Minimal clinically important decline in physical function over one year: EPOSA study

Background: The Australian/Canadian hand Osteoarthritis Index (AUSCAN) and the Western Ontario and McMaster Universities knee and hip Osteoarthritis Index (WOMAC) are the most commonly used clinical tools to manage and monitor osteoarthritis (OA). Few studies have as yet reported longitudinal changes in the AUSCAN index regarding the hand. While there are published data regarding WOMAC assessments of the hip and the knee, the two sites have always evaluated separately. The current study therefore sought to determine the minimal clinically important difference (MCID) in decline in the AUSCAN hand and WOMAC hip/knee physical function scores over 1 year using anchor-based and distribution-based methods. Methods: The study analysed data collected by the European Project on Osteoarthritis, a prospective observational study investigating six adult cohorts with and without OA by evaluating changes in the AUSCAN and WOMAC physical function scores at baseline and 12–18 months later. Pain and stiffness scores, the performance-based grip strength and walking speed and health-related quality of life measures were used as the study’s anchors. Receiver operating characteristic curves and distribution-based methods were used to estimate the MCID in the AUSCAN and WOMAC physical function scores; only the data of those participants who possessed paired (baseline and follow up-measures) AUSCAN and WOMAC scores were included in the analysis. Results: Out of the 1866 participants who were evaluated, 1842 had paired AUSCAN scores and 1845 had paired WOMAC scores. The changes in the AUSCAN physical function score correlated significantly with those in the AUSCAN pain score (r = 0.31). Anchor- and distribution-based approaches converged identifying 4 as the MCID for decline in the AUSCAN hand physical function. Changes in the WOMAC hip/knee physical function score were significantly correlated with changes in both the WOMAC pain score (r = 0.47) and the WOMAC stiffness score (r = 0.35). The different approaches converged identifying two as the MCID for decline in the WOMAC hip/knee physical function. Conclusions: The most reliable MCID estimates of decline over 1 year in the AUSCAN hand and WOMAC hip/knee physical function scores were 4 and 2 points, respectively.This work was supported by a non-commercial private funder. The Indicators for Monitoring COPD and Asthma - Activity and Function in the Elderly in Ulm study (IMCA - ActiFE) was supported by the European Union [2005121] and the Ministry of Science, Baden-Württemberg. The Italian cohort study is part of the National Research Council Project on Aging (PNR). The Longitudinal Aging Study Amsterdam (LASA) is financially supported by the Dutch Ministry of Health, Welfare and Sports. The Peñagrande study was partially supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain [FIS PI 05/1898; FIS RETICEF RD06/0013/ 1013 and FIS PS09/02143]. The Swedish Twin Registry is supported in part by the Swedish Ministry of Higher Education. The Hertfordshire Cohort Study is funded by the Medical Research Council of Great Britain, Arthritis Research UK, the British Heart Foundation and the International Osteoporosis Foundation

Outcome Priorities for Older Persons With Sarcopenia

Discrete-choice experiment (DCE) SETTING AND PARTICIPANTS: Community-dwelling individuals older than 65 years suffering from sarcopenia recruited in Belgium, France, Germany, Italy, Spain, and Switzerland, who visited the clinic and were cognitively able to understand and fill out the survey

Factors Associated With Functional Decline in Hand and Hip/Knee Osteoarthritis After One Year: Data From a Population-Based Study

Objective To investigate factors that together with hand or hip/knee osteoarthritis (OA) could contribute to functional decline over a year's time in elderly individuals. Methods The data of 1,886 individuals between ages 65 and 85 years in a prospective, observational population-based study with 12-18 months of follow-up in the context of the European Project on Osteoarthritis were analyzed. The outcome measures were self-reported hand and hip/knee functional decline, evaluated using a minimum clinically important difference of 4 on the Australian/Canadian Hand OA Index and of 2 on the Western Ontario and McMaster Universities Osteoarthritis Index hip/knee physical function subscales, both normalized to 0-100. Using regression models adjusted for sex, age, country, and education level, the baseline factors considered were clinical hand or hip/knee OA, pain, analgesic/antiinflammatory medications, comorbidities, social isolation, income, walking time, grip strength, physical activity time, and medical/social care. Results After a year, 453 participants were identified as having worse hand functionality and 1,389 as not worse. Hand OA, anxiety, walking time, and grip strength were risk factors for hand functional decline; pain was a confounder of the effect of hand OA. Analgesic/antiinflammatory medications mediated the combined effect of hip/knee OA plus pain on functional decline in the 554 individuals classified as having worse hip/knee functionality and the 1,291 persons who were not worse. Peripheral artery disease, obesity, and cognitive impairment were other baseline risk factors. Conclusion Study findings showed that together with emotional status and chronic physical and cognitive conditions, OA affects hand and hip/knee functional decline

