Testtheoretische Überprüfung der deutschen Version des Intermittent and Constant Osteoarthritis Pain Score (ICOAP) – ein Fragebogen zur Schmerzerfassung bei Patienten mit Gonarthrose

Less pain reported 5 years after cementless compared to cemented unicompartmental knee replacement: an analysis of pain, neuropathy, and co-morbidity scores

PURPOSE

To compare patient-reported pain scores and assess the influence of neuropathy and co-morbidity, on knee pain following cemented and cementless medial unicompartmental knee replacement (UKR) 5 years after surgery.

METHOD

In this longitudinal study, 262 cemented and 262 cementless Oxford UKR performed for the same indications and with the same techniques were recruited. Patients were reviewed at five years, evaluating patient-reported pain and association with clinical outcomes. Intermittent and Constant Osteoarthritis Pain (ICOAP), PainDETECT (PD), Charnley score, Oxford Knee Score (OKS) and American Knee Society Score (AKSS) were compared.

RESULTS

In both cohorts, intermittent pain was more common than constant pain (47% vs 21%). Cementless knees reported significantly less pain than cemented (ICOAP-Total 5/100 vs 11/100, p < 0.0001). A greater proportion of cementless knees experienced no pain at all (ICOAP = 0/100, 61% vs 43%, p < 0.0001) and 75% fewer experienced severe or extreme pain. Pain sub-scores in PD, OKS and AKSS follow this trend. Pain was unlikely to be neuropathic (PD positive: 5.26%), but patients reporting high levels of 'strongest' pain were three times more likely to be neuropathic. Patients with co-morbidities (Charnley C) experienced greater pain than those without (Charnley A+B) across all knee-specific scores, despite scores being knee specific.

CONCLUSION

Both cemented and cementless UKR in this study had substantially less pain than that reported in literature following TKR. Cementless UKR had significantly less pain than cemented UKR in all scores. Two-thirds of patients with a cementless UKR had no pain at all at 5 years, and pain experienced was most likely to be mild and intermittent with no patients in severe or extreme pain. Patients with cementless UKR that had higher levels of pain were more likely to have co-morbidity or evidence or neuropathic pain. It is unclear why cementless UKR have less pain than cemented; further study is necessary.

rain connectivity-guided, Optimised theta burst transcranial magnetic stimulation to improve Central Pain Modulation in knee Osteoarthritis Pain (BoostCPM): protocol of a pilot randomised clinical trial in a secondary care setting in the UK

INTRODUCTION

Chronic pain is a common health problem that is not efficiently managed by standard analgesic treatments. There is evidence that treatment resistance may result from maladaptive brain changes in areas that are fundamental to the perception of pain. Knee osteoarthritis is one of the most prevalent causes of chronic pain and commonly associated with negative affect. Chronic knee osteoarthritis pain is also associated with altered right anterior insula functional connectivity. We posit that reversal of these brain circuit alterations may be critical to alleviate chronic pain and associated negative affect, and that this can be achieved through non-invasive neuromodulation techniques. Despite growing interest in non-invasive neuromodulation for pain relief and proven efficacy in depression, results in chronic pain are mixed with limited high-quality evidence for clinical and mechanistic efficacy. Limitations include patient heterogeneity, imprecision of target selection, uncertain blinding and protocols that may deliver pulses at subclinical efficacy.

METHODS AND ANALYSIS

We hence developed an optimised treatment protocol of connectivity-guided intermittent theta-burst stimulation (iTBS) targeting the left dorsolateral prefrontal cortex with accelerated delivery on four consecutive days (allowing 4 days within the same week as protocol variation) with five daily treatment sessions that will be piloted in a sham-controlled design in 45 participants with chronic knee pain. This pilot study protocol will assess feasibility, tolerability and explore mechanistic efficacy through serial functional/structural magnetic resonance imaging (MRI) and quantitative sensory testing.

ETHICS AND DISSEMINATION

This pilot trial has been approved by the Ethics Committee Cornwall and Plymouth.Results of the pilot trial will be submitted to peer-reviewed journals, presented at research conferences and may be shared with participants and PPI/E advisors.

TRIAL REGISTRATION NUMBER

ISRCTN15404076.

Identifying multiple knee pain trajectories and the prediction of opioid and NSAID medication used: A latent class growth approach

BACKGROUND

Knee pain is a major source of distress and disability, with pain progression highly variable between individuals. Previous studies defining pain trajectories have all used a single measure of pain, and these differ across studies. Different measures reflect diverse pain mechanisms. To ascertain the clinical utility of pain trajectories, we explored associations between opioid and non-steroidal anti-inflammatory drug (NSAID) use.

