Broekman Melle M, Brinkman Niels, van de Ree Cornelis L P, Ring David, Doornberg Job N, Agricola Rintje, Jayakumar Prakash
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA.
Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, t he Netherlands.
Clin Orthop Relat Res. 2025 Jul 16. doi: 10.1097/CORR.0000000000003612.
Among patients seeking care for osteoarthritis (OA), there is evidence that mindsets contribute more to variation in levels of musculoskeletal discomfort and incapability than does radiographic severity. While the importance of mindsets among those seeking specialty care is well established, less is known about the relationship of thoughts and feelings with levels of joint-related discomfort and incapability in the general population, many of whom experience symptoms of aging joints and are accommodating these symptoms. By studying individuals with hip pain who have not sought specialty care, using a statistical technique that can account for the interrelationship of psychological and social variables (cluster analysis) and accounting for levels of OA, we can better study the association of mindset with levels of discomfort and incapability relative to the grade of OA while limiting or avoiding the potential for distortion of linear and logistic regression by even relatively lower levels of collinearity among mental health variables.
QUESTIONS/PURPOSES: Using a Dutch population-based cohort we asked: (1) Are there distinct 10-year trajectories of comfort and capability by statistical grouping based on mental health measures and grade of OA in a population-based cohort of individuals with hip pain? (2) Are groupings with less healthy mindsets associated with worse 10-year trajectories for both comfort and capability compared with groups defined by healthier mindsets?
We analyzed data from a prospective longitudinal cohort from the Dutch general population from between October 2002 and September 2005. Individuals age 45 to 65 years were included if they experienced new onset of hip or knee pain or stiffness and either had not sought care for their symptoms or their first general practitioner consultation for symptoms was within 6 months of enrollment. Originally, a total of 1002 participants were included, of which 74% (n = 740, 79% [584 of 740] women, mean ± SD age 56 ± 5 years) met our inclusion criteria and were included in this study. Each year for 10 years, participants completed the SF-36 (measuring general capability and mental health, with higher scores indicating better overall health); the WOMAC questionnaire (measuring capability specifically for hip and knee OA, with lower scores indicating greater capability); the EuroQol-5D-3L (EQ-5D-3L) questionnaire, which measures five domains of health (mobility, self-care, usual activities, pain, and anxiety/depression); and the VAS for pain intensity. All 740 included participants completed the WOMAC, the SF-36 physical component summary, and the Numeric Rating Scale for pain at 10 years. Cluster analysis identified statistical groupings of participants with similar scores on the SF-36 mental component summary (MCS), EQ-5D-3L anxiety/depression item, and Kellgren-Lawrence grade of radiographic hip OA. We then constructed a conditional growth model, which is a statistical technique that analyzes the average rate of decline in capability and increase in pain intensity over 10 years between groups of people with similar baseline mental health and radiographic arthritis severity. The conditional growth model quantifies the relationship between mindset and grade of OA at baseline and 10-year trajectories of levels of comfort and capability.
The cluster analysis identified four statistical groups of participants with similar mean grades of radiographic OA at the 10-year evaluation and variation in mental health scores. All groups had a mean Kellgren-Lawrence Grade of 2. Group 1, summarized as "accommodative mindset" (44% [326 of 740] of patients), had high mean scores on the SF-36 MCS (a mean of 60, which represents an SD better than the population mean of 50) and low mean scores on the EQ-5D-3L anxiety/depression questions, representing minimal symptoms of anxiety and depression. Group 2, summarized as "neutral mindset" (37% [276 of 740] of patients), had scores near the population mean of 50 on the SF-36 MCS and slightly higher mean scores on the EQ-5D-3L anxiety/depression questions, representing relatively neutral mental health. Group 3, summarized as "less healthy mindsets" (12% [89 of 740] of patients), had mean scores of 1 SD below the population mean on the SF-36 MCS and higher mean scores on the EQ-5D-3L anxiety/depression questions, representing relatively greater symptoms of anxiety and depression. Group 4, summarized as "least healthy mindset" (6% [45 of 740] of patients), had mean scores of 2 SD below the population mean on the SF-36 MCS and high mean scores on the EQ-5D-3L anxiety/depression questions, representing notable symptoms of anxiety and depression. Patients with less healthy mindsets experienced more rapid decline in comfort and capability over a decade.
The finding among the general population of people with hip pain-many of whom have sensations from hip arthritis but are not seeking care-that worse mental health accounted for worse 10-year trajectories of hip symptoms independent of the radiographic severity of hip arthritis is further evidence that strategies for enhancing musculoskeletal health must account for symptoms of anxiety and depression. Seeking care for hip pain from relatively mild arthritis might, in part, signal higher levels of emotional distress. Timely diagnosis and effective treatment of unhealthy levels of anxiety and depression have the potential to improve a patient's hip health and their health in general.
