Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain

Grace H. Lo; Jing Song; Timothy E. McAlindon; Gillian A. Hawker; Jeffrey B. Driban; Lori Lyn Price; Charles B. Eaton; Marc C. Hochberg; Rebecca D. Jackson; C. Kent Kwoh; Michael C. Nevitt; Dorothy D. Dunlop

doi:10.1007/s10067-018-4352-3

Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain

Grace H. Lo^*, Jing Song, Timothy E. McAlindon, Gillian A. Hawker, Jeffrey B. Driban, Lori Lyn Price, Charles B. Eaton, Marc C. Hochberg, Rebecca D. Jackson, C. Kent Kwoh, Michael C. Nevitt, Dorothy D. Dunlop

^*Corresponding author for this work

Medicine, Rheumatology Division

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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/m ² ; 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.

Original language	English (US)
Pages (from-to)	851-858
Number of pages	8
Journal	Clinical Rheumatology
Volume	38
Issue number	3
DOIs	https://doi.org/10.1007/s10067-018-4352-3
State	Published - Mar 14 2019

Keywords

Knee
Measurement
Osteoarthritis
Outcome measure
Validation

ASJC Scopus subject areas

Rheumatology

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10.1007/s10067-018-4352-3

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@article{ce9e1e9a6e68440cae88a76f8407c710,

title = "Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain",

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/m 2 ; 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.",

keywords = "Knee, Measurement, Osteoarthritis, Outcome measure, Validation",

author = "Lo, {Grace H.} and Jing Song and McAlindon, {Timothy E.} and Hawker, {Gillian A.} and Driban, {Jeffrey B.} and Price, {Lori Lyn} and Eaton, {Charles B.} and Hochberg, {Marc C.} and Jackson, {Rebecca D.} and Kwoh, {C. Kent} and Nevitt, {Michael C.} and Dunlop, {Dorothy D.}",

note = "Funding Information: Funding information Dr. Lo is supported by K23 AR062127, an NIH/ NIAMS funded mentored award; and Dr. Dunlop{\textquoteright}s awards, R01 AR054155 and P60 AR064464, provided support for design and conduct of the study, analysis, and interpretation of the data; and preparation and review of this work. This work is supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (No. CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX. Dr. Hawker receives support as the Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto. The Osteoarthritis Initiative is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the Osteoarthritis Initiative Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the Osteoarthritis Initiative is managed by the Foundation for the National Institutes of Health. Publisher Copyright: {\textcopyright} 2018, International League of Associations for Rheumatology (ILAR).",

year = "2019",

month = mar,

day = "14",

doi = "10.1007/s10067-018-4352-3",

language = "English (US)",

volume = "38",

pages = "851--858",

journal = "Clinical Rheumatology",

issn = "0770-3198",

publisher = "Springer London",

number = "3",

}

TY - JOUR

T1 - Validation of a new symptom outcome for knee osteoarthritis

T2 - the Ambulation Adjusted Score for Knee pain

AU - Lo, Grace H.

AU - Song, Jing

AU - McAlindon, Timothy E.

AU - Hawker, Gillian A.

AU - Driban, Jeffrey B.

AU - Price, Lori Lyn

AU - Eaton, Charles B.

AU - Hochberg, Marc C.

AU - Jackson, Rebecca D.

AU - Kwoh, C. Kent

AU - Nevitt, Michael C.

AU - Dunlop, Dorothy D.

N1 - Funding Information: Funding information Dr. Lo is supported by K23 AR062127, an NIH/ NIAMS funded mentored award; and Dr. Dunlop’s awards, R01 AR054155 and P60 AR064464, provided support for design and conduct of the study, analysis, and interpretation of the data; and preparation and review of this work. This work is supported in part with resources at the VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (No. CIN 13-413), at the Michael E. DeBakey VA Medical Center, Houston, TX. Dr. Hawker receives support as the Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto. The Osteoarthritis Initiative is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the Osteoarthritis Initiative Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the Osteoarthritis Initiative is managed by the Foundation for the National Institutes of Health. Publisher Copyright: © 2018, International League of Associations for Rheumatology (ILAR).

PY - 2019/3/14

Y1 - 2019/3/14

N2 - 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/m 2 ; 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.

AB - 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/m 2 ; 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.

KW - Knee

KW - Measurement

KW - Osteoarthritis

KW - Outcome measure

KW - Validation

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EP - 858

JO - Clinical Rheumatology

JF - Clinical Rheumatology

IS - 3

ER -

Validation of a new symptom outcome for knee osteoarthritis: the Ambulation Adjusted Score for Knee pain

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