METHODS

We model pain trajectories using two measures-Intermittent and Constant Osteoarthritis Pain (ICOAP) and the painDETECT, in 2141 participants, across 3 waves (the baseline, 1- and 3-year assessments) of the Knee Pain In the Community (KPIC) cohort.

RESULTS

Latent class growth analysis identified six trajectories using ICOAP subscales (High-Stable, Low-Stable, Moderate Worsening, Moderate Recovering, Worsening, and Recovering) and four trajectories using painDETECT (High-stable, Low-stable, Moderate Worsening, and Moderate Recovering). There was a high degree of correspondence between people assigned to pain trajectories between ICOAP intermittent and constant subscales, but less so using painDETECT. Opioid use was associated with ICOAP trajectories only (e.g., High-Stable and Worsening intermittent ICOAP trajectories) and in women.

CONCLUSION

Different measures of pain produce different patterns of pain progression and these are differentially related to medication use. Opioid use is linked to trajectories of pain based on the impact of pain on behavior and not pain symptoms. Thus, managing pain's behavioral impact is more central to understanding opioid use than managing pain symptoms. These findings support more in-depth questioning about the type of pain and its progression in clinical practice.

Can pain flares in knee osteoarthritis be predicted?

Objectives: This study examined whether risk factors for knee osteoarthritis (KOA) pain such as age, gender, body mass index (BMI), baseline pain, and other putative risk factors for knee osteoarthritis pain flares (KOAF) (e.g. knee buckling, injury, mood/stress/social support scores, and footwear) could predict KOAF.Method: People with KOA and previous history of KOAF were selected from a 3 month web-based longitudinal study. KOAF was defined as an increase of ≥ 2 points on a numeric rating scale (compared with background pain) which resolved within 20 days. Predictors assessed at baseline were gender, age, duration of KOA, BMI, pain, knee injury (7 days before), knee buckling (2 days before), Lubben Social Support, Knee Injury and Osteoarthritis Outcome Score, Intermittent and Constant Osteoarthritis Pain score (ICOAP), Positive/Negative Affect Score, and footwear stability/heel height. Outcome was occurrence of any KOAF during the ensuing 30 days. The combined ability of the above variables to predict occurrence of any KOAF was evaluated by multiple logistic regression with a 10-fold cross-validation method to build and internally validate the model. Variables that assessed similar domains were eliminated using receiver operating characteristics curve assessment for best fit.Results: Complete data were available for 313 people (66.6% female, mean ± sd age 62.3 ± 8.2 years, BMI 29.7 ± 6.5 kg/m²). Increasing age, years of osteoarthritis, BMI, background/worst levels of pain, knee injury, knee buckling, ICOAP, and footwear category/heel height significantly predicted the occurrence of KOAF during the following 30 days, with an area under the curve of 0.73 (95% confidence interval 0.67-0.80).Conclusion: A combination of risk factors assessed at baseline, including exposures with potential to vary, successfully predicts the KOAF in the ensuing 30 days.

Effect of liraglutide on body weight and pain in patients with overweight and knee osteoarthritis: protocol for a randomised, double-blind, placebo-controlled, parallel-group, single-centre trial

INTRODUCTION

With an increasing prevalence of citizens of older age and with overweight, the health issues related to knee osteoarthritis (OA) will intensify. Weight loss is considered a primary management strategy in patients with concomitant overweight and knee OA. However, there are no widely available and feasible methods to sustain weight loss in patients with overweight and knee OA. The present protocol describes a randomised controlled trial evaluating the efficacy and safety of the glucagon-like peptide-1 receptor agonist liraglutide in a 3 mg/day dosing in patients with overweight and knee OA.

METHODS AND ANALYSIS

150 volunteer adult patients with overweight or obesity and knee OA will participate in a randomised, double-blind, placebo-controlled, parallel-group and single-centre trial. The participants will partake in a run-in diet intervention phase (week -8 to 0) including a low calorie diet and dietetic counselling. At week 0, patients will be randomised to either liraglutide 3 mg/day or liraglutide placebo 3 mg/day for 52 weeks as an add-on to dietetic guidance on re-introducing regular foods and a focus on continued motivation to engage in a healthy lifestyle. The co-primary outcomes are changes in body weight and the Knee Injury and Osteoarthritis Outcome Score pain subscale from week 0 to week 52.

ETHICS AND DISSEMINATION

The trial has been approved by the regional ethics committee in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. An external monitoring committee (The Good Clinical Practice Unit at Copenhagen University Hospitals) will oversee the trial. The results will be presented at international scientific meetings and through publications in peer-reviewed journals.

