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Queiroga F, Cross M, Thomas MJ, March L, Epstein J, Guillemin F. A scoping review of patient self-report measures of flare in knee and hip osteoarthritis (OA): A report from the OMERACT flares in OA working group. Semin Arthritis Rheum 2023; 63:152281. [PMID: 37948937 DOI: 10.1016/j.semarthrit.2023.152281] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE We aimed to analyze the content validity/domain match and feasibility of self-report instruments that could measure flare in osteoarthritis (OA), by extending our 2017 literature review on the definition of flare in knee and hip OA. METHOD We searched PubMed (Medline), Web of Science and PsycInfo (Ebsco Host) databases for original articles reporting research about flare (or synonyms) in humans with knee and hip OA, between 2017 and 2023. Four experts worked independently, checking the records, and assessing content validity and feasibility, writing justification for exclusion. RESULTS At literature review phase, 575 papers were filtered. After experts' analysis, 59 studies were included, and 44 instruments associated with flare in OA were identified. Most were studies about pain in knee or hip OA (35 %), cultural adaptation of a measure (33 %) or studies investigating psychometric properties of full (16 %) or short form (4 %) instruments. The assessment of domain match and feasibility revealed that 15 instruments were assigned a label of 'yes' or 'uncertain' as to whether or not there was a good match with the domain concept or whether the instrument was considered feasible to use. DISCUSSION Most identified instruments considered different aspects of pain and the associated discomfort in performing daily activities but did not include the central aspects of flare in OA, i.e. the change of state, nor the additional Outcome Measures in Rheumatology (OMERACT) endorsed domains for OA flare namely stiffness, swelling, psychological aspects, impact of symptoms including fatigue and sleep disturbance. Although it is possible that the period specified to conduct this literature review may have led to some recognized instruments being excluded, this review demonstrates the need for the research community to reach consensus on the best way to measure self-reported flares in future clinical trials and observational studies.
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Affiliation(s)
| | | | - Martin J Thomas
- Keele University, School of Medicine, Keele, Staffordshire, UK; Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Haywood Hospital, Staffordshire, UK
| | - Lyn March
- Institute of Bone and Joint Research - Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore, Hospital, Sydney, Australia
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Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H, Skou ST, Thoma LM, Rydz R, Wellsandt E, White DK, Bennell K. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis Cartilage 2023; 31:386-396. [PMID: 36367486 DOI: 10.1016/j.joca.2022.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
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Affiliation(s)
- M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - B Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - B J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - M Boyd
- Patient Representative, Australia
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK.
| | - N J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia.
| | - E Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - Y Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium.
| | - J B Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark.
| | - H Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | - L M Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - R Rydz
- Patient Representative, Australia.
| | - E Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA.
| | - K Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Fidelis-de-Paula-Gomes CA, Dibai-Filho AV, Ferreira CSB, da Silva ACB, de Oliveira AR, Politti F, Biasotto-Gonzalez DA. Correlation Among Pain Intensity, Catastrophizing, and Falls in Older Individuals With Unilateral Knee Osteoarthritis: A Cross-Sectional Study. J Manipulative Physiol Ther 2022; 45:196-201. [PMID: 35879126 DOI: 10.1016/j.jmpt.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/15/2022] [Accepted: 06/09/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate whether pain intensity and catastrophizing are associated with fear of falls and the number of falls in older persons with knee osteoarthritis (OA). METHODS A cross-sectional study was conducted involving 100 volunteers (male and female participants), 60 to 80 years old, with a diagnosis of knee OA. Patients were recruited from a physical therapy clinic in the city of São Paulo, Brazil, from March 2019 to November 2019. The following measures were used for the evaluations: Numerical Rating Pain Scale (NRPS), Pain-Related Self-Statement Scale (PRSS), and Falls Efficacy Scale. In statistical analysis, histograms were created to determine the distribution of data. Spearman's correlation coefficients (rs) were then calculated to determine the strength of the associations among the variables. The receiver operating characteristic curve was used to identify the accuracy of PRSS and NRPS in differentiating participants with a history of falls from those without. RESULTS No significant correlation was found among the pain intensity, pain catastrophizing, fear of falling, and number of falls (rs value ranging from -0.033 to -0.167; P value ranging from .096-.743). The accuracy of PRSS and NRPS in differentiating participants with falls from those without was insufficient, with area under the curve values of 0.46 and 0.42, respectively. CONCLUSION Pain catastrophizing and intensity were not significantly associated with fear of falling and numbers of falls in older individuals with unilateral knee OA.
