机会进行长期随访，以描述疾病不同阶段的完整轨迹和结果的概率，以在其长期课程中识别脆弱和受保护的表型，并研究这些结果的潜在可修改预测指标。结果将跨越一系列健康领域，包括：膝关节相关（疼痛，功能限制和性能，全球影响，膝关节置换），残疾/参与和一般健康。扩展的随访为分析设计提供了机会，该设计通过允许使用从基线到4年级的变化来定义“成立事件”，例如膝盖疼痛或结构性OA的更高级阶段或对膝关节的良好和不利的风险轨迹（膝关节健康）（膝关节健康）（knee oa oa Aa oa oa oa oa oa oa and oa oa oa oa and oa a ane oa oa oa oa oa，yaeper and oa s andecors，降低了疾病的变化，从而降低了疾病进展研究的常见风险和疾病进展研究的风险。然后，将评估这些变化与从5年级到15年的随后结果的关联，这是在一系列基线膝关节OA相关和其他协变量的条件下，具有对撞机分层偏置的风险最小的协变量。使用这种方法，我们将调查可以为新兴策略提供预防和治疗的问题，这些问题侧重于改善膝盖OA的成绩。其中包括描述膝盖疼痛和结构性OA的不同阶段差和良好的长期结局的可能性，将最近过渡到更高级阶段的人与那些课程稳定的结果进行比较，并确定了在疾病的不同阶段的可修改长期测定者，以及这些疾病的长期衰落效果以及这些阶段的不同阶段以及这些阶段的不同之处，从而提高了对尾部的互动，以改善级别的划分，以改善级别的划分，以改善级别的划分。