Carlesso Lisa C, Hawker Gillian A, Waugh Esther J, Davis Aileen M
École de réadaptation, Faculté de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
Unité de recherche clinique en orthopédie, Centre de Recherche Hôpital Maisonneuve-Rosemont, Montréal, Canada.
Clin Rheumatol. 2016 Dec;35(12):2999-3005. doi: 10.1007/s10067-016-3401-z. Epub 2016 Sep 6.
The objective of this study is to determine if osteoarthritis (OA) pain and function, persistent low back pain (LBP) and psychosocial factors predict future pain impact (PI) in people with hip and knee OA. In a population-based cohort with hip/knee OA, a standardized telephone questionnaire was used to assess baseline sociodemographics, baseline PI, patient-reported OA severity (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) summary score), psychosocial factors (fatigue, pain catastrophizing (PC), anxiety, social network, and depression), and self-reported persistent LBP. Two years post-baseline, PI was assessed using the Pain Impact Questionnaire. The association of key independent variables with PI was evaluated through multivariable linear regression, adjusting for covariates (e.g., age, sex, baseline PI, etc.) In 462 participants, the mean age was 76 years (range 58 to 96), 78 % were female and 35 % reported LBP at baseline. Mean scores for PC (9.4), and anxiety (3.7) were low and social network (20.1) high. In multivariable regression analyses, only the WOMAC summary score (unstandardized ß 0.181 95% CI (0.12, 0.24) p < 0.001) was independently associated with greater PI at follow-up. In a population-based cohort with hip/knee OA, only the baseline WOMAC summary score was an independent predictor of future PI. This suggests that treatment needs to be focused on limiting pain severity and functional limitations in individuals with hip and knee OA. However, scores for the psychosocial factors are indicative of a healthy cohort and therefore results may not be generalizable to those with poorer psychosocial health.
本研究的目的是确定骨关节炎（OA）疼痛与功能、持续性下腰痛（LBP）以及心理社会因素是否可预测髋膝关节OA患者未来的疼痛影响（PI）。在一个基于人群的髋/膝OA队列中，采用标准化电话问卷评估基线社会人口统计学特征、基线PI、患者报告的OA严重程度（西安大略和麦克马斯特大学骨关节炎指数（WOMAC）总分）、心理社会因素（疲劳、疼痛灾难化（PC）、焦虑、社交网络和抑郁）以及自我报告的持续性LBP。基线后两年，使用疼痛影响问卷评估PI。通过多变量线性回归评估关键自变量与PI的关联，并对协变量（如年龄、性别、基线PI等）进行校正。462名参与者的平均年龄为76岁（范围58至96岁），78%为女性，35%在基线时报告有LBP。PC（9.4）和焦虑（3.7）的平均得分较低，社交网络（20.1）得分较高。在多变量回归分析中，只有WOMAC总分（未标准化β 0.181，95%CI（0.12，0.24），p < 0.001）与随访时更高的PI独立相关。在一个基于人群的髋/膝OA队列中，只有基线WOMAC总分是未来PI的独立预测因素。这表明治疗需要聚焦于限制髋膝关节OA患者的疼痛严重程度和功能受限。然而，心理社会因素的得分表明该队列健康，因此结果可能不适用于心理社会健康较差的人群。