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Affiliation(s)
| | | | | | | | | | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
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Hu H, Liu W, Liu Y, Pan J, Zheng X. Association of depressive symptoms and risk of knee pain: the moderating effect of sex. BMC Musculoskelet Disord 2021; 22:640. [PMID: 34311715 PMCID: PMC8314447 DOI: 10.1186/s12891-021-04511-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Depression has been shown in some studies to be associated with knee pain. Females were widely recognized as more vulnerable to depression and knee pain than males. However, the role of sex in this correlation was under-researched. This study aimed to investigate the association between depressive symptoms and subsequent knee pain, as well as whether and how sex would moderate this association based on a four-wave (Wave 1 in 2010–2011, Wave 2 in 2013, Wave 3 in 2015, and Wave 4 in 2018) longitudinal study among middle-aged and elderly Chinese adults. Methods Seventeen thousand seven hundred eight participants were recruited and followed in the China Health and Retirement Longitudinal Study (CHARLS). Ten thousand four hundred fifty-one entered the final analysis based on the inclusion and exclusion criteria. Knee pain was assessed by self-report. Depressive symptoms were evaluated using the validated 10-item Center for Epidemiological Studies-Depression Scale (CESD-10). Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals (CIs) after controlling potential confounders to examine the association between depressive symptoms and subsequent incident and persistent knee pain. Non-linear association of depressive symptoms score (CESD-10) and risk of knee pain was also investigated via applying 3-knotted restricted cubic spline regression. An interaction term of depressive symptoms status and sex was added to investigate the moderating effect of sex on the relationship between depressive symptoms status and the risk of knee pain. Results The median follow-up time was seven years for all the outcomes. Participants with depressive symptoms were 1.45 times (95% CI: 1.34–1.56) and 2.16 times (95% CI: 1.85–2.52) more likely to develop the incident and persistent knee pain after multivariable were adjusted, compared with those without depressive symptoms. There was a non-linear association between CESD-10 score and risk of knee pain. Compared with females, males had an enhanced correlation between depressive symptoms status and knee pain (multivariable-adjusted HR: 1.22, 95% CI: 1.05–1.42 and HR: 1.57, 95% CI: 1.14–2.17 for the incident and persistent knee pain, respectively). Conclusion Depressive symptoms are independently associated with an excess risk of knee pain, with a stronger correlation for males than females among middle-aged and elderly Chinese adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04511-2. This study investigated the incidence of knee pain, the correlation of depressive symptoms with knee pain, and the moderating effect of sex on this correlation in a nationally representative cohort of middle-aged and elderly Chinese adults. Results suggested that depressive symptoms were associated with an excess risk of knee pain, with a stronger correlation for males than females.
