Short‐Term Recovery Trajectories of Acute Flares in Knee Pain: A UK‐Netherlands Multicenter Prospective Cohort Analysis

Abstract

Objective. To identify distinct recovery trajectories of acute flares of knee pain and associated participant characteristics. Methods. Data were from the FLARE randomized controlled trial, a multicenter trial in 27 primary care centers in the UK and Netherlands of 3 regimes of oral nonsteroidal antiinflammatory therapy for acute flares of knee pain. Individuals with a history of inflammatory/crystal arthritis, fibromyalgia, and chronic pain syndrome were excluded. Latent class growth analysis was applied to measures of pain intensity repeated over 5 days to identify distinct recovery trajectories. The concurrent courses of interference with activity, stiffness, and swelling for each trajectory group were modelled using generalized estimating equations. Participant age, sex, obesity, and osteoarthritis diagnosis were described for each trajectory group. Results. A total of 449 participants were included (median age 55 years, 41% female, 35% obese, and 42% diagnosed with osteoarthritis). A 6-group cubic model was deemed optimal, with trajectories distinguished by rate of pain reduction and absolute level at final measurement. At the extremes were rapid and near-complete resolution (n = 41, 9%) and persistent, high pain (n = 25, 6%), but most participants showed a reduction and plateau in pain severity within 3-5 days. Within each pain trajectory group, interference with activity, stiffness, and swelling followed the same course as pain. Baseline characteristics did not differ substantially between trajectory groups. Conclusion. Even under a well-adhered to regime of oral nonsteroidal antiinflammatory medication, recovery following acute flares of knee pain is heterogeneous. Our observations that favorable trajectories are apparent within 3-5 days can help to inform treatment decision-making in the patient-health care professional consultation.

Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults

“…Further research is needed to confirm whether the cumulative frequency of flare episodes drives OA etiopathogenesis 43 . Our observed median 5-day flare duration, is broadly consistent with previous estimates 35 , 44 . The nature of trigger exposures and the duration of flare episodes are important insights for patient-healthcare professional consultations, particularly as our data suggest flares appear more common among working age adults.…”

The Flare-OA-16 questionnaire measuring flare in knee and hip osteoarthritis in the patient perspective: scale reduction and validation using a Rasch model

“…Results found in the validation sample effectively validated the decisions adopted with the derivation sample. When comparing our results to other studies, we found theoretical consistency in endorsed dimensions related to are in OA(8, 16), and methodological coherence in using self-report questionnaire, which proved useful for measuring the construct (4,24).…”

“…In step 7, local dependency between items was detected when a residual correlation was 0.2 point above the average of all items residual correlations (24). Local dependency was solved by combining items modalities into a super-item, a solution which involved a sum of the dependent items also called "subtest" (21).…”

“…Item suppression attempts negatively affected the overall t of the pain dimension, which con rm the importance of both items to measure the construct. Situations such as this are not uncommon in the literature of clinical instrument validation, which applied the Rasch model (15,19,24) because pairs of symptoms may be expected in clinical practice. For Questionnaire Flare-OA-16 a super item was created for score calculation in order to solve this.…”

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