Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis

Leena Sharma*, Kent Kwoh, Jungwha Lee, Jane Cauley, Rebecca Jackson, Marc Hochberg, Alison Hsin-I Chang, Charles Eaton, Michael Nevitt, Jing Song, Orit Almagor, Joan S Chmiel

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

Original languageEnglish (US)
JournalAnnals of the Rheumatic Diseases
DOIs
StatePublished - Jan 1 2019

Fingerprint

Knee Osteoarthritis
Trees (mathematics)
Osteoarthritis
Walking Speed
Gait
Area Under Curve
Aptitude
Sports
ROC Curve
Multicenter Studies
Logistics

Keywords

  • disability
  • functional impairment
  • knee osteoarthritis
  • osteoarthritis
  • prevention

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Sharma, Leena ; Kwoh, Kent ; Lee, Jungwha ; Cauley, Jane ; Jackson, Rebecca ; Hochberg, Marc ; Chang, Alison Hsin-I ; Eaton, Charles ; Nevitt, Michael ; Song, Jing ; Almagor, Orit ; Chmiel, Joan S. / Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. In: Annals of the Rheumatic Diseases. 2019.
@article{1d65b87f34d04007b8426e758fc5207a,
title = "Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis",
abstract = "Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11{\%}, varying 0{\%}-29 {\%} (derivation) and 2{\%}-23 {\%} (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95{\%} CI 0.72 to 0.78 (derivation); 0.72, 95{\%} CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.",
keywords = "disability, functional impairment, knee osteoarthritis, osteoarthritis, prevention",
author = "Leena Sharma and Kent Kwoh and Jungwha Lee and Jane Cauley and Rebecca Jackson and Marc Hochberg and Chang, {Alison Hsin-I} and Charles Eaton and Michael Nevitt and Jing Song and Orit Almagor and Chmiel, {Joan S}",
year = "2019",
month = "1",
day = "1",
doi = "10.1136/annrheumdis-2019-215353",
language = "English (US)",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
publisher = "BMJ Publishing Group",

}

Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. / Sharma, Leena; Kwoh, Kent; Lee, Jungwha; Cauley, Jane; Jackson, Rebecca; Hochberg, Marc; Chang, Alison Hsin-I; Eaton, Charles; Nevitt, Michael; Song, Jing; Almagor, Orit; Chmiel, Joan S.

In: Annals of the Rheumatic Diseases, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis

AU - Sharma, Leena

AU - Kwoh, Kent

AU - Lee, Jungwha

AU - Cauley, Jane

AU - Jackson, Rebecca

AU - Hochberg, Marc

AU - Chang, Alison Hsin-I

AU - Eaton, Charles

AU - Nevitt, Michael

AU - Song, Jing

AU - Almagor, Orit

AU - Chmiel, Joan S

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

AB - Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

KW - disability

KW - functional impairment

KW - knee osteoarthritis

KW - osteoarthritis

KW - prevention

UR - http://www.scopus.com/inward/record.url?scp=85068137963&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068137963&partnerID=8YFLogxK

U2 - 10.1136/annrheumdis-2019-215353

DO - 10.1136/annrheumdis-2019-215353

M3 - Article

C2 - 31243017

AN - SCOPUS:85068137963

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

ER -