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Affiliation(s)
- Haiyan Hu
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China
| | - Wenjun Liu
- Department of Spine Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China.,Department of Spine Surgery, Yichang Central People's Hospital, Yichang, 443003, Hubei, China
| | - Yang Liu
- Department of Spine Surgery, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443003, Hubei, China.,Department of Spine Surgery, Yichang Central People's Hospital, Yichang, 443003, Hubei, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16, Section 3, Ren Min Nan Road, Chengdu, 610041, China. .,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Xiaozuo Zheng
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Thomas MJ, Rathod-Mistry T, Parry EL, Pope C, Neogi T, Peat G. Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults. Osteoarthritis Cartilage 2021; 29:956-964. [PMID: 33933585 PMCID: PMC8239447 DOI: 10.1016/j.joca.2021.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify proximate causes ('triggers') of flares in adults with, or at risk of, knee osteoarthritis (OA), estimate their course and consequences, and determine higher risk individuals. METHODS In this 13-week web-based case-crossover study adults aged ≥40 years, with or without a recorded diagnosis of knee OA, and no inflammatory arthropathy who self-reported a knee flare completed a questionnaire capturing information on exposure to 21 putative activity-related, psychosocial and environmental triggers (hazard period, ≤72 h prior). Comparisons were made with identical exposure measurements at four 4-weekly scheduled time points (non-flare control period) using conditional logistic regression. Flare was defined as a sudden onset of worsening signs and symptoms, sustained for ≥24 h. Flare characteristics, course and consequence were analysed descriptively. Associations between flare frequency and baseline characteristics were estimated using Poisson regression. RESULTS Of 744 recruited participants (mean age [SD] 62.1 [10.2] years; 61% female), 376 reported 568 flares (hazards) and provided 867 valid control period measurements. Thirteen exposures (eight activity-related, five psychosocial/environmental) were positively associated with flare onset within 24 h (strongest odds ratio estimate, knee buckling: 9.06: 95% confidence interval [CI] 5.86, 13.99; weakest, cold/damp weather: 1.45: 95%CI 1.12, 1.87). Median flare duration was 5 days (IQR 3, 8), less common if older (incident rate ratio [IRR] 0.98: 95%CI 0.97, 0.99), more common if female (IRR 1.85: 95%CI 1.43, 2.39). CONCLUSIONS Multiple activity-related, psychosocial and environmental exposures are implicated in triggering flares. This evidence can help inform prevention and acute symptom management for patients and clinicians.
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Affiliation(s)
- M J Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK.
| | - T Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK; Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - E L Parry
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - C Pope
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
| | - T Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, Suite X-200, Boston, 02118, MA, USA.
| | - G Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK.
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Booker S, Herr K, Tripp-Reimer T. Black American older adults' motivation to engage in osteoarthritis treatment recommendations for pain self-management: A mixed methods study. Int J Nurs Stud 2019; 116:103510. [PMID: 32169337 PMCID: PMC7314646 DOI: 10.1016/j.ijnurstu.2019.103510] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Osteoarthritis is a long-term condition, and four core treatments are recommended to minimize the interference of pain and symptoms on their daily function. However, older Black Americans have traditionally been at a disadvantage in regard to knowledge of and engagement in chronic disease self-management and self-care. Surprisingly, minimal research has addressed understanding motivational factors key to self-management behaviors. Thus, it is important to understand if older Black Americans' self-management is supported by current recommendations for the management of symptomatic osteoarthritis and what factors limit or motivate engagement in recommended treatments. OBJECTIVE Our objectives are to: (1) identify stage of engagement in four core recommended treatments for osteoarthritis, (2) describe the barriers and motivators to these recommended treatments, and (3) construct an understanding of the process of pain self-management motivation. DESIGN A mixed-methods concurrent parallel design. SETTING Participants were recruited from communities in northern Louisiana, USA. PARTICIPANTS Black Americans (≥50 years of age) with clinical osteoarthritis and/or provider-diagnosed osteoarthritis were enrolled. One hundred ten participants completed the study, and 18 of these individuals were also interviewed individually. METHODS Data were collected using in-person surveys and interviews. Over a period of 11 months, close- and open-ended surveys and in-depth interviews were conducted with participants. Descriptive statistics describe utilization/engagement level as well as barriers and motivators of recommended treatments for non-surgical osteoarthritis. Content and thematic analyses of interviews summarized perspectives on the process and role of motivation in pain self-management. RESULTS Overall, engagement levels in treatments ranged from very low to high. Over 55% of older Black Americans were actively engaged in two of the recommended treatments: land-based exercise and strength training. Major motivators included reduction in pain and stiffness and maintenance of mobility and good health. The majority of participants were not using water-based exercise and self-management education. Primary barriers were lack of access, time, and knowledge of resources. CONCLUSIONS In order to maximize the benefits of osteoarthritis pain self-management, older Black Americans must be equipped with the motivation, resources, information and skills, and time to engage in recommended treatment options. Their repertoire of behavioral self-management did not include two key treatments and is inconsistent with what is recommended, predominantly due to barriers that are difficult to overcome. In these cases, motivation alone is not optimal in promoting self-management. Providers, researchers, and community advocates should work collaboratively to expand access to self-management resources, particularly when personal and community motivation are high.
