Rebecca J Cleveland

• PhD
• Statistician at University of North Carolina at Chapel Hill

Background Self-monitoring of blood glucose (SMBG) is a low value health care practice that does not benefit most patients with non-insulin treated type 2 diabetes (T2DM). This paper evaluates Re-Think the Strip (RTS), a multi-component study aimed at de-implementing SMBG among non-insulin treated T2DM patients in primary care. Methods This study...

Background Knee osteoarthritis (OA) is a leading cause of pain and disability globally. Pain from knee OA leads to functional limitation. Physical activity (PA), e.g., taking more steps/day, reduces the risk of functional limitation. However, little is known about patterns of activity throughout the day and to what extent such patterns may be assoc...

Background Shoulder pain is a leading cause of disability. Occupations requiring high upper extremity demands may put workers at greater risk of shoulder injury and resulting pain. We examined associations of occupation with shoulder pain and upper extremity disability in the Johnston County Osteoarthritis Project. Methods Work industry and occupa...

Objective Walk With Ease (WWE) is an effective low-cost walking program. We estimated the budget impact of implementing WWE in persons with knee osteoarthritis (OA) as a measure of affordability that can inform payers’ funding decisions. Methods We estimated changes in two-year healthcare costs with and without WWE. We used the Osteoarthritis Poli...

Objective: The Walk With Ease (WWE) program was developed by the Arthritis Foundation to help people with arthritis learn to exercise safely and improve arthritis symptoms. We sought to establish the value of the WWE program. Methods: We used the Osteoarthritis Policy (OAPol) Model, a widely published and validated computer simulation of knee os...

Objective: To develop sets of core and optional recommended domains for describing and evaluating Osteoarthritis Management Programs (OAMPs), with a focus on hip and knee OA. Design: We conducted a 3-round modified Delphi survey involving an international group of researchers, health professionals, health administrators and people with OA. In Ro...

Objective: To determine if baseline biomarkers are associated with longitudinal changes in the worsening of disc space narrowing (DSN), vertebral osteophytes (OST), and low back pain (LBP). Design: Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for severi...

Objective: The objective of this cross-sectional study was to investigate the impact of the COVID-19 pandemic on physical activity (PA) levels of patients with rheumatic and musculoskeletal diseases (RMDs) and to examine factors associated with decreased PA. Methods: A sample of adult patients with RMDs (n = 7,776) was identified through electro...

Objective In prior cross‐sectional analyses of African American patients with rheumatoid arthritis (RA), measures of socioeconomic status (SES) were associated with clinical joint damage and poorer patient‐reported outcome scores. The purpose of this study was to determine whether SES measures are associated with disease progression in a cohort of...

Objective To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). Methods Paired baseline (2003–2004) and follow‐up (2006–2010) lumbar spine radiographs from the Johnston County Ost...

Objective Describe the association between biomarkers and lumbar spine degeneration (vertebral osteophytes [OST], facet joint osteoarthritis [FOA], and disc space narrowing [DSN]), for persons with and without low back pain (LBP) and determine whether clusters based on biomarkers differentiate lumbar spine structure with and without LBP. Methods U...

Objective: Acceptance and commitment therapy (ACT) has demonstrated effectiveness in addressing symptoms of anxiety and depression, frequently experienced by patients with systemic lupus erythematosus (SLE). The goal of this pilot study was to develop and assess the feasibility and acceptability of a novel web-based ACT skills training program tai...

Objective To describe the point prevalence of hip symptoms, radiographic hip osteoarthritis (rHOA), severe rHOA, and symptomatic rHOA (sxHOA) at five time points in the longitudinal, population-based Johnston County Osteoarthritis Project (JoCoOA). Design Data were from 3068 JoCoOA participants who attended up to five study visits (1991–2018). Sta...

Introduction Biochemical biomarkers may provide insight into musculoskeletal pain reported at individual or multiple body sites. The purpose of this study was to determine if biomarkers or pressure-pain threshold (PPT) were associated with individual or multiple sites of pain. Methods This cross-sectional analysis included 689 community-based part...

