Performance of global assessments of hip, knee, and back symptom change

Health Services Research and Development (152), Veterans Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
Clinical Rheumatology (Impact Factor: 1.77). 03/2011; 30(3):331-8. DOI: 10.1007/s10067-010-1536-x
Source: PubMed


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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    • "In addition, we are collecting exploratory measures that are of interest in this patient population and type of intervention. These measures include additional pain measures (visual analog and visual numeric scales [47,48], measure of pain predictability from the Measure of Constant and Intermittent Osteoarthritis Pain [49]), fatigue visual analog scale [48], sleep quality (Insomnia Severity Index [28] and Berlin Questionnaire [50]), foot symptoms (Foot Assessment Clinical Tool [51]), Social Support for Diet and Exercise [52], Satisfaction with Physical Function [53], and Global Assessment of Joint Symptom Change (at follow-up only [54,55]). At follow-up we will also assess perceptions of patients and providers about the respective interventions, as well as suggestions for improvements for future implementation, using open-ended questions. "
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    ABSTRACT: Osteoarthritis (OA) of the hip and knee are among the most common chronic conditions, resulting in substantial pain and functional limitations. Adequate management of OA requires a combination of medical and behavioral strategies. However, some recommended therapies are under-utilized in clinical settings, and the majority of patients with hip and knee OA are overweight and physically inactive. Consequently, interventions at the provider-level and patient-level both have potential for improving outcomes. This manuscript describes two ongoing randomized clinical trials being conducted in two different health care systems, examining patient-based and provider-based interventions for managing hip and knee OA in primary care. METHODS / DESIGN: One study is being conducted within the Department of Veterans Affairs (VA) health care system and will compare a Combined Patient and Provider intervention relative to usual care among n = 300 patients (10 from each of 30 primary care providers). Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only, Provider Only, and Combined (Patient + Provider) interventions relative to usual care among n = 560 patients across 10 clinics. Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis, are overweight, and do not meet current physical activity guidelines. The 12-month, telephone-based patient intervention focuses on physical activity, weight management, and cognitive behavioral pain management. The provider intervention involves provision of patient-specific recommendations for care (e.g., referral to physical therapy, knee brace, joint injection), based on evidence-based guidelines. Outcomes are collected at baseline, 6-months, and 12-months. The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (self-reported pain, stiffness, and function), and secondary outcomes are the Short Physical Performance Test Protocol (objective physical function) and the Patient Health Questionnaire-8 (depressive symptoms). Cost effectiveness of the interventions will also be assessed. Results of these two studies will further our understanding of the most effective strategies for improving hip and knee OA outcomes in primary care settings. NCT01130740 (VA); NCT 01435109 (NIH).
    BMC Musculoskeletal Disorders 04/2012; 13(1):60. DOI:10.1186/1471-2474-13-60 · 1.72 Impact Factor