ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2849

Pain and Functional Trajectories in Symptomatic Knee Osteoarthritis over a 12-Week Period of Non-Pharmacological Exercise Interventions

Augustine Lee1, William F. Harvey2, Xingyi Han1, Lori Lyn Price3,4, Jeffrey B. Driban1, Raveendhara R. Bannuru1 and Chenchen Wang2, 1Rheumatology, Tufts Medical Center, Boston, MA, 2Rheumatology, Center of Integrative Medicine and Division of Rheumatology, Tufts Medical Center, Boston, MA, Boston, MA, 3Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 4Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: , ,

Session Information

Date: Tuesday, November 7, 2017

Title: Orthopedics, Low Back Pain and Rehabilitation

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Exercise is the recommended treatment for knee osteoarthritis (OA). However, heterogeneous patterns in treatment response are poorly understood. Our purpose was to identify pain and functional trajectories from exercise interventions among adults with symptomatic knee OA, and to determine their association with baseline factors.

Methods: Secondary analysis of a single-blind, randomized trial comparing 12-week Tai Chi and Physical Therapy exercise programs among adults with symptomatic knee OA (ACR Criteria). We used weekly measures of WOMAC pain (0-500) and function (0-1700) to identify trajectories using group-based trajectory models. Associations between baseline factors and trajectories were examined using multinomial logistic regression.

Results: We examined 171 participants (mean age 61 years, BMI 32kg/m2, 71% female, 57% white), and identified four pain trajectories: Lower-Early Improvement (43.3%), Moderate-Early Improvement (32.2%), Higher-Delayed Improvement (15.2%), and Higher-No Improvement (9.4%) (Figure). We found similar trajectories for function, except that the lower function trajectories diverged into gradual (11.7%) or delayed improvement (14.6%). Compared with the Lower-Early Improvement pain trajectory, moderate and higher pain trajectories were significantly associated with younger age, obesity, black race, and poorer physical health (Table). Importantly, psychological morbidities, such as greater depressive symptoms were significantly associated with Higher-Delayed (Odds Ratio [OR]: 1.06; 95% CI, 1.004-1.12) and Higher-No Improvement pain trajectories (OR: 1.07; 95% CI, 1.01-1.13) compared with the Lower-Early Improvement group. A similar pattern of significant associations were found among the functional trajectories (data not shown).

Conclusion: Using innovative analytical techniques, we found four distinct trajectories for pain and function over 12-week exercise interventions among adults with symptomatic knee OA. While most participants experienced early improvements, subgroups with greater baseline pain/physical disability had either gradual, delayed, or no improvements. Notably, psychological morbidities tended to distinguish non-responders or delayed-responders from early responders. These findings help disentangle the heterogeneity of treatment response and may advance patient-centered care for these patients.

 

 

 

 

 

Table.  Associations Between  Pain Trajectories  and Baseline Participant Factors

Characteristic 

Lower Pain, Early Improvement

n= 74

Odds Ratio (95% CI)

Moderate Pain, Early Improvement

n= 55

Odds Ratio (95% CI)

Higher Pain,  Delayed Improvement

n= 26

Odds Ratio (95% CI)

Higher Pain, 

No Improvement

n= 16

Odds Ratio (95% CI)

Age, years                            

Reference

0.98 (0.94, 1.01)

0.95 (0.90, 0.99)

0.95 (0.90, 1.00)

Female Sex

Reference

1.10 (0.51, 2.36)

1.50 (0.53, 4.24)

1.35 (0.39, 4.65)

Black (vs. White and Others)

Reference

2.48 (1.09, 5.61)

4.02 (1.52, 10.68)

7.82 (2.41, 25.35)

Body Mass Index, kg/m2,  >30 (vs. ≤ 30)

Reference

2.78 (1.33, 5.78)

3.93 (1.41, 10.98)

1.24 (0.42, 3.67)

Duration of knee pain, years

Reference

0.97 (0.93, 1.01)

1.01 (0.98, 1.05)

0.91 (0.81, 1.03)

Highest Level of Education

 

 

 

 

Some College or more (vs. High school Graduate or Less)

Reference

0.62 (0.23, 1.66)

1.06 (0.26, 4.26)

0.23 (0.07, 0.79)

Intervention assignment

 

 

 

 

Tai Chi (vs. Physical Therapy)

Reference

1.67 (0.83, 3.39)

1.78 (0.72, 4.44)

1.43 (0.48, 4.25)

Physical Health

 

 

 

 

WOMAC Physical Function

(Range: 0-1700)

Reference

1.49 (1.28, 1.73)

