Tanaka Ryo, Hirohama Kenta, Kurashige Yuki, Mito Kenichiro, Miyamoto Shintaro, Masuda Ryosuke, Morita Tetsushi, Yokota Shinichi, Sato Seisuke
Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan; Department of Rehabilitation, Hiroshima International University, Hiroshima, Japan.
Department of Rehabilitation, Sakamidorii Hospital, Hiroshima, Japan.
J Orthop Sci. 2020 Jul;25(4):618-626. doi: 10.1016/j.jos.2019.06.016. Epub 2019 Aug 2.
Pain-related affective and/or cognitive characteristics such as depressive symptoms, pain catastrophizing, and self-efficacy are known to exacerbate pain in people with knee osteoarthritis. However, no studies have investigated whether these psychological factors can interfere with pain relief during conservative treatment. The object of this study was to assess the prediction models considering psychological factors to predict pain relief in people with knee osteoarthritis receiving conservative treatment.
Study design was a multicenter, and prospective cohort study. Data were collected in the department of physical therapy in 1 hospital and 7 orthopedic clinics. Eighty-eight people with knee osteoarthritis participated in this study and were followed for 3 months. The numeric rating scale and the Knee Injury and Osteoarthritis Outcome Score scale were used to evaluate pain relief. Potential predictors for pain relief were depressive symptoms, self-efficacy, and pain catastrophizing. The classification and regression trees methodology was used to develop the model for predicting the presence of pain relief at 1 and 3 months after the start of observation. The prediction accuracy was evaluated using the area under the receiver operating characteristic curves (AUCs).
The model at 1 month after the start of observation included pain intensity at baseline, positive affect, and disease duration. The AUC of this model was 0.793 (95% confidential interval, 0.687-0.898). The model at 3 months after the start of observation included pain catastrophizing and self-efficacy. The AUC of this model was 0.808 (95% confidential interval, 0.682-0.934).
The accuracy of prediction model considering pain-related affective and/or cognitive characteristics is moderate for pain relief in people with knee osteoarthritis receiving conservative treatment.
疼痛相关的情感和/或认知特征，如抑郁症状、疼痛灾难化和自我效能感，已知会加重膝骨关节炎患者的疼痛。然而，尚无研究调查这些心理因素是否会干扰保守治疗期间的疼痛缓解。本研究的目的是评估考虑心理因素的预测模型，以预测接受保守治疗的膝骨关节炎患者的疼痛缓解情况。
研究设计为多中心前瞻性队列研究。在1家医院的物理治疗科和7家骨科诊所收集数据。88名膝骨关节炎患者参与本研究，并随访3个月。使用数字评分量表和膝关节损伤与骨关节炎结局评分量表评估疼痛缓解情况。疼痛缓解的潜在预测因素为抑郁症状、自我效能感和疼痛灾难化。采用分类与回归树方法建立模型，以预测观察开始后1个月和3个月时疼痛缓解的情况。使用受试者工作特征曲线下面积（AUC）评估预测准确性。
观察开始后1个月的模型包括基线疼痛强度、积极情绪和病程。该模型的AUC为0.793（95%置信区间，0.687 - 0.898）。观察开始后3个月的模型包括疼痛灾难化和自我效能感。该模型的AUC为0.808（95%置信区间，0.682 - 0.934）。
对于接受保守治疗的膝骨关节炎患者的疼痛缓解情况，考虑疼痛相关情感和/或认知特征的预测模型准确性中等。
