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Composite measures of physical activity and pain associate better with functional assessments than pain alone in knee osteoarthritis

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Abstract

Introduction

Recent research showed that physical activity (PA)–adjusted pain measures were more strongly associated with radiographic osteoarthritis (OA) severity than an unadjusted pain measure. This exploratory study examined whether PA-adjusted pain measures were more closely associated with other key OA-related measures, compared to unadjusted pain scores.

Method

Participants were 122 Veterans (mean age = 61.2 years, 88.5% male) with knee OA. Baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores were adjusted for accelerometer-derived daily: (1) step counts, (2) minutes of any activity, (3) minutes of moderate or greater intensity activity, (4) minutes of light intensity activity, and (5) energy expenditure. Partial correlations, adjusted for age, sex, and body mass index, estimated associations of unadjusted and PA-adjusted WOMAC pain scores with functional assessments (6-minute walk test, 8-foot walk test, chair stand test, satisfaction with physical function), fatigue (Brief Fatigue Inventory), and anxiety/depressive symptoms (single item).

Results

Significant (p < 0.05) associations were found in 29 of 36 of models. For the four function-related assessments, step count and energy expenditure–adjusted WOMAC pain scores had stronger associations (partial rs = 0.24–0.48) than WOMAC pain score (partial rs = 0.19–0.25). For fatigue and anxiety/depressive symptoms, WOMAC pain score had stronger, positive associations than most PA-adjusted pain scores. Of the PA-adjusted measures, the strongest associations overall were observed for step count and energy expenditure.

Conclusion

PA-adjusted pain scores may have particular value for OA studies involving functional assessments, whereas unadjusted WOMAC pain scores are more closely associated with psychological symptoms. This has implications for measurement in clinical OA studies.

Trial registration

NCT01058304

Key points

• Among patents with osteoarthritis, physical activity–adjusted pain measures (particularly those adjusted for step count and energy expenditure) were more strongly associated with measures of physical function, compared to unadjusted pain scores, whereas unadjusted pain score was more strongly associated with a measure of psychological symptoms.

• In clinical osteoarthritis research, the most appropriate or sensitive symptom measure (pain vs. physical activity–adjusted pain) may depend on the type of intervention or outcome being studied.

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Funding

This study received financial support from the Department of Veterans Affairs, Health Services Research and Development Service (IIR 09-056). Dr. Hall receives support from the Rehabilitation Research and Development Service of the Department of Veterans Affairs (2RX001316). Drs. Allen, Coffman, and Oddone receive support from the Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (CIN 13-410). This work is supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX (Dr. Lo). Dr. Allen receives support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases Multidisciplinary Clinical Research Center P60 AR062760.

Author information

Authors and Affiliations

  1. Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Bld., CB# 7280, Chapel Hill, NC, 27599-7280, USA

    Kelli D. Allen

  2. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA

    Kelli D. Allen

  3. Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC, USA

    Kelli D. Allen, Jennifer H. Lindquist, Cynthia Coffman & Eugene Z. Oddone

  4. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Grace Lo

  5. Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, TX, USA

    Grace Lo

  6. Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA

    Lauren M. Abbate

  7. Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Lauren M. Abbate

  8. College of Nursing, East Carolina University, Greenville, NC, USA

    Theresa A. Floegel

  9. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA

    Cynthia Coffman

  10. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Eugene Z. Oddone & Katherine Hall

  11. University of South Carolina School of Medicine Greenville, Greenville, SC, USA

    Shannon Stark Taylor

  12. Greenville Health System, Greenville, SC, USA

    Shannon Stark Taylor

  13. Center for Aging and Human Development, Duke University, Durham, NC, USA

    Katherine Hall

  14. Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA

    Katherine Hall

Authors
  1. Kelli D. Allen
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  2. Grace Lo
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  3. Lauren M. Abbate
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  4. Theresa A. Floegel
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  5. Jennifer H. Lindquist
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  6. Cynthia Coffman
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  7. Eugene Z. Oddone
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  8. Shannon Stark Taylor
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  9. Katherine Hall
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Corresponding author

Correspondence to Kelli D. Allen.

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This research was approved by the Institutional Review Board at the DVAHCS. All participants provided written informed consent.

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Allen, K.D., Lo, G., Abbate, L.M. et al. Composite measures of physical activity and pain associate better with functional assessments than pain alone in knee osteoarthritis. Clin Rheumatol 38, 2241–2247 (2019). https://doi.org/10.1007/s10067-019-04530-4

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  • DOI: https://doi.org/10.1007/s10067-019-04530-4

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