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Affiliation(s)
- Staja Booker
- University of Florida, College of Nursing, PO Box 100197, Gainesville, FL 32610, United States.
| | - Keela Herr
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, United States.
| | - Toni Tripp-Reimer
- The University of Iowa, College of Nursing, 50 Newton Road, Iowa City, IA 52242, United States.
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7
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Thomas MJ, Rathod-Mistry T, Harper S, Parry EL, Pope C, Neogi T, Peat G. Acute Flares of Knee Osteoarthritis (the ACT-FLARE Study): Protocol for a Web-Based Case-Crossover Study in Community-Dwelling Adults. JMIR Res Protoc 2019; 8:e13428. [PMID: 31008709 PMCID: PMC6658279 DOI: 10.2196/13428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background The cardinal feature of osteoarthritis (OA) is pain. Although heterogeneity in pain and function have been demonstrated in the long-term course of OA, the more proximate determinants of acute flare-ups remain less clear. How short-term intermittent or transient exposures trigger acute flare-ups has important implications for effective and sustainable self-management strategies. Objective The primary objective of this study is to identify potential triggers of acute flares in knee OA. Secondary objectives are to determine their course and consequences and describe high-risk participant profiles. Methods We carried out a Web-based case-crossover study. This study aims to recruit 620 community-dwelling adults aged ≥40 years, resident in England, and who have knee pain, with or without a recorded diagnosis of knee OA, and no preexisting diagnosis of inflammatory arthropathy. Participants will be recruited via 3 routes: (1) general practice registers, (2) offline community advertisement, and (3) online social media advertisement. By using questionnaires comparing periods before participants’ self-reported flare-up episodes (hazard periods) with periods during the study when their knee OA symptoms are stable (control periods), triggers preceding flare-ups will be identified and examined using conditional logistic regression. Time-to-resolution of flare-up will be examined by monitoring people’s daily pain, bothersomeness, and medication usage until the participant reports when their flare-up episode ends. Rates of flare-ups will be examined across different participant and flare characteristics using regression models to identify high-risk participant profiles. A study-specific Patient Advisory Group (PAG) is providing suggestion, input, and ongoing support for all stages of the research process. Results Participant recruitment opened in July 2018 and is anticipated to continue for 6 months. The study results will be disseminated through a number of channels, including relevant national or international conferences and peer-reviewed publication in a medical journal, via advocacy or charity organizations, such as Versus Arthritis and across social media. Findings will be fed back to members of our PAG, study participants, and clinicians from participating primary care general practices. The PAG will also take an active role in the overall dissemination strategy. Conclusions This study will provide empirical evidence to help patients identify common knee OA flare triggers and provide health care professionals with questions to identify patients at most risk of frequent flare-ups. International Registered Report Identifier (IRRID) DERR1-10.2196/13428
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Affiliation(s)
- Martin J Thomas
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom.,Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom.,Keele Clinical Trials Unit, Keele University, Staffordshire, United Kingdom
| | - Stephen Harper
- Keele Clinical Trials Unit, Keele University, Staffordshire, United Kingdom
| | - Emma L Parry
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Christopher Pope
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - George Peat
- Primary Care Centre Versus Arthritis, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom
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Thomas MJ, Butler-Walley S, Rathod-Mistry T, Mayson Z, Parry EL, Pope C, Neogi T, Peat G. Acute flares of knee osteoarthritis in primary care: a feasibility and pilot case-crossover study. Pilot Feasibility Stud 2018; 4:167. [PMID: 30410785 PMCID: PMC6217776 DOI: 10.1186/s40814-018-0359-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/16/2018] [Indexed: 01/06/2023] Open
Abstract