Objective To examine the association of disease activity and disability with rehabilitation utilization in African American adults with rheumatoid arthritis (RA). Methods We analyzed cross‐sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with RA (CLEAR) I and CLEAR II registry. Disease activity was q...

Objective To describe point prevalence of knee symptoms, radiographic knee osteoarthritis (rKOA), severe rKOA, and symptomatic rKOA at four time points in the longitudinal, population-based Johnston County Osteoarthritis Project (JoCo OA). Methods Data were from 2573 JoCo OA participants with up to 18 years of follow-up (1999-2018) and standardize...

Objective: To examine relationships between knee osteoarthritis (KOA) and obesity, diabetes mellitus (DM), and cardiovascular disease (CVD). Methods: Associations of time-dependent obesity, DM, and CVD with KOA transition states over approximately 18 years were examined among 4093 participants from a community-based cohort. Transition states wer...

Background Patients with Systemic Lupus Erythematosus (SLE) often experience pain and other symptoms that negatively impact quality of life. Interventions that enhance the use of behavioral and cognitive coping strategies may lead to improved outcomes among patients with SLE. Pain coping skills training (PCST) programs have been shown to improve ou...

Objective To apply a precision medicine approach to determine the optimal treatment regime for participants in an exercise (E), dietary weight loss (D), and D + E trial for knee osteoarthritis that would maximize their expected outcomes. Methods Using data from 343 participants of the Intensive Diet and Exercise for Arthritis (IDEA) trial, we appl...

Background: This study examined patterns of physical activity and associations with pain, function, fatigue, and sleep disturbance among individuals with knee or hip osteoarthritis. Methods: Participants (n = 54) were enrolled in a telephone-based physical activity coaching intervention trial; all data were collected at baseline. Self-reported m...

Background Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individu...

Context The contribution of lumbar scoliosis to osteoporosis is unknown. Objective To determine prevalence and relationship of lumbar scoliosis to osteoporosis in aging women. Design A cross-sectional analysis used dual-energy X-ray absorptiometry (DXA) scans of randomly selected groups of postmenopausal women (64-68, 74-78, and 84-88 years; N=30...

OA is a highly prevalent painful and disabling condition that affects the population globally. KOA and hip OA and their associated outcomes vary by race/ethnicity, SES, and geographic regions. Based on current evidence, the burden of OA may be generally higher among particular subgroups, such as AAs and those with lower SES. However, there are nota...

Physical activity (PA) is important for managing osteoarthritis (OA), but many patients are inactive. Research is needed on strategies to leverage clinical encounters to engage patients in PA. Guided by the socioecological model of health behavior, this study aimed to engage stakeholders in the process of refining an Osteoarthritis Physical Activit...

Objective To investigate the impact of hip osteoarthritis (OA) and/or hip symptoms on excess mortality. Design We analyzed data from 3,919 individuals in a community-based prospective cohort of African Americans and Caucasians age ≥45 years. Women ≥ 50 years of age and all men underwent supine anteroposterior pelvic radiography at baseline, with t...

Objective Adults with radiographic knee OA (rKOA) are at increased risk of mortality and walking difficulty may modify this relation. Little is known about specific aspects of walking difficulty that increase mortality risk. We investigated the association of walking speed (objective measure of walking difficulty) with mortality and examined the th...

Objective To determine if associations between demographic and clinical characteristics and appendicular joint osteoarthritis (OA) reflect different phenotypes of OA in the lumbar spine. Methods Participants were from the Johnston County OA Project. Demographic information consisted of age, sex, and race (white and African American), and clinical...

Abstract Background To obtain information on feasibility and acceptability, as well as preliminary data on efficacy, of an Osteoarthritis Physical activity Care Pathway (OA-PCP). Methods This was a single group pilot study involving 60 participants with symptomatic, physician diagnosed knee or hip OA, recruited from primary care clinics. Participan...

Objective The goal of this paper is to describe approaches for the joint analysis of repeatedly measured data with time‐to‐event end points, first separately and then in the framework of a single comprehensive model, emphasizing the efficiency of the latter approach. Data from the Johnston County Osteoarthritis (JoCo OA) Project will be used as an...

