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

Leena Sharma, Kent Kwoh, Jungwha Julia 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)
Pages (from-to)1412-1419
Number of pages8
JournalAnnals of the Rheumatic Diseases
Volume78
Issue number10
DOIs
StatePublished - Oct 1 2019

Keywords

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

ASJC Scopus subject areas

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

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  • Cite this

    Sharma, L., Kwoh, K., Lee, J. J., Cauley, J., Jackson, R., Hochberg, M., Chang, A. H., Eaton, C., Nevitt, M., Song, J., Almagor, O., & Chmiel, J. S. (2019). Development and validation of risk stratification trees for incident slow gait speed in persons at high risk for knee osteoarthritis. Annals of the Rheumatic Diseases, 78(10), 1412-1419. https://doi.org/10.1136/annrheumdis-2019-215353