Toward a Clinical Definition of Early Osteoarthritis: Onset of Patient-Reported Knee Pain Begins on Stairs. Data From the Osteoarthritis Initiative
Toward a Clinical Definition of Early Osteoarthritis: Onset of Patient-Reported Knee Pain Begins on Stairs. Data From the Osteoarthritis Initiative
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DOI：
10.1002/acr.22418
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发表时间：
2015-01-01
影响因子：
4.7
通讯作者：
Conaghan, Philip G.
中科院分区：
文献类型：
--
作者：
Hensor, Elizabeth M. A.;Dube, Bright;Conaghan, Philip G.
客观的。早期发现骨关节炎（OA）将增加有效干预的机会。我们的目的是调查患者报告的哪些活动首先与膝盖疼痛相关。我们假设疼痛首先发生在需要负重和弯曲膝盖的活动中。方法。数据来自骨关节炎倡议 (OAI)，这是一个针对骨关节炎高危人群的多中心纵向前瞻性观察队列。参与者每年完成西安大略省和麦克马斯特大学骨关节炎指数（WOMAC；李克特量表），持续长达 7 年。随着疼痛评分从 0 开始增加，Rasch 分析用于按照肯定顺序对 WOMAC 疼痛问题（活动）进行排名。对于每个 WOMAC 总评分类别 (0-20)，我们根据所有访问中的最高评分随机选择 25 个人。在此子集中评估了 Rasch 模型的拟合度；完整的 OAI 结果证实了连续访问中问题排名的稳定性。 WOMAC 数据涉及 4,673 人，其中 491 人被选择进行子集分析。子集数据显示与 Rasch 模型良好拟合（chi 2 = 43.31，P = 0.332）。在完整的 OAI 中，“使用楼梯”问题是第一个得分的问题，因为总疼痛评分从 0 开始增加（基线 Logit 评分 +/- 95% 置信区间 -4.74 +/- 0.07），然后是“行走”（-2.94 +/- 0.07）、“站立”（-2.65 +/- 0.07）、“躺着/坐着”（- 2.00 +/- 0.08）和最后“躺在床上”（-1.32 +/- 0.09）。这个顺序在连续访问中是一致的。结论。膝盖疼痛最有可能首先出现在涉及弯曲膝盖的负重活动中，例如爬楼梯。这种症状的首次出现可能会识别出适合早期干预策略的群体。
Objective. Early detection of osteoarthritis (OA) would increase the chances of effective intervention. We aimed to investigate which patient-reported activity is first associated with knee pain. We hypothesized that pain would occur first during activities requiring weight bearing and knee bending.Methods. Data were obtained from the Osteoarthritis Initiative (OAI), a multicenter, longitudinal prospective observational cohort of people who have or are at high risk of OA. Participants completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; Likert scale) annually for up to 7 years. Rasch analysis was used to rank the WOMAC pain questions (activities) in order of affirmation as the pain score increased from 0. For each total WOMAC score category (0-20) we selected 25 individuals at random based on their maximum score across all visits. Fit to the Rasch model was assessed in this subset; stability of question ranking over successive visits was confirmed in the full OAI.Results. WOMAC data on 4,673 people were included, with 491 selected for subset analysis. The subset data showed good fit to the Rasch model (chi 2 = 43.31, P = 0.332). In the full OAI, the "using stairs" question was the first to score points as the total pain score increased from 0 (baseline logit score +/- 95% confidence interval -4.74 +/- 0.07), then "walking" (-2.94 +/- 0.07), "standing" (-2.65 +/- 0.07), "lying/sitting" (- 2.00 +/- 0.08), and finally " in bed" (-1.32 +/- 0.09). This ordering was consistent over successive visits.Conclusion. Knee pain is most likely to first appear during weight-bearing activities involving bending of the knee, such as using stairs. First appearance of this symptom may identify a group suitable for early intervention strategies.