Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Bld., CB# 7280, Chapel Hill, NC, 27599-7280, USA.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
Clin Rheumatol. 2019 Aug;38(8):2241-2247. doi: 10.1007/s10067-019-04530-4. Epub 2019 Mar 30.
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.
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).
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.
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.
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.
最近的研究表明，与未经调整的疼痛测量相比，经过身体活动（PA）调整的疼痛测量与放射学骨关节炎（OA）的严重程度更密切相关。这项探索性研究检验了经过 PA 调整的疼痛测量与其他关键的 OA 相关测量指标的关联程度是否比未经调整的疼痛评分更密切。
参与者为 122 名患有膝骨关节炎的退伍军人（平均年龄 61.2 岁，88.5%为男性）。基于加速度计测量的日常活动，对基线 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）疼痛评分进行了以下 5 种调整：（1）步数；（2）任何活动的分钟数；（3）中等到高强度活动的分钟数；（4）低强度活动的分钟数；（5）能量消耗。采用偏相关分析，调整了年龄、性别和体重指数的影响，评估了未经调整和经过 PA 调整的 WOMAC 疼痛评分与功能评估（6 分钟步行测试、8 英尺步行测试、椅子站立测试、对身体功能的满意度）、疲劳（Brief Fatigue Inventory）和焦虑/抑郁症状（单项）之间的关联。
在 36 个模型中，有 29 个模型存在显著关联（p<0.05）。对于四项与功能相关的评估，经过步计数和能量消耗调整的 WOMAC 疼痛评分与 WOMAC 疼痛评分（偏 rs=0.19-0.25）相比，与疼痛评分的关联更强（偏 rs=0.24-0.48）。对于疲劳和焦虑/抑郁症状，WOMAC 疼痛评分与心理症状的关联比大多数经过 PA 调整的疼痛评分更强。在经过 PA 调整的测量指标中，与其他指标相比，步计数和能量消耗的关联最强。
在涉及功能评估的 OA 研究中，经过 PA 调整的疼痛评分可能具有特殊价值，而未经调整的 WOMAC 疼痛评分与心理症状的关联更密切。这对临床 OA 研究中的测量具有影响。
NCT01058304
在患有骨关节炎的患者中，与未经调整的疼痛评分相比，经过身体活动（PA）调整的疼痛测量（特别是经过步计数和能量消耗调整的疼痛测量）与身体功能测量的关联更强，而未经调整的疼痛评分与心理症状的关联更强。
在临床骨关节炎研究中，最合适或最敏感的症状测量（疼痛与经过 PA 调整的疼痛）可能取决于正在研究的干预措施或结果的类型。