Background Osteoarthritis (OA) is a leading cause of persistent pain and disability. Traditionally viewed as a slowly progressive disease, the impact of symptom variability on prognosis remains unclear. 'Acute-on-chronic' episodes are a well-recognised feature of many long-term conditions but only recently formally described in OA. This study aimed to develop a web-based data collection platform and establish key methodological design parameters, to develop a larger community-based study investigating acute flares of knee OA in England. Methods The study is a 9-week feasibility and pilot web-based observational case-crossover study. Adults aged ≥ 40 years registered with two general practices who had consulted their general practitioner for knee pain/OA in the last 2 years were recruited. Participants completed a baseline questionnaire and scheduled (control-period) questionnaires at follow-up weeks 1, 5, and 9. Participants were invited to self-declare via the website on any occasion they experienced a knee pain flare-up lasting ≥ 24 h. Upon notification, an event-driven (case-period) questionnaire comparable to the scheduled questionnaires was completed and daily measurements on the course and consequences were taken until resolution. A sub-study of 10 participants logged daily pain measurements. The analysis estimated key parameters including recruitment (selective non-participation, eligibility, consent), retention, and flare-up capture processes. Questionnaire completeness and website usability were evaluated. Results Of 442 patients invited, 14 completed baseline questionnaires. Eligibility rate was 26.9% (95% CI 19.3, 36.2), consent rate 53.6% (35.8, 70.5), and overall recruitment rate 3.2% (1.9, 5.2). Compared to those mailed, baseline responders were more likely to be male and ≥ 65 years, as were those reporting ≥ 1 flare-up. Eleven scheduled questionnaires were completed (mean response 35%). Although seven participants (50%) self-declared 11 flare-ups, only one event-driven questionnaire was completed and three participants contributed daily flare measurement for four flares. Missing data was ≤ 3.7% across completed baseline, scheduled, and event-driven questionnaires. Aspects of website usability require minor refinement. Conclusions Recruitment was not feasible with the current strategy. An evaluation of processes has suggested several substantial changes in design that may enhance recruitment, retention, and data quality in a future full-scale study.
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Affiliation(s)
- Martin J Thomas
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK.,2Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire ST6 7AG UK
| | - Stephanie Butler-Walley
- 3Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Trishna Rathod-Mistry
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK.,3Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Zoe Mayson
- 3Keele Clinical Trials Unit, David Weatherall Building, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Emma L Parry
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Christopher Pope
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Tuhina Neogi
- 4Department of Medicine, Sections of Clinical Epidemiology Research and Training Unit, and Rheumatology, Boston University School of Medicine, 650 Albany Street, Clinical Epidemiology Unit, Suite X-200, Boston, MA 022118 USA
| | - George Peat
- 1Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire ST5 5BG UK
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9
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Mahler E, den Broeder AA, Woodworth TG, Busch V, van den Hoogen FH, Bijlsma J, van den Ende C. How should worsening in osteoarthritis be defined? Development and initial validation of preliminary criteria for clinical worsening in knee and hip osteoarthritis. Scand J Rheumatol 2017; 46:396-406. [PMID: 28276959 DOI: 10.1080/03009742.2016.1235226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES There is a need to define and validate measures of clinical worsening in knee and hip osteoarthritis (OA). The objectives of this exploratory project were: (i) to characterize worsening criteria in knee and hip OA using psychometric methods; (ii) to estimate their sensitivity and specificity; and (iii) to validate and compare these criteria with worsening criteria previously described in the literature. METHOD An Expert Group reached consensus on 10 sets of worsening criteria to be tested in observational data sets of patients with knee or hip OA who received multimodal conservative treatment. These sets included 219 patients (derivation cohort) and 296 patients (validation cohort). We estimated minimal clinically important worsening (MCIW) values for pain, function, stiffness, and patient global assessment, and tested candidate worsening criteria in the derivation cohort. Finally, using patient judgement, we examined the sensitivity and specificity of literature-based as well as candidate worsening criteria in the validation cohort. RESULTS Literature-based worsening criteria were found to have high specificity (range 60-92%) but low sensitivity (range 22-59%). Two out of 10 candidate worsening criteria constructed by the Expert Group showed an acceptable combination of sensitivity and specificity in the derivation cohort, which was confirmed in the validation cohort (ranging from 54% to 65% and 67% to 74%, respectively). CONCLUSIONS This is the first study to describe symptomatic worsening criteria based on expert consensus after examining the performance of candidate criteria derived from the literature applied to data in an observational study. The newly proposed worsening criteria show an acceptable combination of sensitivity and specificity.
