Long-term Outcomes of Knee OA in the OAI Cohort

OAI 队列中膝关节 OA 的长期结果

基本信息

批准号：
9977059
负责人：
REBECCA D JACKSON
金额：
$ 94.03万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9977059
关键词：
Address Aging Arthralgia Clinic Visits Clinical Clinical Course of Disease Cohort Studies Consequentialism Data Degenerative polyarthritis Development Disease Disease Progression Event Gait speed Goals Health Heterogeneity Image Intervention Investigation Knee Knee Injuries Knee Osteoarthritis Knowledge Leg Longitudinal Studies Longterm Follow-up Measures Mental Depression Musculoskeletal Natural History Obesity Observational Study Outcome Outcome Assessment Pain Participant Pathology Patients Performance Persons Phenotype Physical Performance Physical activity Population Prevention Prevention strategy Probability Psychosocial Factor Quality of life Research Personnel Risk Risk Factors Scientific Inquiry Severities Severity of illness Source Stratification Structure Symptoms Telephone Time clinically significant cohort comorbid depression comorbidity coping cost design disability effective therapy follow-up illness length improved outcome knee pain knee replacement arthroplasty minimal risk outcome forecast outcome prediction psychosocial public health relevance standardize measure

项目摘要

DESCRIPTION (provided by applicant): Knee osteoarthritis (OA) is a major cause of pain, functional limitation and disability and among the most costly musculoskeletal conditions. A burgeoning population with knee OA and poor clinical outcomes in the absence of effective treatments are key drivers of the soaring rates and costs of knee replacement. Knee OA pathology and clinical outcomes typically unfold over decades and have a highly varied time course. It is a priority to understand the range of factors that contribute to poor and good outcomes in knee OA, but there are critical gaps in knowledge about the long-term course of the disease and its determinants. It is sensible to target prevention and treatment on those most at risk for poor outcomes. However, there is a paucity of longitudinal studies long enough (≥10 years) with frequent assessment using standardized measures to capture the full trajectory, range and variability of outcomes and investigate their determinants. In addition, investigation of these questions is hampered by baseline heterogeneity in knee OA severity and impact, which can be a source of imprecision and bias in observational studies of disease prognosis. Started in 2002, the OAI is a unique cohort study of 4796 persons with or at risk for knee OA that has uniform, rich clinical and imaging data from annual assessments and has been followed comprehensively for up to 8 years with good retention. We now propose to continue assessment of outcomes of knee OA for up to 15 years after baseline, primarily by phone and mail, an efficient and less burdensome approach that will yield more complete follow-up than clinic visits alone in this aging cohort. A brief clinic visit in a subset of participants will enale us to study performance measures of function as a long-term outcome. Our goal is to take advantage of this unprecedented opportunity for long-term follow-up to describe the full trajectory and probability of outcomes at different stages of disease, to identify vulnerable and protected phenotypes in its long-term course and investigate potentially modifiable predictors of these outcomes. Outcomes will span a range of health domains, including: knee-OA related (pain, functional limitation and performance, OA global impact, knee replacement), disability/participation and general health. The extended follow-up provides the opportunity for an analysis design that reduces the risk of common sources of bias and imprecision in studies of disease prognosis by allowing the use of changes from baseline to year 4 to define "inception events," such as the transition to more advanced stages of knee pain or structural OA or the development of favorable and unfavorable trajectories of risk factors (knee OA-related, physical performance, general health and psychosocial variables). These changes will then be evaluated for their association with subsequent outcomes occurring from year 5 to year 15 in analyses conditioned on a range of baseline knee OA-related and other covariates with a minimal risk of collider stratification bias. Using this approach we will investigate questions that can inform emerging strategies for prevention and treatment that are focused on improving outcomes in persons with knee OA. These include describing the probabilities of both poor and good long-term outcomes at different stages of knee pain and structural OA, comparing outcomes in those with recent transitions to more advanced stages with those whose course has been stable, and identifying the modifiable determinants of long-term outcomes at different stages of disease and whether these differ by stage, thus suggesting the need for tailored interventions to improve outcomes.

描述（由申请人提供）：膝骨关节炎 (OA) 是导致疼痛、功能受限和残疾的主要原因，也是最昂贵的肌肉骨骼疾病之一。膝骨关节炎患者数量不断增加，且在缺乏有效治疗的情况下临床结果不佳是关键驱动因素。膝关节置换术的发病率和费用不断飙升，膝关节骨关节炎的病理学和临床结果通常会持续数十年，并且时间进程变化很大，因此优先了解导致不良和良好结果的一系列因素。膝骨关节炎，但对疾病的长期病程及其决定因素的认识存在重大差距，针对那些最有不良结果风险的人进行预防和治疗是明智的。足够长的时间（≥10年），并使用标准化措施进行频繁评估，以捕获结果的完整轨迹、范围和变异性，并调查其决定因素。这些问题受到膝关节 OA 严重程度和影响的基线异质性的阻碍，这可能是疾病预后观察性研究不精确和偏差的根源。OAI 于 2002 年开始，是一项针对 4796 名膝关节患者或有膝关节风险患者的独特队列研究。 OA 具有统一、丰富的年度评估临床和影像数据，并已全面随访长达 8 年且保留良好。我们现在建议继续评估膝关节 OA 的结果长达 15 年。基线后数年，主要通过电话和邮件，这是一种有效且负担较轻的方法，与仅在这一老龄群体中进行临床访问相比，对一部分参与者进行简短的临床访问将使我们能够研究绩效指标。我们的目标是利用这一前所未有的长期随访机会来描述疾病不同阶段结果的完整轨迹和概率，以确定其长期的脆弱和受保护的表型。学期课程并调查这些结果的潜在可修改预测因素。结果将涵盖一系列健康领域，包括：膝关节骨关节炎相关（疼痛、功能限制和表现、骨关节炎全球影响、膝关节置换）、残疾/参与和一般健康状况。延长的随访为分析设计提供了机会。通过允许使用从基线到第 4 年的变化来定义“起始事件”，例如过渡到膝盖疼痛或结构性 OA 的更高级阶段或发展有利和然后，将在以一系列基线膝关节骨关节炎为条件的分析中，评估这些变化与第 5 年至第 15 年发生的后续结果的关联。使用这种方法，我们将研究一些问题，这些问题可以为新的预防和治疗策略提供信息，这些策略的重点是改善膝关节骨关节炎患者的预后。在膝关节疼痛和结构性 OA 的不同阶段，长期结果不佳和良好的概率，将最近过渡到更高级阶段的患者的结果与病程稳定的患者的结果进行比较，并确定长期结果的可修改决定因素疾病的不同阶段以及这些阶段是否有所不同，因此表明需要采取量身定制的干预措施来改善结果。