TRIAL REGISTRATION NUMBERS

2015-005163-16, NCT02905864, U1111-1171-4970 BASED ON PROTOCOL VERSION: V.6; 30 January 2017, 15:30 hours.

Translation, cross-cultural adaptation and validation of the traditional Chinese intermittent and constant osteoarthritis pain (ICOAP) questionnaire for knee osteoarthritis

OBJECTIVES

To translate and culturally adapt the Intermittent and Constant Osteoarthritis and Pain (ICOAP) measure to a traditional Chinese version, and to study its psychometric properties in patients with knee osteoarthritis (KOA).

METHOD

The ICOAP was translated and cross-culturally adapted into traditional Chinese according to the recommended international guidelines. A total of 110 participants with KOA in Hong Kong were invited to complete the traditional Chinese ICOAP (tChICOAP), the Chinese Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and the Chinese Short form of Health Survey (SF-12v2). Psychometric evaluations included content validity, construct validity, internal consistency and test and retest reliability.

RESULTS

All participants completed the tChICOAP questionnaire without missing items. The content validity index of all items ranged from 80% to 100%. The tChICOAP total pain and subscale scores had excellent internal consistency with Cronbach's alpha value (0.902-0.948) and good corrected item-total subscale correlations. It had high test and retest reliability (intra-class correlations 0.924-0.960). The tChICOAP constant, intermittent and total pain scores correlate strongly with the WOMAC pain subscale (r=0.671, 0.678 and 0.707, respectively, p<0.001). The tChICOAP intermittent and total scores correlate strongly with SF-12v2 physical component score (r=-0.590 and -0.558, respectively, p<0.001).

CONCLUSIONS

The tChICOAP is a reliable and valid instrument to measure the pain experience of Chinese patients with KOA.

Relationships between fatty infiltration in the thigh and calf in women with knee osteoarthritis

BACKGROUND

In individuals with knee osteoarthritis (OA), fatty infiltration into thigh muscle is associated with poor physical performance and strength. However, it is not known whether this also occurs in the calf and if this impacts physical function.

AIMS

We investigated the relationships between volumes of intramuscular fat (intraMF), intermuscular fat (IMF), subcutaneous fat (SCF), lean muscle and muscle adiposity, in the thighs compared to the calves of women with knee OA.

METHODS

MRI scans of the thigh and calf were acquired from 20 women over 55 years with knee OA (3.0T Discovery MR750, GE Healthcare). Axial IDEAL (iterative decomposition of water and fat with echo asymmetry and least-squares estimation) fat-separated images were segmented to quantify intraMF, IMF, SCF and lean muscle volumes (SliceOmatic 5.0, Tomovision). Correlation and linear regression analyses were run.

RESULTS

We found a positive relationship between thigh and calf intraMF (R ² = 0.592; B = 5.49; p = 0.001), muscle adiposity (R ² = 0.539; B = 0.567; p = 0.001), and SCF volume (R ² = 0.699; B = 12.847; p = 0.001), controlling for waist-to-hip ratio. Relationships between thigh and calf IMF (R ² = 0.239; B = 7.743; p = 0.061), lean muscle (R ² = 0.245; B = 4.149; p = 0.047) and combined intraMF and IMF volume (R ² = 0.242; B = 6.162; p = 0.044) were not significant.

DISCUSSION

Although a correlation exists between thigh and calf muscle adiposity, intraMF and SCF, this does not hold true for IMF or lean muscle. A greater amount of intraMF infiltration occurs in the thigh compared to the calf of women with knee OA.

CONCLUSION

The calf and thigh may both be involved in pathologic changes in muscle composition in knee OA.

Transcultural adaptation and validation of the Chinese version of the intermittent and constant osteoarthritis pain (ICOAP) measure in patients with knee osteoarthritis

OBJECTIVE

This study aimed to translate and adapt the intermittent and constant osteoarthritis pain (ICOAP) measure into the Chinese language (ICOAP-C), and to study its psychometric properties in patients with knee osteoarthritis (OA).

DESIGN

The ICOAP was translated and cognitively pretested following internationally recommended guidelines. The reliability, including the internal consistency and the test-retest reliability, was then evaluated in 108 outpatients with knee OA. The validity was assessed by comparing the ICOAP-C with the Western Ontario and McMaster Universities Osteoarthritis Index Pain Subscale (WOMAC-PS), the Knee Injury and Osteoarthritis Outcome Score Pain Short-Form (KOOS-PS), and pain on a visual analogue scale (VAS). Seventy-four patients undergoing total knee arthroplasty (TKA) participated in the evaluation of the responsiveness of the ICOAP-C over a 6-month period.

