Observational studyArthritis care & research2015
Toward a clinical definition of early osteoarthritis: onset of patient-reported knee pain begins on stairs. Data from the osteoarthritis initiative.
Observational study in Arthritis care & research, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 1 synthesis or guideline pooled it, 107 citations in OpenAlex.
- Identification of pain categories associated with change in pain in patients receiving placebo: data from two phase 3 randomized clinical trials in symptomatic knee osteoarthritis.BMC musculoskeletal disorders · 2018Pooled it
- Toward personalizing prosthesis prescription: A take-home study of three microprocessor-controlled prosthetic knees: A randomized crossover study.PM & R : the journal of injury, function, and rehabilitation · 2026Trial
- Lower limb kinematics improvement after genicular nerve blockade in patients with knee osteoarthritis: a milestone study using inertial sensors.BMC musculoskeletal disorders · 2020Trial
- Development and validation of a simple nomogram for predicting knee osteoarthritis using movement evoked pain in a community setting.Scientific reports · 2026Article
- Multimodal magnetic resonance imaging of the vastus medialis for quantitative diagnosis and grading in early-stage knee osteoarthritis and its correlation with severity.Scientific reports · 2026Article
- Associations of quadriceps activation during step-up with pain during movement and physical function in people with knee osteoarthritis.Clinical biomechanics (Bristol, Avon) · 2025Article
- Prefrontal cortex activation during daily movements and its association with clinical symptoms in knee osteoarthritis.Osteoarthritis and cartilage open · 2025Article
- Article
- Whole-body angular momentum during stair ascent and descent in individuals with and without knee osteoarthritis.Scientific reports · 2024Article
- Associations amongst dynamic knee stiffness during gait, quadriceps stiffness, and the incidence of knee osteoarthritis over 24 months: a cohort study with a mediation analysis.BMC musculoskeletal disorders · 2024Article
- Balance Control is Sequentially Correlated with Proprioception, Joint Range of Motion, Strength, Pain, and Plantar Tactile Sensation Among Older Adults with Knee Osteoarthritis.Sports medicine - open · 2024Article
- The Association of Stair Climbing Behaviors With Hazard of All-Cause Mortality in Adults With or At Risk of Knee Osteoarthritis.The Journal of rheumatology · 2024Article
- Article
- Bilateral Asymmetry in Knee and Hip Musculoskeletal Loading During Stair Ascending/Descending in Individuals with Unilateral Mild-to-Moderate Medial Knee Osteoarthritis.Annals of biomedical engineering · 2023Article
- Reflections from the OARSI 2022 clinical trials symposium: The pain of OA-Deconstruction of pain and patient-reported outcome measures for the benefit of patients and clinical trial design.Osteoarthritis and cartilage · 2023Review
- Passive stiffness of the quadriceps predicts the incidence of clinical knee osteoarthritis in twelve months.European journal of physical and rehabilitation medicine · 2023Article
- Early Osteoarthritis Questionnaire (EOAQ): a tool to assess knee osteoarthritis at initial stage.Therapeutic advances in musculoskeletal disease · 2023Article
- Validity of the Osteoarthritis Research Society International (OARSI) recommended performance-based tests of physical function in individuals with symptomatic Kellgren and Lawrence grade 0-2 knee osteoarthritis.BMC musculoskeletal disorders · 2022Article
- Experiences of Health-Promoting Activities among Individuals with Knee Pain: The Halland Osteoarthritis Cohort.International journal of environmental research and public health · 2022Article
- Effectiveness and safety of aromatherapy massage for knee osteoarthritis: A protocol for systematic review and meta-analysis.Medicine · 2022Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveEarly detection of osteoarthritis (OA) would increase the chances of effective intervention. We aimed to investigate which patient-reported activity is first associated with knee pain. We hypothesized that pain would occur first during activities requiring weight bearing and knee bending.
methodsData were obtained from the Osteoarthritis Initiative (OAI), a multicenter, longitudinal prospective observational cohort of people who have or are at high risk of OA. Participants completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; Likert scale) annually for up to 7 years. Rasch analysis was used to rank the WOMAC pain questions (activities) in order of affirmation as the pain score increased from 0. For each total WOMAC score category (0-20) we selected 25 individuals at random based on their maximum score across all visits. Fit to the Rasch model was assessed in this subset; stability of question ranking over successive visits was confirmed in the full OAI.
resultsWOMAC data on 4,673 people were included, with 491 selected for subset analysis. The subset data showed good fit to the Rasch model (χ(2) = 43.31, P = 0.332). In the full OAI, the "using stairs" question was the first to score points as the total pain score increased from 0 (baseline logit score ± 95% confidence interval -4.74 ± 0.07), then "walking" (-2.94 ± 0.07), "standing" (-2.65 ± 0.07), "lying/sitting" (-2.00 ± 0.08), and finally "in bed" (-1.32 ± 0.09). This ordering was consistent over successive visits.
conclusionKnee pain is most likely to first appear during weight-bearing activities involving bending of the knee, such as using stairs. First appearance of this symptom may identify a group suitable for early intervention strategies.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.