School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA.
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA.
Pain Med. 2021 Mar 18;22(3):653-662. doi: 10.1093/pm/pnaa398.
To identify clinical phenotypes of knee osteoarthritis (OA) using measures from the following domains: 1) multimorbidity; 2) psychological distress; 3) pain sensitivity; and 4) knee impairment or pathology.
Data were collected from 152 people with knee OA and from 31 pain-free individuals. In participants with knee OA, latent profile analysis (LPA) was applied to the following measures: normalized knee extensor strength, Functional Comorbidity Index (FCI), Pain Catastrophizing Scale (PCS), and local (knee) pressure pain threshold. Comparisons were performed between empirically derived phenotypes from the LPA and healthy older adults on these measures. Comparisons were also made between pheonotypes on pain intensity, functional measures, use of health care, and history of knee injury.
LPA resulted in a four-group solution. Compared with all other groups, group 1 (9% of the study population) had higher FCI scores. Group 2 (63%) had elevated pain sensitivity and quadriceps weakness relative to group 4 and healthy older adults. Group 3 (11%) had higher PCS scores than all other groups. Group 4 (17%) had greater leg strength, except relative to healthy older adults, and reduced pain sensitivity relative to all groups. Groups 1 and 3 demonstrated higher pain and worse function than other groups, and group 4 had higher rates of knee injury.
Four phenotypes of knee OA were identified using psychological factors, comorbidity status, pain sensitivity, and leg strength. Follow-up analyses supported the replicability of this phenotype structure, but future research is needed to determine its usefulness in knee OA care.
使用以下领域的措施来确定膝骨关节炎（OA）的临床表型：1）多种合并症；2）心理困扰；3）疼痛敏感性；4）膝关节损伤或病理学。
数据来自 152 名膝骨关节炎患者和 31 名无痛个体。在膝骨关节炎患者中，应用潜在剖面分析（LPA）对以下措施进行分析：正常化膝关节伸肌力量、功能合并症指数（FCI）、疼痛灾难化量表（PCS）和局部（膝关节）压痛阈值。在这些措施上，对 LPA 得出的经验性表型与健康老年人进行了比较。还比较了不同表型的疼痛强度、功能测量、医疗保健使用和膝关节损伤史。
LPA 产生了一个四组的解决方案。与所有其他组相比，第 1 组（研究人群的 9%）的 FCI 评分较高。第 2 组（63%）的疼痛敏感性和股四头肌无力高于第 4 组和健康老年人。第 3 组（11%）的 PCS 评分高于所有其他组。第 4 组（17%）的腿部力量除了相对健康老年人较弱外，疼痛敏感性相对所有组都较低。第 1 组和第 3 组的疼痛和功能比其他组更差，第 4 组的膝关节损伤发生率更高。
使用心理因素、合并症状况、疼痛敏感性和腿部力量确定了膝骨关节炎的 4 种表型。后续分析支持了该表型结构的可复制性，但需要进一步研究确定其在膝骨关节炎护理中的有用性。