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Affiliation(s)
- Eam Mahler
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - A A den Broeder
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - T G Woodworth
- b Division of Rheumatology , Geffen School of Medicine UCLA , Los Angeles , CA , USA
| | - Vjjf Busch
- c Department of Orthopedics , Sint Maartenskliniek , Nijmegen , The Netherlands
| | - F H van den Hoogen
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands.,d Department of Rheumatology , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - Jwj Bijlsma
- e Department of Rheumatology and Clinical Immunology , University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Chm van den Ende
- a Department of Rheumatology , Sint Maartenskliniek , Nijmegen , The Netherlands
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10
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de Rooij M, van der Leeden M, Heymans MW, Holla JFM, Häkkinen A, Lems WF, Roorda LD, Veenhof C, Sanchez-Ramirez DC, de Vet HCW, Dekker J. Prognosis of Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken) 2016; 68:481-92. [PMID: 26316234 DOI: 10.1002/acr.22693] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/10/2015] [Accepted: 08/11/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To systematically summarize the literature on the course of pain in patients with knee osteoarthritis (OA), prognostic factors that predict deterioration of pain, the course of physical functioning, and prognostic factors that predict deterioration of physical functioning in persons with knee OA. METHODS A search was conducted in PubMed, CINAHL, Embase, Psych-INFO, and SPORTDiscus up to January 2014. A meta-analysis and a qualitative data synthesis were performed. RESULTS Of the 58 studies included, 39 were of high quality. High heterogeneity across studies (I(2) >90%) and within study populations (reflected by large SDs of change scores) was found. Therefore, the course of pain and physical functioning was interpreted to be indistinct. We found strong evidence for a number of prognostic factors predicting deterioration in pain (e.g., higher knee pain at baseline, bilateral knee symptoms, and depressive symptoms). We also found strong evidence for a number of prognostic factors predicting deterioration in physical functioning (e.g., worsening in radiographic OA, worsening of knee pain, lower knee extension muscle strength, lower walking speed, and higher comorbidity count). CONCLUSION Because of high heterogeneity across studies and within study populations, no conclusions can be drawn with regard to the course of pain and physical functioning. These findings support current research efforts to define subgroups or phenotypes within knee OA populations. Strong evidence was found for knee characteristics, clinical factors, and psychosocial factors as prognostics of deterioration of pain and physical functioning.
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Affiliation(s)
- Mariëtte de Rooij
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Centre, Reade, and VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Martijn W Heymans
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Jasmijn F M Holla
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Arja Häkkinen
- University of Jyväskylä and Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Willem F Lems
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
| | - Cindy Veenhof
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Henrica C W de Vet
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
| | - Joost Dekker
- VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands
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11
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Han HS, Lee JY, Kang SB, Chang CB. The relationship between the presence of depressive symptoms and the severity of self-reported knee pain in the middle aged and elderly. Knee Surg Sports Traumatol Arthrosc 2016; 24:1634-42. [PMID: 25982621 DOI: 10.1007/s00167-015-3628-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 04/29/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Knee pain is a very common symptom of knee osteoarthritis (OA), and identification of the major contributors to knee pain is important to establish management plans for patients with knee OA. Among the potential contributors, we hypothesized that coexisting depressive symptoms might increase the severity of knee pain because the increased cytokine levels and neurotransmitter changes related to depression are known to influence the threshold of physical pain perception. Therefore, a possible relationship between self-reported depressive symptoms and self-reported knee pain has been explored. Additionally, we sought to determine factors influencing the severity of knee pain in a middle-aged and elderly Korean population using data from the fifth Korean National Health and Nutrition Examination Survey. METHODS In total, 6599 persons aged ≥50 years were evaluated in terms of the radiographic severity of OA and pain severity using 10-point numerical rating scales. Depressive mood was assessed using a polar question: "Had the subject felt despair or depression every day for more than 2 weeks during the past year?" RESULTS The Kellgren-Lawrence knee OA grade, depression, gender, educational level, household income, smoking status, marital status, living place, comorbidity status, BMI, and age were identified by multiple linear regression as variables affecting knee pain severity. The presence of depressive symptoms was associated with an increased risk of severe knee pain (odds ratio 2.55 [95 % confidence interval 1.77-3.66]). After stratifying the group in terms of the radiographic severity of knee OA, the relationship with depression persisted in the minimal (2.89 [1.90-4.32]) and moderate OA subgroups (2.29 [1.33-3.94]), but not in the severe OA subgroup. CONCLUSIONS Severe knee pain was independently associated with the presence of depressive symptoms in middle-aged and elderly Korean subjects. This suggests that screening for and treatment of depression may help improve knee pain in elderly individuals. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ho-Sung Han
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Yon Lee
- Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 156-707, South Korea.
