Background
Paper | Sample | Trajectories | Predictors |
---|---|---|---|
Arthritis | |||
Collins, Katz, Dervan Losina [5] | OAI cohort (osteoarthritis): LCGA with up to 4th order polynomial | 5 stable trajectories: severe pain (6%), high (17%) and low (32%) moderate pain, mild pain (35%), no pain (11%) (WOMAC) | Multivariate MLR, ref. no pain: female sex, depression, graded OA severity (moderate/severe +), obesity, non-white race (severe +), pre-college education (high mod./severe +) |
Barnabe et al. [9] | CATCH cohort (early rheumatoid arthritis): LCGA with cubic polynomial | 5 trajectories differing in baseline and speed of remission: high to medium (10%), low (19%) or remission (20%), medium to low (30%) or remission (21%) (DAS28) | Univariate analyses, Bonferroni corrected: age 50+, non-white, non-college education, unemployment, < $50K income, comorbidities, (non-remission trajectories +, High > Med/Low ++), symptom duration (mod. at baseline/High > Med+), DAS28, tender/swollen joints, ESR, CRP, physician, patient and pain score (High +), HAQ (high baseline and High > Med +) |
Bastick et al. [6] | CHECK cohort (assumed early OA hip respondents only): LCGA with up to quadratic polynomial | 4 trajectories: mild pain (42%), moderate decrease (17%), moderate progression (24%), severe pain (16%) (NRS) | Univariable and multivariable MLR, final model: pre-university education, use of pain transformation to cope, pain with internal hip rotation (progression/severe +), WOMAC physical function (all but mild +) |
Nicholls, Thomas, van der Windt, Croft and Peat [10] | CAS-K (knee OA risk group), replicated in OAI (OA cohort): LCGA (polynomial info. reported in appendix) | 5 in CAS-K: mild non-progressive (35%), progressive (28%), moderate (22%), improving (12%), severe non-improving (3%). 4 in OAI: mild, non-progressive (41%), moderate A (24%), B (19%) and C (11%), severe, non-improving (5%) (WOMAC pain) | Baseline CAS-K: differences reported on age, gender, BMI, IMD, employment, manual job, self-reported health, HADS, widespread pain, knee pain, WOMAC function, radiography, health care use inc. knee replacement |
Holla et al. [7] | CHECK cohort (early symptomatic OA, knee OA only): LCGA (no info. on polynomials reported) | 3 mostly stable trajectories differing in baseline and follow-up pain: good (47%), moderate (37%) and poor outcomes (16%) (WOMAC) | Uni/multivariate analyses, ref. good outcome: age, knee flexion range (poor –), BMI (mod. +), NRS, hip pain, comorbidity (mod./poor +), SF-36 vitality (mod./poor –), bony tenderness, osteophytosis, PCI resting (poor +) |
Verkleij et al. [8] | Previously reported RCT (hip OA study): LCGA, linear model only | 5 trajectories; three stable, two changing: mild (31%) or moderate pain (14%), alwaysin pain (14%) and regular (22%) or rapidly (19%) progressing (VAS) | Univariate MLR, ref. mild: low education, (mod./always +), BMI, morning hip stiffness, hip flexion (all bar mild +), KL, hip pain > 3 years (always/rapid +), generalised OA (always/regular prog. +), hip internal rotation (always +), back pain (all bar mild and reg prog.), trochanteric pain (all bar mild and rapid prog. +) |
