Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis

Leena Sharma, Chian K Kwoh, Jungwha Lee, Jane Cauley, Rebecca Jackson, Marc Hochberg, Alison H. Chang, Charles Eaton, Michael Nevitt, Jing Song, Orit Almagor, Joan S. Chmiel

Research output: Contribution to journalArticle

Abstract

Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

Original languageEnglish (US)
JournalAnnals of the Rheumatic Diseases
DOIs
StatePublished - Jan 1 2019

Fingerprint

Knee Osteoarthritis
Trees (mathematics)
Osteoarthritis
Walking Speed
Gait
Area Under Curve
Aptitude
Sports
ROC Curve
Multicenter Studies
Logistics

Keywords

  • disability
  • functional impairment
  • knee osteoarthritis
  • osteoarthritis
  • prevention

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. / Sharma, Leena; Kwoh, Chian K; Lee, Jungwha; Cauley, Jane; Jackson, Rebecca; Hochberg, Marc; Chang, Alison H.; Eaton, Charles; Nevitt, Michael; Song, Jing; Almagor, Orit; Chmiel, Joan S.

In: Annals of the Rheumatic Diseases, 01.01.2019.

Research output: Contribution to journalArticle

Sharma, Leena ; Kwoh, Chian K ; Lee, Jungwha ; Cauley, Jane ; Jackson, Rebecca ; Hochberg, Marc ; Chang, Alison H. ; Eaton, Charles ; Nevitt, Michael ; Song, Jing ; Almagor, Orit ; Chmiel, Joan S. / Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. In: Annals of the Rheumatic Diseases. 2019.
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AU - Sharma, Leena

AU - Kwoh, Chian K

AU - Lee, Jungwha

AU - Cauley, Jane

AU - Jackson, Rebecca

AU - Hochberg, Marc

AU - Chang, Alison H.

AU - Eaton, Charles

AU - Nevitt, Michael

AU - Song, Jing

AU - Almagor, Orit

AU - Chmiel, Joan S.

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N2 - Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

AB - Objectives: Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods: Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results: 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%-29 % (derivation) and 2%-23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions: In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

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