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12
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Hamilton CB, Wong MK, Gignac MAM, Davis AM, Chesworth BM. Validated Measures of Illness Perception and Behavior in People with Knee Pain and Knee Osteoarthritis: A Scoping Review. Pain Pract 2016; 17:99-114. [PMID: 26990402 DOI: 10.1111/papr.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 11/17/2015] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify validated measures that capture illness perception and behavior and have been used to assess people who have knee pain/osteoarthritis. METHODS A scoping review was performed. Nine electronic databases were searched for records from inception through April 19, 2015. Search terms included illness perception, illness behavior, knee, pain, osteoarthritis, and their related terms. This review included English language publications of primary data on people with knee pain/osteoarthritis who were assessed with validated measures capturing any of 4 components of illness perception and behavior: monitor body, define and interpret symptoms, take remedial action, and utilize sources of help. Seventy-one publications included relevant measures. Two reviewers independently coded and analyzed each relevant measure within the 4 components. RESULTS Sixteen measures were identified that capture components of illness perception and behavior in the target population. These measures were originally developed to capture constructs that include coping strategies/skills/styles, illness belief, illness perception, self-efficacy, and pain behavior. Coding results indicated that 5, 11, 12, and 5 of these measures included the monitor body, define and interpret symptoms, take remedial action, and utilize sources of help components, respectively. CONCLUSIONS Several validated measures were interpreted as capturing some components, and only 1 measure was interpreted as capturing all of the components of illness perception and behavior in the target population. A measure that comprehensively captures illness perception and behavior could be valuable for informing and evaluating therapy for patients along a continuum of symptomatic knee osteoarthritis.
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Affiliation(s)
- Clayon B Hamilton
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Ming-Kin Wong
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Monique A M Gignac
- Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Aileen M Davis
- Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network and Institute of Health Policy, Management and Evaluation, Rehabilitation Science Institute, Toronto, Ontario, Canada.,Departments of Physical Therapy and Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bert M Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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13
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Urquhart DM, Phyomaung PP, Dubowitz J, Fernando S, Wluka AE, Raajmaakers P, Wang Y, Cicuttini FM. Are cognitive and behavioural factors associated with knee pain? A systematic review. Semin Arthritis Rheum 2014; 44:445-55. [PMID: 25151034 DOI: 10.1016/j.semarthrit.2014.07.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/11/2014] [Accepted: 07/11/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Although studies that have examined the relationship between cognitive and behavioural factors and knee pain report conflicting results, no systematic review has been performed to summarise the evidence. The aim of this systematic review was to examine the relationship between cognitive and behavioural factors and pain at the knee. METHODS Electronic searches of MEDLINE, EMBASE and PsycINFO were performed to identify relevant studies published up to April 2014 using MeSH terms and keywords. Studies that met a set of predefined criteria were included. Coping, self-efficacy, somatising, pain catastrophising and helplessness were grouped together as "cognitive factors," while kinesiophobia and pain-related fear-avoidance were considered "behavioural factors." Two independent reviewers extracted the data and assessed the methodological quality of the selected studies. Due to the heterogeneity of the studies, a best-evidence synthesis was performed. RESULTS A total of 14 studies were included in the review, of which nine examined cognitive factors, one investigated behavioural factors and four studied both cognitive and behavioural factors. Eight of 14 studies were of high quality. The best-evidence synthesis showed moderate evidence for a relationship between cognitive factors and knee pain and limited evidence for no association between the behavioural factors and knee pain. CONCLUSION This review found evidence for a relationship between cognitive factors, but not behavioural factors, and knee pain. These findings will need to be confirmed with high-quality longitudinal studies, but the data suggest that cognitive factors may be important to target in the management of knee pain.