Bastick et al. [11] | CHECK cohort (early symptomatic OA, knee only): LCGA up to cubic polynomials | 6 trajectories: constant mild (26%) or severe pain (10%), severe (5%) or moderate progression (24%), major (3%) or moderate regression (29%) (NRS) | Uni/multivariate MLR, ref. constant mild: BMI (mod. prog. and severe +), education (all bar ref. and severe –), comorbidity (severe cons. and prog. +), WOMAC physical (all bar sev., prog. and ref. +), knee joint space tenderness (prog. and mod. reg. +), painful knee flexion (maj. reg. –) |
Norton et al. [13] | ERAS cohort (early (< 2 years) RA), baseline, 6 months and annual to 10 years follow-up: GMM, MAR assumed | 4 trajectories: low (6%), moderate (28%) and high stable (20%), and moderate increasing (46%) (HAQ) | Univariate analyses: age, female, educational/economic disadvantage, unemployment, DAS/VAS/Larsen, comorbidity, mortality (track severity) |
Wesseling et al. [4] | CHECK cohort (symptomatic knee OA), 5 years follow-up: LCGA, quadratic added | 3 trajectories: marginal pain (31%), mild pain (42%) and moderate pain (26%) (with progression) (NRS, last week) | Univariate and multivariate LRs: BMI ≤ 25, subtertiary education, hip pain, comorbidities, PCI worrying and resting (marginal –) |
Norton et al. [12] | ERAS and NOAR cohorts (early RA and early inflammatory polyarthritis): LCGM, polynomials added | Both cohorts showed 4 J-shaped trajectories differing in baseline severity, low (21%), moderate (32%, 33%), high (30%, 26%) and severe (16%, 20%) (HAQ) | Age, % female gender, lower SES, DAS28 increase alongside severity |
Cancer | |||
Miaskowski et al. [14] | Sampled from breast care centres, post surgery: GMM, quadratic added, 0–6 months follow-up (NRS at shoulder/arm) | 3 trajectories: no pain (42%), mild pain (24%), moderate pain (35%). All differ at baseline and remain stable | Age, white ethnicity (no pain +), education (mild pain longer time in educ.), income mild > mod. at > $100K), BMI, depression, trait anxiety (mod. +), QoL (tracks pain severity) |
Miaskowski et al. [2] | Sampled from breast care centres, post surgery: GMM, quadratic added, 0–6 months follow-up (NRS at breast) | 4 trajectories: no pain (32%), mild (43%), moderate (13%) and severe pain (12%). Moderate group shows progression, severe shows slight pain regression | Age (no +), trait anxiety, sleep disturbance, QoL (no –), non-white ethnicity, household income (severe –), BMI, comorbidities, QoL (severe +), CES-D depression (mod./sev +) |
Pain progression in arthritis and cancer
Methods
Sample
Measures
Coding of subsamples
Pain
Health-centred demographics
Holidays
Civic, social and political engagement
Voting behaviour
Social activities
Missing data and modelling
Results
Latent class growth modelling
k
| AIC | BIC | Entropy | VLMR-LRT p |
---|---|---|---|---|
Whole sample | ||||
1 | 177,684.561 | 177,839.979 | – | – |
2 | 133,343.915 | 133,476.949 | 0.871 | < 0.001 |
3 | 130,255.155 | 130,454.705 | 0.848 | < 0.001 |
4 | 126,764.571 | 127,030.638 | 0.851 | < 0.001 |
+ Quadratic | 124,206.071 | 124,501.701 | 0.859 | |
+ Cubic | 123,577.681 |
123,902.874
| 0.869 | |
5 |
125,988.308
|