RESULTS

All participants completed the questionnaires, and no floor or ceiling effects were found. All ICOAP-C scales exhibited satisfactory internal consistency. The intraclass correlation coefficients (ICCs) were excellent, i.e., 0.932 for "total pain", 0.908 for "intermittent pain" and 0.892 for "constant pain". Regarding the convergent validity, the ICOAP-C scores exhibited strong correlations with the WOMAC-PS and moderate correlations with the KOOS-PS and the VAS. The responsiveness of the ICOAP-C at 6 months after TKA was good [standardized response mean (SRM) range: 0.94-1.20; effect size (ES) range: 1.41-1.71].

CONCLUSIONS

The ICOAP-C exhibited good reliability, validity, and responsiveness. This scale is a reliable instrument for evaluating the pain experiences of patients with knee OA and is useful for outcome measurement in clinical research.

Lean muscle volume of the thigh has a stronger relationship with muscle power than muscle strength in women with knee osteoarthritis

BACKGROUND

Thigh lean muscle and intramuscular fat have been implicated in the impairment of physical function observed in people with knee osteoarthritis. We investigated the relationships of quadriceps and hamstrings intramuscular fat fraction and lean muscle volume with muscle power and strength, controlling for neuromuscular activation, and physical performance in women with knee OA.

METHODS

Women (n=20) 55years or older with symptomatic, radiographic knee osteoarthritis underwent a 3.0T magnetic resonance imaging scan of the thigh of their most symptomatic knee. Axial fat-separated images were analyzed using software to quantify intramuscular fat and lean muscle volumes of the quadriceps and hamstrings. To quantify strength and power of the knee extensors and flexors, participants performed maximum voluntary isometric contraction and isotonic knee extensions and flexions, respectively. Electromyography of the quadriceps and hamstrings was measured. Participants also completed five physical performance tests.

FINDINGS

Quadriceps and hamstrings lean muscle volumes were related to isotonic knee extensor (B=0.624; p=0.017) and flexor (B=1.518; p=0.032) power, but not knee extensor (B=0.001; p=0.615) or flexor (B=0.001; p=0.564) isometric strength. Intramuscular fat fractions were not related to isotonic knee extensor or flexor power, nor isometric strength. No relationships were found between intramuscular fat or lean muscle volume and physical performance.

INTERPRETATION

Muscle power may be more sensitive than strength to lean muscle mass in women with knee osteoarthritis. Thigh lean muscle mass, but neither intramuscular nor intermuscular fat, is related to knee extensor and flexor power in women with knee osteoarthritis.

Cross-cultural adaptation and validation of the Persian version of the Intermittent and Constant Osteoarthritis Pain Measure for the knee

Objective:

The present study aimed to translate and evaluate the reliability and validity of the Persian version of the 11-item Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in Iranian subjects with Knee Osteoarthritis (KOA).

Materials and Methods:

The ICOAP questionnaire was translated according to the Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. The procedure consisted of forward and backward translation, as well as the assessment of the psychometric properties of the Persian version of the questionnaire. A sample of 230 subjects with KOA was asked to complete the Persian versions of ICOAP and Knee injury and Osteoarthritis Outcome Score (KOOS). The ICOAP was readministered to forty subjects five days after the first visit. Test–retest reliability was assessed using Intraclass Correlation Coefficient (ICC), and internal consistency was assessed by Cronbach's alpha and item-total correlation. The correlation between ICOAP and KOOS was determined using Spearman's correlation coefficient.

Result:

Subjects found the Persian-version of the ICOAP to be clear, simple, and unambiguous, confirming its face validity. Spearman correlations between ICOAP total and subscale scores with KOOS scores were between 0.5 and 0.7, confirming construct validity. Cronbach's alpha, used to assess internal consistency, was 0.89, 0.93, and 0.92 for constant pain, intermittent pain, and total pain scores, respectively. The ICC was 0.90 for constant pain and 0.91 for the intermittent pain and total pain score.

Conclusion:

The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA.