PurposeWe investigated whether the relationship between diabetes and all-cause and CVD-related mortality differed between women with and without breast cancer among a cohort drawn from the same source population.Methods We interviewed 1,363 women newly diagnosed with breast cancer in 1996–1997, and 1,358 age-matched women without breast cancer, to...

We provide additional statistical background for the methodology developed in the clinical analysis of knee osteoarthritis in "A Precision Medicine Approach to Develop and Internally Validate Optimal Exercise and Weight Loss Treatments for Overweight and Obese Adults with Knee Osteoarthritis" (Jiang et al. 2020). Jiang et al. 2020 proposed a pipeli...

Objective To evaluate whether joint hypermobility modifies the association between knee joint injury and knee osteoarthritis (OA) among adults. Methods Data were from three studies: Genetics of Generalized Osteoarthritis (GOGO; N = 2341), Genetics of Osteoarthritis (GO; N = 1872), and the population-based Johnston County Osteoarthritis Project (Jo...

Background: We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). Methods: This longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in Nor...

The purpose of this work is to determine the relationship between biomarkers of inflammation, structure, and pain with radiographic disc space narrowing (DSN) in community‐based participants. A total of 74 participants (37 cases and 37 controls) enrolled in the Johnston County Osteoarthritis (OA) Project during 2006‐2010 were selected. Cases had at...

Rheumatic and musculoskeletal diseases (RMDs) are common, with osteoarthritis (OA) being the most prevalent. RMDs, including OA, are associated with significant pain and functional limitations, as well as mortality rates up to 1.6-fold higher than in the general population. Most studies of OA and mortality have focused on knee and hip OA. Some, but...

Objective To conduct a proof-of-concept pilot evaluation of the self-directed format of Walk With Ease (WWE), a 6-week walking program developed for adults with arthritis, in patients with systemic lupus erythematosus (SLE). Methods This was a single arm, 6-week pre- and post-evaluation of the self-directed WWE program to assess feasibility, toler...

Background This cross-sectional study evaluated associations of joint hypermobility and multiple joint osteoarthritis (MJOA) in a community-based cohort of adults 45+ years of age. Methods MJOA and joint hypermobility data were from 1677 participants (mean age 69 years, 68% women) who completed research clinic visits during 2003–2010. Prevalent MJ...

Background: Chronic low back pain (cLBP) affects millions of Americans and costs billions. Studies suggest a link between cLBP and joint hypermobility. Methods: We conducted cross-sectional primary analyses of joint hypermobility and cLBP, lumbar spine osteoarthritis (OA), and lumbar facet joint OA (FOA) in 3 large studies-the Generalized Osteoa...

Objective: Knee osteoarthritis (KOA) is a heterogeneous condition representing a variety of potentially distinct phenotypes. The purpose of this study was to apply innovative machine learning approaches to KOA phenotyping in order to define progression phenotypes that are potentially more responsive to interventions. Design: We used publicly ava...

Objective To explore associations of joint hypermobility (a condition where range of motion is greater than normal) with ankle and foot radiographic osteoarthritis (OA) and symptoms in a large community‐based cohort of African American and white adults ages 55–94 years old. Methods Ankle and foot radiographs and joint hypermobility data (Beighton...

Objective: To investigate the impact of knee osteoarthritis (OA) and/or knee pain on excess mortality. Method: We analyzed data from 4,182 participants in a community-based prospective cohort study of African American and Caucasian men and women aged ≥45 years. Participants completed knee radiographs and questionnaires at baseline and at up to t...

Purpose: To examine 143 diabetes risk single nucleotide polymorphisms (SNPs), identified from genome‐wide association studies, in association with breast cancer (BC) incidence and subsequent mortality. Methods: A population‐based sample of Caucasian women with first primary invasive BC (n = 817) and controls (n = 1,021) were interviewed to assess d...

Background Osteoarthritis (OA) is associated with worsening physical function and a high prevalence of comorbid health conditions. In particular, cardiovascular disease (CVD) risk is higher in individuals with OA than the general population. Limitations in physical function may be one pathway to the development of CVD among individuals with OA. Thi...

