Grace H Lo1,2, Jing Song3, Timothy E McAlindon4, Gillian A Hawker5, Jeffrey B Driban4, Lori Lyn Price6, Charles B Eaton7, Marc C Hochberg8, Rebecca D Jackson9, C Kent Kwoh10, Michael C Nevitt11, Dorothy D Dunlop3. 1. Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, BCM-285, Houston, TX, 77030, USA. ghlo@bcm.edu. 2. Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Medical Center, Houston, TX, USA. ghlo@bcm.edu. 3. Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA. 4. Division of Rheumatology, Tufts Medical Center, Boston, MA, USA. 5. Department of Medicine, University of Toronto, Toronto, ON, Canada. 6. The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA. 7. Department of Family Medicine and Epidemiology, Warren Alpert Medical School of Brown University, Providence, RI and Department of Epidemiology, School of Public Health of Brown University, Providence, RI, USA. 8. Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA. 9. Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, OH, USA. 10. University of Arizona Arthritis Center, University of Arizona, Tucson, AZ, USA. 11. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Abstract
OBJECTIVE: Validation of a symptom measure for early knee OA may help identify new treatments and modifiable risk factors. Symptom measures that consider pain in the context of activity level may provide better discrimination than pain alone. Therefore, we aimed to compare sensitivity to change for radiographic progression between Ambulation Adjusted Score for Knee pain (AASK), which accounts for self-reported ambulation, and Western Ontario McMaster Osteoarthritis (WOMAC) knee pain score. DESIGN: Participants were assessed annually up to 48 months using WOMAC, Physical Activity Scale for the Elderly (PASE) ambulation, and knee radiographs. AASK was defined as ((WOMAC pain) + 1)/((average daily hours of walking) + 1). Radiographs were scored for Kellgren-Lawrence (KL) grade. Linear regression, stratified by OA status, evaluated relationships between changes in AASK and WOMAC pain and KL grade over time. RESULTS: For 4191 people (8030 knees), the mean age was 61.2 (+ 9.2) years old and BMI was 28.6 (+ 4.8) kg/m2; 58% female. Over 40% of knees had WOMAC pain scores of 0; by design, no knees had AASK scores of 0. Annual changes in AASK were more sensitive to changes in KL than changes in WOMAC in those without baseline OA (0.20 and 0.16 change per unit KL change, p = 0.005 and 0.070 respectively), but performed similarly in knees with OA. CONCLUSION: AASK is simple to assess using existing validated questionnaires. AASK performs well in individuals with and without OA and should be considered in clinical trials and observational studies of early knee OA.
OBJECTIVE: Validation of a symptom measure for early knee OA may help identify new treatments and modifiable risk factors. Symptom measures that consider pain in the context of activity level may provide better discrimination than pain alone. Therefore, we aimed to compare sensitivity to change for radiographic progression between Ambulation Adjusted Score for Knee pain (AASK), which accounts for self-reported ambulation, and Western Ontario McMaster Osteoarthritis (WOMAC) knee pain score. DESIGN:Participants were assessed annually up to 48 months using WOMAC, Physical Activity Scale for the Elderly (PASE) ambulation, and knee radiographs. AASK was defined as ((WOMACpain) + 1)/((average daily hours of walking) + 1). Radiographs were scored for Kellgren-Lawrence (KL) grade. Linear regression, stratified by OA status, evaluated relationships between changes in AASK and WOMACpain and KL grade over time. RESULTS: For 4191 people (8030 knees), the mean age was 61.2 (+ 9.2) years old and BMI was 28.6 (+ 4.8) kg/m2; 58% female. Over 40% of knees had WOMACpain scores of 0; by design, no knees had AASK scores of 0. Annual changes in AASK were more sensitive to changes in KL than changes in WOMAC in those without baseline OA (0.20 and 0.16 change per unit KL change, p = 0.005 and 0.070 respectively), but performed similarly in knees with OA. CONCLUSION:AASK is simple to assess using existing validated questionnaires. AASK performs well in individuals with and without OA and should be considered in clinical trials and observational studies of early knee OA.
Authors: A M Davis; A V Perruccio; M Canizares; G A Hawker; E M Roos; J-F Maillefert; L S Lohmander Journal: Osteoarthritis Cartilage Date: 2009-01-31 Impact factor: 6.576
Authors: A A Guccione; D T Felson; J J Anderson; J M Anthony; Y Zhang; P W Wilson; M Kelly-Hayes; P A Wolf; B E Kreger; W B Kannel Journal: Am J Public Health Date: 1994-03 Impact factor: 9.308