Factors associated with functional decline in hand and hip/knee osteoarthritis after a year’s time: data from the eposa study

Objective: the study investigated factors that together with hand or hip/knee osteoarthritis (OA) could contribute to functional decline over a year’s time in elderly individuals.Methods: the data of 1,886 individuals between the ages of 65‐85 in a prospective, observational population‐based study with 12‐18 month follow‐up in the context of the European Project on OSteoArthritis were analyzed. The outcome measures were self‐reported hand and hip/knee functional decline evaluated using a Minimal Clinically Important Difference of 4 on the AUStralian/CANadian hand OA Index and of 2 on the Western Ontario and McMaster Universities hip/knee OA physical function subscales, both normalized to 0‐100. Using regression models adjusted for sex, age, country, and education level, the baseline factors considered were: clinical hand or hip/knee OA, pain, analgesic/anti‐inflammatory medications, comorbidities, social isolation, income, walking time, grip strength, physical activity time, and medical/social care.Results: after a year, 453 participants were identified as having “worse” hand functionality and 1,389 as “not worse”. Hand OA, anxiety, walking time and grip strength were risk factors for hand functional decline; pain was a confounder of the effect of hand OA.Analgesic/anti‐inflammatory medications mediated the combined effect of hip/knee OA+pain on functional decline in the 554 individuals classified as having “worse” hip/knee functionality and the 1,291 “not worse” persons. Peripheral artery disease, obesity, and cognitive impairment were other baseline risk factors.Conclusion: study findings showed that together with emotional status, chronic physical and cognitive conditions, OA affects hand and hip/knee functional decline.<br/

Role of Osteoarthritis, Comorbidity, and Pain in Determining Functional Limitations in Older Populations: European Project on Osteoarthritis

OBJECTIVE: To evaluate the role of comorbidity and pain in the association between hip/knee osteoarthritis (OA) with self-reported as well as performance-based functional limitations in a general elderly population. METHODS: We analyzed the data of 2,942 individuals, ages between 65 and 85 years, who participated in the European Project on Osteoarthritis, which was made up of 6 European cohorts (from Germany, Italy, The Netherlands, Spain, Sweden, and the UK). Outcomes included self-reported physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the participants' performance-based physical function was evaluated using the walking test. RESULTS: While comorbidity did not affect the significant association between hip/knee OA and physical function limitations found in the participants, pain reduced the effect of OA on self-reported physical function, and it cancelled the effect of OA on the walking test. Obesity, anxiety, depression, and cardiovascular diseases were associated with the worst WOMAC scores. Obesity, cognitive impairment, depression, peripheral artery disease, and stroke were associated with the worst walking times. CONCLUSION: These findings demonstrate that while comorbidity is strongly and independently associated with functional limitations, it does not affect the OA-physical function association. Hip/knee OA is associated with self-reported impairment in physical function, which was only partially mediated by pain. Its association with physical function, as evaluated by the walking test, was instead completely mediated by pain

Factors associated with functional decline in hand and hip/knee osteoarthritis after a year’s time: Data from the eposa study

Objective To investigate factors that together with hand or hip/knee osteoarthritis (OA) could contribute to functional decline over a year's time in elderly individuals. Methods The data of 1,886 individuals between ages 65 and 85 years in a prospective, observational population-based study with 12-18 months of follow-up in the context of the European Project on Osteoarthritis were analyzed. The outcome measures were self-reported hand and hip/knee functional decline, evaluated using a minimum clinically important difference of 4 on the Australian/Canadian Hand OA Index and of 2 on the Western Ontario and McMaster Universities Osteoarthritis Index hip/knee physical function subscales, both normalized to 0-100. Using regression models adjusted for sex, age, country, and education level, the baseline factors considered were clinical hand or hip/knee OA, pain, analgesic/antiinflammatory medications, comorbidities, social isolation, income, walking time, grip strength, physical activity time, and medical/social care. Results After a year, 453 participants were identified as having worse hand functionality and 1,389 as not worse. Hand OA, anxiety, walking time, and grip strength were risk factors for hand functional decline; pain was a confounder of the effect of hand OA. Analgesic/antiinflammatory medications mediated the combined effect of hip/knee OA plus pain on functional decline in the 554 individuals classified as having worse hip/knee functionality and the 1,291 persons who were not worse. Peripheral artery disease, obesity, and cognitive impairment were other baseline risk factors. Conclusion Study findings showed that together with emotional status and chronic physical and cognitive conditions, OA affects hand and hip/knee functional decline