Introduction: Latinos are disproportionately likely to lack a high school diploma, compared with non-Hispanic whites, a trend associated with worse outcomes in arthritis and indicating a need for health interventions. Camine Con Gusto (CCG) is the Spanish version of the evidence-based Walk With Ease program for arthritis. This study compared basel...

Background/purpose: To update definitions of multiple joint osteoarthritis (MJOA), and to determine the frequency and impact of MJOA in a community-based cohort. Methods: Following PRISMA guidelines and with the help of a professional research librarian, we performed a systematic review in Medline using the terms osteoarthritis, generalized, pol...

Background Fatigue and arthritis are common sources of impairment in SLE patients that persist despite lifestyle and pharmacologic interventions. Walk with Ease (WWE) is the Arthritis Foundation’s 6 week evidence-based walking program developed for adults with arthritis that has been shown to improve physical function, pain, stiffness and fatigue i...

Background: Diabetes is associated with increased risk of breast cancer and subsequent mortality; however, whether genetic variants that increase diabetes risk also influence breast cancer has received little attention. Herein, we examined the associations between 143 single nucleotide polymorphisms (SNPs) identified from genome-wide association st...

Objective: To determine the contribution of the gut microbiota to the development of injury-induced osteoarthritis (OA). Design: OA was induced using the destabilized medial meniscus (DMM) model in 20 germ-free (GF) C57BL/6J male mice housed in a gnotobiotic facility and 23 strain-matched specific pathogen free (SPF) mice in 2 age groups -13.5 w...

Background Osteoarthritis (OA) prevalence differs by race. General joint hypermobility (GJH) may be associated with OA, but differences by race are not known. This community-based study examined the frequency of GJH and its relationship with knee, hip, and lumbar spine OA by race (African American vs. Caucasian). Methods Data were from the Johnston...

Osteoarthritis is the most common musculoskeletal condition. Due to the aging population and rising obesity worldwide, the projected increase in osteoarthritis is expected to be substantial. Since osteoarthritis has been associated with disability and many chronic conditions such as obesity, diabetes, and cardiovascular disease, it is important to...

Background In postmenopausal women diagnosed with breast cancer (BC), most BC tumors are hormone receptor positive and guidelines recommend adjuvant endocrine therapy that includes an aromatase inhibitor (AI). This study investigates the impact of a 6-week, home-based, self-directed walking program on the commonly reported side effect of AI-associa...

Purpose: To examine associations between 22 CYP single nucleotide polymorphisms (SNPs) and breast cancer incidence and their interactions with grilled-smoked meat intake, a source of polycyclic aromatic hydrocarbons. Methods: White women with first primary in situ or invasive breast cancer (n = 988) and frequency-matched controls (n = 1021) from...

Introduction: Camine Con Gusto (CCG) is the Hispanic version of an evidence-based walking program for people with arthritis. This study examined CCG outcomes, feasibility, tolerability, safety, and acceptability and potential tailoring. Method: A pre and post 6-week evaluation was conducted in Hispanic people with arthritis. Outcomes included pa...

Background Low back pain (LBP) and osteoarthritis (OA) of the lumbar spine are common causes of disability. The contribution of joint hypermobility (range of motion greater than normal at most joints) to LBP and lumbar spine OA is not well known. Objectives This cross-sectional study examined the relationship of joint hypermobility with LBP and lu...

Background Clinical impressions suggest that joint hypermobility, a condition in which range of motion is greater than normal at most joints, is associated with osteoarthritis (OA), but results vary across the few published cohort studies on this subject. To our knowledge, no prior cohort study has examined the association of hypermobility and ankl...

Purpose Despite the overlap between the clinical symptoms/sequelae of polycystic ovarian syndrome (PCOS) and many known reproductive risk factors for breast cancer, the relationship between PCOS and breast cancer remains unclear, possibly because of the complex heterogeneity and challenges in diagnosing PCOS over time. We hypothesized that PCOS, sp...

