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Discordance between self-reported and performance-based physical function in patients who have knee osteoarthritis: Associations with pain intensity and negative affect
Journal article   Peer reviewed

Discordance between self-reported and performance-based physical function in patients who have knee osteoarthritis: Associations with pain intensity and negative affect

Yong-Hao Pua, Bryan Yijia Tan, Juanita Low, Ee-Lin Woon, Seng-Jin Yeo, Ross Allan Clark, Janet Prvu Bettger, Michelle Jessica Pereira, Chun-Yue Tan and Julian Thumboo
Journal of Arthroplasty, Vol.38(9), pp.1705-1713
2023
DOI: https://doi.org/10.1016/j.arth.2023.03.044
PMID: 36940758
url
https://doi.org/10.1016/j.arth.2023.03.044View
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Abstract

Knee Pain PROM Discordance Osteoarthritis Physical function
Objective: Although self-reported measures (SRM) of physical disability are strong indication criterion for total knee arthroplasty (TKA) in painful knee osteoarthritis (OA), some patients may report greater-than-observed disability. Contributing factors to this discordance are relatively unexplored. We aimed to examine whether pain and negative affect, including anxiety and depression, were associated with discordance of SRM with performance-based measures (PPM) of physical function. Methods: We used cross-sectional data (n=212) from 2 randomized rehabilitation trials in knee OA. All patients were assessed for knee pain intensity and symptoms of anxiety and depression. Self-reported function was assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical-function subscale. Objective performance-based measures (PPMs) of physical function were assessed by timed gait and stair tests. Continuous discordance scores were quantified by difference in percentiles between WOMAC and PPMs (WOMAC-PPM), where a positive discordance, WOMAC-PPM > 0, implied greater perceived than observed disability. Results: Around 1 in 4 patients had > 20 percentile units in WOMAC-PPM discordance. In Bayesian regression analyses, knee pain intensity had >99% posterior probability of positive associations with WOMAC-PPM discordance. Among patients awaiting TKA, anxiety intensity had approximately 99% probability of positive associations with discordance, and these associations had >65% probability of exceeding 10 percentile units. In contrast, depression had low (79 to 88%) probability of any association with discordance. Conclusions: In patients who have knee OA, a sizable proportion reported substantially greater physical disability than actually observed. Pain and anxiety intensity, but not depression, were meaningful predictors of this discordance. If validated, our findings may help in refining patient selection criteria for TKA.

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