126,320.892
|
0.901
|
< 0.001
|
Arthritis | ||||
1 | 14,198.301 | 14,298.893 | – | – |
2 | 11,316.565 | 11,407.577 | 0.702 | < 0.001 |
3 | 11,200.776 | 11,339.689 | 0.702 | 0.008 |
4 | 11,105.289 |
11,292.103
| 0.757 |
0.001
|
+ Quadratic | 10,942.055 |
11,148.029
| 0.841 | |
+ Cubic | 10,914.137 |
11,139.272
|
0.850
| |
5 |
11,084.221
| 11,318.936 |
0.778
| 0.29 |
Cancer | ||||
1 | 6298.329 | 6384.856 | – | – |
2 | 4662.729 | 4736.895 | 0.904 |
< 0.001
|
3 | 4474.875 | 4586.123 |
0.998
| 0.052 |
+ Quadratic | 4420.884 | 4544.492 |
0.998
| |
+ Cubic | 4390.708 | 4526.677 |
0.998
| |
4 | 4198.800 | 4347.131 |
0.998
| 0.37 |
5 |
4128.545
|
4313.958
| 0.947 | 0.37 |
Whole sample
Arthritis subsample
Cancer subsample
Baseline differences
Covariate | Low/no chronic pain (a)N = 7257 | Increasing chronic pain (b)N = 1428 | Decreasing chronic pain (c)N = 1010 | Severe regressing chronic pain (d)N = 2282 |
---|---|---|---|---|
BMI | 26.36 (6.45)b, d | 27.19 (8.16)a | 26.67 (7.72) | 27.18 (9.97)a |
Age | 63.16 (10.77)c, d | 63.80 (10.20)d | 64.68 (10.64)a | 65.70 (10.37)a, b |
GHQ-12 | 0.78 (1.90)b, c, d | 1.33 (2.45)a, d | 1.46 (2.63)a, d | 2.22 (3.19)a, b, c |
Sex (F) | 3803 (52.40%)a, b, c | 833 (58.33%) a, d | 608 (60.20%) a | 1455 (63.76%) a, b |
Non-white ethnicity | 193 (2.66%)a, b, c | 52 (3.64%)a, c | 15 (1.49%)a, b, d | 91 (3.99%)a, c, d |
Alcohol: | ||||
Non-drinker | 610 (8.41%)a, b, c | 176 (12.32%)a, d | 132 (13.07%)a, d | 477 (20.90%)a, b, c |
Special occasions | 1259 (17.35%) | 281 (19.68%) | 202 (20.00%) | 573 (25.11%) |
Monthly | 754 (10.39%) | 166 (11.62%) | 119 (11.78%) | 219 (9.60%) |
Weekly | 2381 (32.81%) | 412 (28.85%) | 288 (28.51%) | 532 (23.31%) |
Daily | 1880 (25.91%) | 327 (22.90%) | 228 (22.57%) | 380 (16.65%) |
> 2 daily | 328 (4.52%) | 62 (4.34%) | 36 (3.56%) | 80 (3.51%) |
Qualifications | ||||
Higher education | 1944 (26.79%)a, b, c | 288 (20.17%)a, d | 183 (18.12%)a, d | 287 (12.58%)a, b, c |
Secondary education | 2111 (29.09%) | 410 (28.71%) | 281 (27.82%) | 502 (22.00%) |
Other | 585 (8.06%) | 126 (8.82%) | 99 (9.8%) | 194 (8.50%) |
None | 2600 (35.83%) | 603 (42.23%) | 446 (44.16%) | 1292 (56.62%) |
Ever smoked | 4479 (61.72%)b, d | 930 (65.13%)a, d | 635 (62.87%)d | 1576 (69.06%)a, b, c |
Smokes now | 1210 (16.67%)d | 269 (18.84%)d | 174 (17.23%)d | 508 (22.26%)a, b, c |
Holidays | 1.89 (0.99)b, c, d | 1.72 (1.00)a, d | 1.66 (1.03)a, d | 1.40 (1.02)a, b, c |
Civic engagement | 0.60 (0.82)d | 0.57 (0.81)d | 0.55 (0.81)d | 0.46 (0.74)a, b, c |
Social engagement | 0.58 (0.73)b, c, d | 0.51 (0.70)a, d | 0.49 (0.69)a, d | 0.40 (0.63)a, b, c |
Social activities | 2.09 (1.09)b, c, d | 1.83 (1.15)a, d | 1.72 (1.08)a, d | 1.47 (1.13)a, b, c |
Wishing to do more social activities | 1.16 (1.38)b, c, d | 1.45 (1.46)a | 1.40 (1.42)a | 1.53 (1.46)a |
Voted, 2001 | 5558 (83.73%)d | 1127 (83.36%)d | 783 (82.77%)d | 1555 (78.26%)a, b, c |
Voted, 2005 | 3611 (88.74%)b, c, d | 830 (85.57%)a, d | 582 (83.5%)a | 821 (79.94%)a, b |
Political membership | 1064 (16.57%)b, d | 186 (14.32%)a, d | 133 (14.70%)d | 182 (9.67%)a, b, c |