Background: There is abundant evidence that low socioeconomic status (SES) is associated with worse health outcomes among people with Rheumatoid Arthritis (RA); however, the influence of socioeconomic disadvantage in early life has yet to be studied within that population. Methods: Data originated from the cross-sectional arm of the Consortium E...

Background: There is abundant evidence that low socioeconomic status (SES) is associated with worse health outcomes among people with Rheumatoid Arthritis (RA); however, the influence of socioeconomic disadvantage in early life has yet to be studied within that population. Methods: Data originated from the cross-sectional arm of the Consortium Eval...

Background To identify baseline radiographic features that predict hip osteoarthritis (HOA) progression, and to explore differences in these associations by race. Methods Radiographs from the community-based Johnston County OA Project were scored using Kellgren-Lawrence (KL) grade and for presence and location of joint space narrowing (JSN), osteo...

Objective: To evaluate the association between patient-reported outcome (PRO) and performance-based (PB) measures of physical functioning (PF) among individuals with self-identified arthritis to inform decisions of which to use when evaluating the effectiveness of a physical activity intervention. Methods: Secondary data analysis of a nonrandomi...

Organochlorine insecticides have been studied extensively in relation to breast cancer incidence and results from two meta-analyses have been null for late-life residues, possibly due to measurement error. Whether these compounds influence survival remains to be fully explored. We examined associations between organochlorine insecticides (p,p'-DDT,...

Evaluate effectiveness of the Arthritis Foundation Tai Chi program for community participants with arthritis. 343 individuals were randomized to intervention or wait-list control. Performance and self-reported outcome (SRO) measures were assessed at baseline and 8 weeks. At 1 year, SROs only were assessed. Adjusted means were determined using regre...

Obesity is associated with increased bioavailability of estrogen, hyperinsulinemia, and chronic inflammation, all of which may promote tumor growth. Given DNA repair and oxidative stress pathways may work together with these mechanisms to influence carcinogenesis, we hypothesized that genetic variation in these pathways may modify the obesity-postm...

Objective: To examine cross-sectional baseline data from the Consortium for the Longitudinal Evaluation of African Americans with Early Rheumatoid Arthritis registry for the association between socioeconomic status (SES) with clinical and self-report health outcomes. Methods: We analyzed data on 937 African Americans who provided comprehensive s...

Introduction Inadequate program design and lack of access to evidence-based programs are major barriers to the management of chronic diseases such as arthritis, particularly for African Americans. This study evaluates the effectiveness of the Arthritis Foundation’s Walk With Ease Program (WWE) in a subsample of African Americans who were part of a...

Physical activity (PA) is associated with physiological responses thought to beneficially affect survival after breast cancer diagnosis, yet few studies have considered the entire survivorship experience. Effects of post-diagnosis activity on survival were examined in a cohort of 1,423 women diagnosed with in situ or invasive breast cancer in 1996-...

In the article by Callahan LF, Cleveland RJ, Shreffler J, et al, “Evaluation of Active Living Every Day in Adults With Arthritis,” in J Phys Act Health , 11(2), p. 285, two authors were omitted from the author byline for the article. Those authors are Teresa Brady and Todd Schwartz. The authors apologize for the error.

s: Thirty-Sixth Annual CTRC-AACR San Antonio Breast Cancer Symposium - Dec 10-14, 2013; San Antonio, TX Background: Most breast cancer cases diagnosed among postmenopausal women are hormone receptor positive (HR+); standard adjuvant endocrine treatment usually includes an aromatase inhibitor (AI). Joint pain/stiffness/achiness (arthralgia) is a co...

Purpose This study presents group (instructor-led) and self-directed (nongroup) participant achievement of exercise objectives and satisfaction with the Arthritis Foundation's Walk With Ease (WWE) program at 6 weeks postintervention and 1-year follow-up. Design Secondary data analysis. Setting Rural and urban counties in North Carolina. Subjects...

Background: Parental exposures to chemicals, and the interplay between chemical exposures in utero and in infancy leading to respiratory disease in childhood, are not yet fully understood. In this study we investigated the impact of chemical exposures to the parent in occupational settings and to the child in the home and children's respiratory he...