Background & Aims
Individuals with knee osteoarthritis often experience worsening pain with movement, a determining factor to pursue knee arthroplasty. Studies have highlighted the importance of evaluating pain with movement rather than focusing on pain at rest, as different underlying mechanisms may be involved.1-5 Multiple assessments capture pain with movement, most commonly relying on patient recall of past movement-evoked pain (MEP) or pain-related activity interference. Emerging evidence suggests evaluating MEP provides a more standardized measurement and improved understanding of the impact of pain on function.6 However, it is unclear whether recalled MEP with questionnaires is a different construct than performance-based MEP assessment, or if each have similar predictors.7-9 Thus, the aim of this study was to examine the relations between recalled and performance-based MEP, and their associations with quantitative sensory testing (QST) and other predictor variables.
Methods
The Acute to Chronic Pain Signatures (A2CPS) is a longitudinal, multi-site, observational study to identify candidate and novel biomarkers and biosignatures that predict development of or resilience to chronic pain 6 months after knee replacement or thoracotomy surgery. Baseline data from the knee replacement cohort were used. Performance-based MEP was assessed as maximum knee pain during a 5 Times Sit-to-Stand (5xSTS) and 10-meter walk test (10mwt) using a 0-10 numerical rating scale, using half or whole numbers. Both absolute and difference relative to resting pain were considered. Recalled MEP was evaluated using components of the pain interference scales from the Brief Pain Inventory (BPI) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Predictors included QST: temporal summation (TS), conditioned pain modulation (CPM) and pressure pain thresholds (PPTs); and self-report PROMIS and other validated surveys. Correlations and linear regression analyses were performed.
Results
603 participants (65.0±8.5yr; 231M, 364F, 8unknown) were included. Pain increased during 10mwt (0.7±1.4) and 5xSTS (1.8±1.9). Recalled MEP was scale specific: BPI interference ~5.1-5.5 out of 10, ±1.9; KOOS interference ~1.6-2.7 out of 4, ±1.0. Weak correlations occurred between 10mwt and 5xSTS MEP difference to the BPI (r=.11,p=.008; r=.22,p<.001) and KOOS (r=.10,p=.023; r=.13,p=.002) composite, but increased with absolute MEP (BPI: r=.47,p<.001, r=.44,p<.001; KOOS: r=.54,p<.001, r=.50,p<.001). Correlations among BPI and KOOS were moderate (r=.61,p<.001), 10mwt and 5xSTS MEP difference were weak (p=.28,p<.001) and strong (r=.71,p<.001) for absolute. Multiple regression indicated unique variables predicted each MEP measure: 10mwt (TS, CPM, PROMIS physical function (PF)); 5xSTS (PF, emotional support, cognitive impairment, catastrophizing); BPI (PF, PainDETECT, fear avoidance beliefs, CPM, symptom severity, cognitive impairment); KOOS (PF, PainDETECT, catastrophizing, resilience).
Conclusions
Recalled and performance-based MEP are weakly related to each other and exhibit distinct predictors, suggesting they represent distinct constructs in individuals undergoing knee replacement. However, the PROMIS PF score was a significant factor for each MEP variable, suggesting it is a common factor amongst each aspect of MEP. Notably correlations within recalled-based measures were moderate and weak-to-strong for performance-based measures, suggesting similar information is captured despite the different assessments used within each domain. Measures of recalled interference and performance-based MEP may each provide important insights to the pain experience, however, may be capturing unique dimensions of pain with movement. Further research is necessary to determine the unique roles each may play in the pain experience, the validity and reliability of each measure, and sensitivity to change with treatment.
References
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Presenting Author
Giovanni Berardi
Poster Authors
Giovanni Berardi
DPT, PhD
University of Iowa
Lead Author
Laura Frey Law
The University of Iowa
Lead Author
Dana Dailey
University of Iowa
Lead Author
Carol Vance
University of Iowa
Lead Author
John Burns
PhD
Rush University
Lead Author
Robert J McCarthy
Pharm D
Rush University
Lead Author
Michael Charters
MD
Henry Ford Health System
Lead Author
Andrew Urquhart
MD
University of Michigan
Lead Author
Elizabeth Dailey
MD
University of Michigan
Lead Author
Martin Lindquist
PhD
Johns Hopkins University
Lead Author
Briha Ansari
MPH
Johns Hopkins
Lead Author
Kathleen Sluka
PT
University of Iowa, Carver College of Medicine
Lead Author
Giovanni Berardi
DPT
The University of Iowa
Lead Author
Topics
- Assessment and Diagnosis