Intermittent and constant pain and physical function or performance in men and women with knee osteoarthritis: data from the osteoarthritis initiative

Severe constant and intermittent knee pain are associated with "unacceptable" symptoms in older adults with osteoarthritis (OA) [22]. We hypothesized that constant and intermittent pain would be independently related to physical function, with intermittent knee pain being a better predictor of future declines in physical function in early symptomatic knee OA. This study included men (n = 189) and women (n = 133) with radiographic, unilateral knee OA, observed using data from the Osteoarthritis Initiative (OAI). Pain types were measured using the Intermittent and Constant Osteoarthritis Pain (ICOAP) scale. Physical function was measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC-PF) and Knee Injury and Osteoarthritis Outcome Score (KOOS-FSR) and physical performance tests. High baseline intermittent (B = 0.277; p = 0.001) and constant (B = 0.252; p = 0.001) knee pain were related to poor WOMAC-PF. Increased constant (B = 0.484; p = 0.001) and intermittent (B = 0.104; p = 0.040) pain were related to 2-year decreased WOMAC-PF. High baseline intermittent knee pain predicted poor KOOS-FSR at year 2 (B = -0.357; p = 0.016). Increased constant pain was related to decreased chair stand test performance over 2 years in women (B = 0.077; p = 0.001). High baseline intermittent pain was related to poor performance on repeated chair stands (B = 0.035; p = 0.021), while baseline constant pain was related to poor 400-m walk performance in women (B = 0.636; p = 0.047). Intermittent and constant knee pain were independent factors in self-perceived physical function and were important predictors of future limitations in physical function. Identifying intermittent and constant pain in early symptomatic OA may allow patients to adopt strategies to prevent worsening pain and future declines in physical function.

Reliability and clinically important improvement thresholds for osteoarthritis pain and function scales: a multicenter study

OBJECTIVE

To assess the reliability and clinically meaningful thresholds of intermittent and constant osteoarthritis pain (ICOAP) score, the Knee injury and Osteoarthritis Outcome Score Physical function Short-form (KOOS-PS), the Hip disability and Osteoarthritis Outcome Score Physical function Short-form (HOOS-PS), and the Quality of life subscales of HOOS/KOOS (HOOS-QOL/KOOS-QOL) in patients with knee or hip arthritis.

METHODS

One hundred and ninety-five patients (141 knee, 54 hip) seen at 2 orthopedic outpatient clinics with a diagnosis of knee or hip OA completed patient-reported questionnaires (ICOAP pain scale, KOOS-PS, HOOS-PS, KOOS-QOL, HOOS-QOL) at baseline and 2-week followup. Reliability was assessed using intraclass correlation coefficients (ICC). We calculated minimum clinically important difference (MCID) and moderate improvement in the subgroup that reported change in the status of their affected joint.

RESULTS

The reliability as assessed by ICC was as follows: ICOAP pain scale, 0.63 (0.48, 0.74) in patients with knee arthritis, and 0.86 (0.73, 0.93) for hip arthritis; KOOS-PS, 0.66 (0.52, 0.77); HOOS-PS, 0.82 (0.66, 0.91); KOOS-QOL, 0.79 (0.69, 0.86); and HOOS-QOL, 0.67 (0.42, 0.83). MCID and moderate improvement estimates in patients with knee arthritis were ICOAP pain scale, 18.5 and 26.7; KOOS-PS, 2.2 and 15.0; and KOOS-QOL, 8.0 and 15.6. A smaller sample in patients with hip arthritis precluded MCID and moderate improvement estimates.

CONCLUSION

We found that ICOAP pain and KOOS-PS/HOOS-PS scales were reasonably reliable in patients with hip OA. Reliability of these scales was much lower in patients with knee arthritis. Thresholds for clinically meaningful change in pain or function on these scales were estimated for patients with knee arthritis.

Rasch analysis of the intermittent and constant osteoarthritis pain (ICOAP) scale

OBJECTIVES

The intermittent and constant osteoarthritis pain (ICOAP) questionnaire was developed to assess two forms of pain reported by people with osteoarthritis: intermittent and constant pain. Studies examining its measurement qualities have provided some support for its use as separate and total scales. However, it has not been previously evaluated using Rasch analysis. The current study examined the fit between data obtained from the ICOAP questionnaire and the Rasch model to determine whether it meets the requirements of interval-level measurement.

DESIGN

ICOAP responses from 175 participants with knee osteoarthritis were collected in a cross-sectional questionnaire study. Participants were recruited from hospital clinics and a group who had taken part in previous research. The questionnaires were completed at home and returned by pre-paid envelope and the data were analysed using RUMM2020.

RESULTS

Fit to the Rasch model was achieved for both the constant and intermittent subscales following removal of a small number of items. The Total scale initially resulted in substantial misfit to the model, but fit was improved by removing four items that misfit the model. However, several participants presented with high fit residuals, which is consistent with misfit.

CONCLUSIONS

The results support the use of Constant and Intermittent subscales as unidimensional measures of pain. The Total scale can be adapted to improve fit to the Rasch model, but there are concerns over participant misfit.