de Rooij Mariëtte, van der Leeden Marike, Heymans Martijn W, Holla Jasmijn F M, Häkkinen Arja, Lems Willem F, Roorda Leo D, Veenhof Cindy, Sanchez-Ramirez Diana C, de Vet Henrica C W, Dekker Joost
Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands.
Amsterdam Rehabilitation Research Centre, Reade, and VU University Medical Centre, EMGO Institute, Amsterdam, The Netherlands.
Arthritis Care Res (Hoboken). 2016 Apr;68(4):481-92. doi: 10.1002/acr.22693.
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.
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.
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).
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.
系统总结有关膝骨关节炎（OA）患者疼痛病程、预测疼痛恶化的预后因素、身体功能病程以及预测膝OA患者身体功能恶化的预后因素的文献。
截至2014年1月，在PubMed、CINAHL、Embase、Psych-INFO和SPORTDiscus中进行检索。进行了荟萃分析和定性数据综合分析。
纳入的58项研究中，39项质量较高。发现研究间（I(2) ＞90%）和研究人群内（以变化分数的大标准差反映）存在高度异质性。因此，疼痛和身体功能的病程被认为不明确。我们发现了一些预测疼痛恶化的预后因素的有力证据（例如，基线时膝关节疼痛较重、双侧膝关节症状和抑郁症状）。我们还发现了一些预测身体功能恶化的预后因素的有力证据（例如，放射学OA加重、膝关节疼痛加重、膝关节伸展肌肉力量降低、步行速度降低和合并症计数较高）。
由于研究间和研究人群内存在高度异质性，无法就疼痛和身体功能的病程得出结论。这些发现支持了目前在膝OA人群中定义亚组或表型的研究工作。发现膝关节特征、临床因素和心理社会因素作为疼痛和身体功能恶化的预后指标有有力证据。
