Abstract
The objective of this study is to compare patients’ global assessments of change in knee, hip, and back symptoms with actual changes over time in pain, function, and radiographic severity. The participants (n = 894, 80% female, mean age = 66 years) completed two assessments (mean of 4 years apart) as part of a study on the genetics of generalized osteoarthritis. At both assessments, participants completed the Western Ontario and McMaster Universities OA Index (WOMAC), and radiographic severity was assessed for knees, hips, and low back. At the second assessment, participants described changes in knee, hip, and low back symptoms as worse, better, same, or never had symptoms. Analysis of covariance models examined mean changes in WOMAC scores and radiographic severity according to categories of the global assessment measures. Statistical significance was examined for linear trend. Mean WOMAC total, pain, and function scores decreased (indicating improvement) among participants who indicated joint symptoms were better, showed little change among those who reported symptoms were the same/never had symptoms, and increased among those who reported symptoms were worse. For all analyses except the comparison of WOMAC pain change according to global assessment of low back symptom change, there was a statistically significant linear trend (p < 0.05). Patterns were similar for changes in radiographic severity, but the tests of linear trend were not statistically significant. Results support the concordance of these global assessments of joint symptom change with actual changes in self-reported symptoms. These global assessments may be useful for assessing change over time when baseline data are unavailable.
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Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840
Bellamy N, Kirwan J, Boers M, Brooks P, Strand V, Tugwell P, Altman R, Brandt K, Dougados M, Lequesne M (1997) Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III. J Rheumatol 24:799–802
Pham T, van der Heijde D, Altman RD, Anderson JJ, Bellamy N, Hochberg M, Simon L, Strand V, Woodworth T, Dougados M (2004) OMERACT-OARSI initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials. Osteoarthritis Cartilage 12:389–399
Chevalier X, Mejjad O, Babini S (2000) Methodology for the assessment of treatments in hand osteoarthritis. Osteoarthritis & Cartilage 8 (Supplement A):S70-S72
Lequesne MG, Maheu E (2000) Methodology of clinical trials in hand osteoarthritis: conventional and proposed tools. Osteoarthritis & Cartilage 8 (Suppl. A):S64-S69
Tubach F, Ravaud P, Baron G, Falissard B, Logeart I, Bellamy N, Bombardier C, Felson DT, Hochberg MC, van der Heijde D, Dougados M (2005) Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 64:29–33
Hoeksma HL, van den Ende CH, Breedveld FC, Ronday HK, Dekker J (2005) A comparison of the OARSI response criteria with patient's global assessment in patients with osteoarthritis of the hip treated with a non-pharmacological intervention. Osteoarthritis Cartilage 14:77–81
Ehrich EW, Davies GM, Watson DJ, Bolognese JA, Seidenberg BC, Bellamy N (2000) Minimal perceptible clinical improvement with the Western Ontario and McMaster Universities osteoarthritis index questionnaire and global assessments in patients with osteoarthritis. J Rheumatol 27:2635–2641
Allen KD, Jordan JM, Renner JB, Kraus VB (2006) Relationship of global assessment of change to AUSCAN and pinch and grip strength among individuals with hand osteoarthritis. Osteoarthritis Cartilage 14:1281–1287
Bellamy N, Campbell J, Haraoui B, Buchbinder R, Hobby K, Roth JH, MacDermid JC (2002) Dimensionality and clinical importance of pain and disability in hand osteoarthritis: development of the Australian/Canadian (AUSCAN) osteoarthritis hand index. Osteoarthritis Cartilage 10:855–862
Bellamy N, Campbell J, Haraoui B, Buchbinder R, MacDermid J, Roth J (1997) Development of the Australian/Canadian (AUSCAN) osteoarthritis (OA) hand index. Arthritis Rheum 40:S110
Kraus VB, Jordan JM, Doherty M, Wilson AG, Moskowitz R, Hochberg M, Loeser R, Hooper M, Renner JB, Crane MM, Hastie P, Versani S, Sundseth S, Atif U (2007) The genetics of generalized osteoarthritis (GOGO) study: study design and evaluation of osteoarthritis phenotypes. Osteoarthritis Cartilage 15:120–127
Kraus VB, Li YJ, Martin ER, Jordan JA, Renner JB, Doherty M, WIlson GG, Moskowitz R, Hochberg M, Loeser R, Sundseth S (2004) Articular hypermobility is a protective factor for hand osteoarthritis. Arthritis Rheum 50:2178–2183
Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials 10:407–415
McConnell S, Kolopack P, Davis AM (2001) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 45:453–61
Peterfy C, Li J, Saim S, Duryea J, Lynch J, Miaux Y, Yu W, Genant HK (2003) Comparison of fixed-flexion positioning with fluoroscopic semi-flexed positioning for quantifying radiographic joint-space width in the knee: test-retest reproducibility. Skeletal Radiol 32:128–132
Kellgren J, Lawrence J (1957) Radiologic assessment of osteoarthritis. Ann Rheum Dis 16:494–502
Wolfe F (1999) Determinants of WOMAC function, pain and stiffness scores: evidence for the role of low back pain, symptom counts, fatigue and depression in osteoarthritis, rheumatoid arthritis and fibromyalgia. Rheumatology 38:355–361
Arden N, Nevitt MC (2006) Osteoarthritis: epidemiology. Best Pract Res Clin Rheumatol 20:3–25
Hunter DJ, McDougall JJ, Keefe FJ (2008) The symptoms of osteoarthritis and the genesis of pain. Rheum Dis Clin N Am 34:623–643
Chatman AB, Hyams SP, Neel JM, Binkley JM, Stratford PW, Schomberg A, Stabler M (1997) The Patient-Specific Functional Scale: measurement properties in patients with knee dysfunction. Phys Ther 77:820–829
Kopec JA, Esdaile JM, Abrahamowicz M, Abenhaim L, Wood-Dauphinee S, Lamping DL, Williams JI (1995) The Quebec Back Pain Disability Scale: measurement properties. Spine 20:341–352
Linton SJ, Melin L (1982) The accuracy of remembering chronic pain. Pain 13:281–285
Herrmann D (1995) Reporting current, past, and changed health status: what we now about distortion. Med Care 33:AS94–AS94
Stone AA, Broderick JE, Kaell AT, DelesPaul PA, Porter LE (2000) Does the peak-end phenomenon observed in laboratory pain studies apply to real-world pain in rheumatoid arthritis? J Pain 1:212–217
Stratford PW, Binkley JM, Riddle DL, Guyatt GH (1998) Sensitivity to change of the Roland-Morris Back Pain Questionnaire: part I. Phys Ther 78:1186–1196
Menzel P, Dolan P, Richardson J, Olsen JA (2002) The role of adaptation to disability and disease in health state valuation: a preliminary normative analysis. Soc Sci Med 55:2149–2158
Funding support and acknowledgements
This study was supported by a grant from GlaxoSmithKline. This study was performed in part, at the Duke General Clinical Research Unit, funded by NIH MO1-RR-30, National Center for Research Resources. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Department of Veterans Affairs.
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Allen, K.D., Jordan, J.M., Doherty, M. et al. Performance of global assessments of hip, knee, and back symptom change. Clin Rheumatol 30, 331–338 (2011). https://doi.org/10.1007/s10067-010-1536-x
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DOI: https://doi.org/10.1007/s10067-010-1536-x