Pain and Functional Trajectories in Symptomatic Knee Osteoarthritis over up to 12 Weeks of Exercise Exposure.
Author: Lee AC1, Harvey WF1, Han X1, Price LL2, Driban JB1, Bannuru RR3, Wang C4
Affiliation:
1Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
2Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA; Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA.
3Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA; Center for Treatment Comparison and Integrative Analysis, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
4Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center, Boston, MA, USA. Electronic address: CWang2@Tuftsmedicalcenter.org.
Conference/Journal: Osteoarthritis Cartilage.
Date published: 2018 Jan 29
Other:
Pages: S1063-4584(18)30071-2 , Special Notes: doi: 10.1016/j.joca.2018.01.016. [Epub ahead of print] , Word Count: 244
OBJECTIVE: 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 in knee OA, and to determine their association with baseline factors.
METHODS: Prospective cohort of 171 participants (mean age 61 years; BMI 32kg/m2, 71% female; 57% white) with symptomatic knee OA from a randomized trial comparing 12-week Tai Chi and Physical Therapy. We analyzed weekly Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain (0-500) and function (0-1700) scores using group-based trajectory models. Associations between baseline factors and trajectories were examined using multinomial logistic regression.
RESULTS: We identified four pain trajectories: Lower-Early Improvement (43%), Moderate-Early Improvement (32%), Higher-Delayed Improvement (15%), and Higher-No Improvement (10%). We found similar trajectories for function, except that the lower function trajectories diverged into gradual (12%) or delayed-improvement (15%). Compared with the Lower-Early Improvement pain trajectory, moderate and higher trajectories were associated with poorer physical and psychosocial health. A similar pattern of associations were found among the function trajectories.
CONCLUSIONS: We found four distinct trajectories for pain and function over up to 12-weeks of exercise interventions. While most participants experienced improvements over a short-term exposure, subgroups with greater baseline pain/physical disability had either gradual, delayed, or no improvements. These findings help disentangle the heterogeneity of treatment response and may advance patient-centered care in knee OA.
Copyright © 2018 Osteoarthritis Research Society International. All rights reserved.
KEYWORDS: Exercise Interventions; Osteoarthritis; Physical Therapy; Tai Chi; Trajectory; Treatment Response
PMID: 29391277 DOI: 10.1016/j.joca.2018.01.016
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