2.06 (1.65, 2.57)

2.18 (1.69, 2.82)

Patient Global Assessment

(Range: 0.0-10.0cm)

Reference

1.41 (1.17, 1.70)

2.33 (1.71, 3.19)

1.71 (1.27, 2.31)

SF-36 Physical Component Summary, 

<40 points (vs. ≥40 points)

(Range: 0-100)#

Reference

2.16 (1.06, 4.39)

18.61 (4.09, 84.75)

4.66 (1.37, 15.83)

PROMIS Sleep Disturbance Short Form, v.8a (Range; T-score: 28.9-76.5)

Reference

0.97 (0.66, 1.41)

2.52 (1.45, 4.39)

2.33 (1.22, 4.45)

SF-36 Energy and Vitality,(Range: 0-100)#

Reference

0.81 (0.66, 0.99)

0.63 (0.49, 0.82)

0.62 (0.46, 0.84)

CHAMPS Physical Activity, mod-high calories/week# <1123.3 (vs. ≥1123.3)

Reference

1.70 (0.83, 3.5)

1.74 (0.67, 4.53)

3.35 (0.99, 11.39)

6-Minute Walk Test, meters

(Normal Range: 400-700)*# 

Reference

0.76 (0.61, 0.95)

0.63 (0.46, 0.84)

0.64 (0.45, 0.89)

Leg Extensor Muscle Strength**, newtons#; 1RM

Reference

0.92 (0.84, 1.01)

0.91 (0.80, 1.04)

0.89 (0.76, 1.04)

Muscle Contraction Velocity** meters/second (40% of 1RM)#

Reference

0.96 (0.78, 1.18)

0.69 (0.51, 0.92)

0.70 (0.50, 0.98)

Berg Balance, ≤50 points (vs. >50 points) (Range: 0-56)#        

Reference

2.19 (0.89, 5.38)

4.27 (1.51, 12.09)

2.13 (0.57, 7.93)

Psychosocial Health

 

 

 

 

SF-36 Mental Component Summary

(Range: 0-100)#

Reference

0.98 (0.94, 1.02)

0.95 (0.90, 0.99)

0.95 (0.90, 1.01)

SF-36 Mental Health; (Range: 0-100)#

Reference

0.88 (0.70, 1.11)

0.77 (0.58, 1.01)

0.71 (0.52, 0.97)

Beck-II Depression, (Range: 0-63)

Reference

1.03 (0.98, 1.08)

1.06 (1.004, 1.12)

1.07 (1.01, 1.13)

Perceived Stress; (Range: 0-40)           

Reference

0.99 (0.94, 1.05)

1.06 (0.99, 1.13)

1.12 (1.03, 1.22)

MOS Social Support; (Range: 19-95)#         

Reference

1.00 (0.99, 1.02)

0.99 (0.98, 1.01)

1.01 (0.98, 1.04)

Arthritis Self-Efficacy Scale-8

(Range: 0-10)#

Reference

0.80 (0.67, 0.96)

0.66 (0.52, 0.84)

0.53 (0.39, 0.72)

Outcome Expectations; (Range: 1.0-5.0)#            

Reference

0.93 (0.49, 1.73)

0.85 (0.38, 1.89)

0.79 (0.30, 2.06)

1RM= one-repetition maximum; CHAMPS= Community Healthy Activities Model Program for Seniors; CI= Confidence Interval; MOS= Medical Outcomes Survey; PROMIS= Patient-Reported Outcomes Measurement Information Systems; SF-36= Short Form-36; WOMAC= Western Ontario and McMasters Osteoarthritis Index. *Normal range reported for the general population. **For muscle strength, and velocity, total n= 165 to 168: 86 to 88 for Tai Chi and 78 to 80 for Physical Therapy. #Higher score indicates greater health. Note: Odds ratios >1.00 favor the first category in dichotomized comparisons. 

 

 

 

 

 

 

 

 

Disclosure: A. Lee, None; W. F. Harvey, None; X. Han, None; L. L. Price, None; J. B. Driban, None; R. R. Bannuru, None; C. Wang, None.

To cite this abstract in AMA style:

Lee A, Harvey WF, Han X, Price LL, Driban JB, Bannuru RR, Wang C. Pain and Functional Trajectories in Symptomatic Knee Osteoarthritis over a 12-Week Period of Non-Pharmacological Exercise Interventions [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/pain-and-functional-trajectories-in-symptomatic-knee-osteoarthritis-over-a-12-week-period-of-non-pharmacological-exercise-interventions/. Accessed .

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