Level II, prognostic study.
在寻求骨关节炎（OA）治疗的患者中，有证据表明，心态对肌肉骨骼不适和功能障碍程度差异的影响，比影像学严重程度更大。虽然心态在寻求专科护理的人群中的重要性已得到充分证实，但对于普通人群中思想和情感与关节相关不适及功能障碍程度之间的关系，我们了解较少，其中许多人经历着关节老化症状并在适应这些症状。通过研究未寻求专科护理的髋部疼痛患者，使用一种能够考虑心理和社会变量相互关系的统计技术（聚类分析）并考虑骨关节炎的程度，我们可以更好地研究心态与相对于骨关节炎等级的不适和功能障碍程度之间的关联，同时限制或避免心理健康变量之间即使相对较低水平的共线性对线性和逻辑回归造成的潜在扭曲。
问题/目的：我们利用一个荷兰人群队列研究了：（1）在一个基于人群的髋部疼痛个体队列中，根据心理健康指标和骨关节炎等级进行统计分组，是否存在不同的10年舒适度和功能轨迹？（2）与由更健康心态定义的组相比，心态较不健康的组在10年的舒适度和功能方面是否有更差的轨迹？
我们分析了2002年10月至2005年9月期间来自荷兰普通人群的前瞻性纵向队列数据。纳入年龄在45至65岁之间、经历过新发髋部或膝部疼痛或僵硬且未因症状寻求过护理或首次因症状咨询全科医生在入组后6个月内的个体。最初，共纳入1002名参与者，其中74%（n = 740，79%[740名中的584名]为女性，平均±标准差年龄56±5岁）符合我们的纳入标准并被纳入本研究。在10年中，参与者每年完成SF - 36问卷（测量总体功能和心理健康，分数越高表明总体健康状况越好）；WOMAC问卷（专门测量髋部和膝部骨关节炎的功能，分数越低表明功能越好）；欧洲五维健康量表（EQ - 5D - 3L）问卷，该问卷测量健康的五个领域（活动能力、自我护理、日常活动、疼痛和焦虑/抑郁）；以及疼痛强度视觉模拟量表。所有740名纳入的参与者在10年时完成了WOMAC问卷、SF - 36身体成分总结和疼痛数字评定量表。聚类分析确定了在SF - 36心理成分总结（MCS）、EQ - 5D - 3L焦虑/抑郁项目和放射学髋部骨关节炎的凯尔格伦 - 劳伦斯等级上得分相似的参与者的统计分组。然后我们构建了一个条件增长模型，这是一种统计技术，用于分析具有相似基线心理健康和放射学关节炎严重程度的人群组在10年期间功能下降和疼痛强度增加的平均速率。条件增长模型量化了基线时心态与骨关节炎等级以及10年舒适度和功能水平轨迹之间的关系。
聚类分析确定了四个统计组的参与者，在10年评估时放射学骨关节炎的平均等级相似，但心理健康得分存在差异。所有组的平均凯尔格伦 - 劳伦斯等级均为2级。第1组，总结为“适应性心态”（占患者的44%[740名中的326名]），在SF - 36 MCS上平均得分较高（平均为60，比总体平均50高出1个标准差），在EQ - 5D - 3L焦虑/抑郁问题上平均得分较低，代表焦虑和抑郁症状极少。第2组，总结为“中性心态”（占患者的37%[740名中的276名]），在SF - 36 MCS上得分接近总体平均50，在EQ - 5D - 3L焦虑/抑郁问题上平均得分略高，代表相对中性的心理健康状况。第3组，总结为“较不健康心态”（占患者的12%[740名中的89名]），在SF - 36 MCS上平均得分比总体平均低1个标准差，在EQ - 5D - 3L焦虑/抑郁问题上平均得分较高，代表焦虑和抑郁症状相对较多。第4组，总结为“最不健康心态”（占患者的6%[740名中的45名]），在SF - 36 MCS上平均得分比总体平均低2个标准差，在EQ - 5D - 3L焦虑/抑郁问题上平均得分较高，代表明显的焦虑和抑郁症状。心态较不健康的患者在十年间舒适度和功能下降更快。
在髋部疼痛的普通人群中发现——其中许多人有髋关节炎的感觉但未寻求护理——心理健康状况较差导致髋部症状在10年中出现更差的轨迹，且独立于髋关节炎的放射学严重程度，这进一步证明，增强肌肉骨骼健康的策略必须考虑焦虑和抑郁症状。因相对轻度关节炎而寻求髋部疼痛治疗，可能部分表明情绪困扰程度较高。及时诊断和有效治疗不健康水平的焦虑和抑郁，有可能改善患者的髋部健康及总体健康状况。
II级，预后研究。