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Affiliation(s)
- Donna M Urquhart
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Pyae P Phyomaung
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Julia Dubowitz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Sanduni Fernando
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Paul Raajmaakers
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia.
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14
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Phyomaung PP, Dubowitz J, Cicuttini FM, Fernando S, Wluka AE, Raaijmaakers P, Wang Y, Urquhart DM. Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review. BMC Musculoskelet Disord 2014; 15:10. [PMID: 24405725 PMCID: PMC3907141 DOI: 10.1186/1471-2474-15-10] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/25/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND While it is recognized that psychosocial factors are important in the development and progression of musculoskeletal pain and disability, no systematic review has specifically focused on examining the relationship between psychosocial factors and knee pain. We aimed to systematically review the evidence to determine whether psychosocial factors, specifically depression, anxiety and poor mental health, are risk factors for knee pain. METHODS Electronic searches of MEDLINE, EMBASE and PsycINFO were performed to identify relevant studies published up to August 2012 using MESH terms and keywords. We included studies that met a set of predefined criteria and two independent reviewers assessed the methodological quality of the selected studies. Due to the heterogeneity of the studies, a best evidence synthesis was performed. RESULTS Sixteen studies were included in the review, of which 9 were considered high quality. The study populations were heterogeneous in terms of diagnosis of knee pain. We found a strong level of evidence for a relationship between depression and knee pain, limited evidence for no relationship between anxiety and knee pain, and minimal evidence for no relationship between poor mental health and knee pain. CONCLUSIONS Despite the heterogeneity of the included studies, these data show that depression plays a significant role in knee pain, and that a biopsychosocial approach to the management of this condition is integral to optimising outcomes for knee pain.
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Affiliation(s)
| | | | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne 3004, Victoria, Australia.
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15
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Riddle DL, Jensen MP. Construct and criterion-based validity of brief pain coping scales in persons with chronic knee osteoarthritis pain. PAIN MEDICINE 2012; 14:265-75. [PMID: 23240934 DOI: 10.1111/pme.12007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES A recent trend in clinical practice is to adopt short screening and diagnostic self-report instruments for patients with chronic pain. Brief two-item pain coping and beliefs measures have recently been developed and have potential to improve decision making in clinical practice. Our study examined the construct and criterion-based validity of the two-item per scale version of the coping strategies questionnaire (CSQ). DESIGN We used data obtained on a community-based sample of 873 persons with chronic knee osteoarthritis pain from the Osteoarthritis Initiative, a large longitudinal cohort study. Persons were administered the two-item per scale version of the CSQ. The International Classification of Functioning framework was used to select a variety of criterion-based measures for comparison with the CSQ. Spearman correlations and hierarchical regression models were used to characterize construct validity and receiver operating characteristic (ROC) curves, sensitivity and specificity were used to describe criterion-based validity. RESULTS Construct validity of the CSQ scales was generally supported, with the Catastrophizing and Praying or Hoping scales demonstrating the strongest construct validity across criterion measures. Criterion-based validity for the CSQ scales varied depending on the criterion measure. The Catastrophizing and Praying or Hoping scales also had the strongest criterion-based validity, with ROC curve areas as high as 0.71 (95% confidence interval = 0.67, 0.75), P < 0.001, for identifying persons with substantial physical function deficits. CONCLUSIONS The findings suggest that several of the two-item CSQ scales demonstrate a modest level of construct validity along with fair criterion-based validity. The Catastrophizing and Praying or Hoping scales appear to hold the most promise for clinical applications and future longitudinal research.
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Affiliation(s)
- Daniel L Riddle
- Department of Physical , Virginia Commonwealth University, Richmond, Virginia 23298-0224, USA.
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