Covariate | Low/no chronic pain (a)N = 381 | Increasing chronic pain (b)N = 143 | Decreasing chronic pain (c)N = 147 | Severe regressing chronic pain (d)N = 218 | Corrected p (false discovery rate) |
---|---|---|---|---|---|
BMI | 26.34 (7.55)d | 27.48 (7.64) | 26.31 (8.95)d | 29.01 (8.44)a, c | 0.029* |
Age | 64.98 (10.55) | 62.90 (9.68)c | 66.66 (10.31)bd | 63.80 (10.60)c | 0.028* |
GHQ-12 | 1.09 (2.22)d | 1.37 (2.34)d | 1.56 (2.90) | 2.29 (3.39)a, b | < 0.001*** |
Sex (F) | 238 (62.47%) | 77 (53.85%) | 92 (62.59%) | 144 (66.06%) | 0.19 |
Non-white ethnicity | 9 (2.38%) | 11 (7.69%) | 2 (1.36%) | 5 (2.30%) | 0.031* |
Alcohol: | 0.095 | ||||
Non-drinker | 49 (12.86%) | 19 (13.29%) | 19 (12.93%) | 34 (15.60%) | |
Special occasions | 68 (17.85%) | 26 (18.18%) | 31 (21.09%) | 64 (29.36%) | |
Monthly | 27 (7.09%) | 15 (10.49%) | 15 (10.20%) | 22 (10.09%) | |
Weekly | 137 (35.96%) | 47 (32.87%) | 48 (32.65%) | 52 (23.85%) | |
Daily | 83 (21.78%) | 29 (20.28%) | 31 (21.09%) | 38 (17.43%) | |
> 2 daily | 17 (4.46%) | 5 (3.5%) | 3 (2.04%) | 4 (1.83%) | |
Qualifications | 0.023* | ||||
Higher education | 99 (25.98%)c, d | 34 (23.78%) | 20 (13.61%)a | 36 (16.51%)a | |
Secondary education | 100 (26.25%) | 41 (28.67%) | 37 (25.17%) | 47 (21.56%) | |
Other | 24 (6.3%) | 11 (7.69%) | 18 (12.24%) | 19 (8.72%) | |
None | 158 (41.47%) | 57 (39.86%) | 72 (48.98%) | 116 (53.21%) | |
Ever smoked | 229 (60.1%) | 86 (60.14%) | 96 (65.31%) | 145 (66.51%) | 0.39 |
Smokes now | 48 (12.6%) | 24 (16.78%) | 27 (18.37%) | 51 (23.39%) | 0.027* |
Osteoarthritis | 171 (44.88%) | 68 (47.55%) | 66 (44.9%) | 102 (46.79%) | 0.93 |
Rheumatoid arthritis | 73 (19.16%) | 27 (18.88%) | 25 (17.01%) | 52 (23.85%) | 0.43 |
Other arthritis | 49 (12.86%) | 22 (15.38%) | 17 (11.56%) | 21 (9.63%) | 0.43 |
Holidays | 1.90 (1.01)c, d | 1.80 (0.99) | 1.55 (1.10)a | 1.51 (0.92)a | < 0.001*** |
Civic engagement | 0.63 (0.81) | 0.65 (0.82) | 0.50 (0.80) | 0.46 (0.76) | 0.095 |
Social engagement | 0.61 (0.72)c | 0.58 (0.80) | 0.39 (0.60)a | 0.51 (0.73) | 0.052 |
Social activities | 2.07 (1.16)c, d | 1.89 (1.16) | 1.64 (1.15)a | 1.62 (1.21)a | 0.004** |
Wishing to do more social activities | 1.31 (1.48) | 1.64 (1.51) | 1.38 (1.38) | 1.40 (1.49) | 0.43 |
Voted, 2001 | 295 (83.33%)d | 116 (86.57%)d | 116 (85.93%)d | 144 (75.39%)a, b, c | 0.048* |
Voted, 2005 | 196 (91.16%)c,d | 83 (87.37%) | 69 (82.14%)a | 91 (76.47%)a | 0.012* |
Political membership | 53 (15.41%) | 27 (20.93%) | 20 (16.26%) | 25 (13.89%) | 0.43 |
Covariate | Emerging chronic pain (a)N = 308 | Low severity chronic pain (b)N = 48 | Fluctuating chronic pain (c)N = 99 | Corrected p (false discovery rate) |
---|---|---|---|---|
BMI | 26.12 (6.16) | 26.71 (9.02) | 24.40 (10.22) | 0.30 |
Age | 66.44 (10.50) | 62.52 (11.90)c | 68.02 (11.14)b | 0.042* |
GHQ-12 | 0.86 (2.08)b, c | 2.29 (3.41)a | 1.82 (2.74)a | < 0.001*** |
Sex (F) | 172 (55.84%) | 35 (72.92%) | 60 (60.61%) | 0.18 |
Non-white ethnicity | 1 (0.33%) | 1 (2.08%) | 5 (5.26%) | 0.015* |
Alcohol: | 0.015* | |||
Non-drinker | 21 (6.82%)c | 7 (14.58%) | 15 (15.15%)c | |
Special occasions | 46 (14.94%) | 7 (14.58%) | 27 (27.27%) | |
Monthly | 38 (12.34%) | 11 (22.92%) | 6 (6.06%) | |
Weekly | 95 (30.84%) | 10 (20.83%) | 22 (22.22%) | |
Daily | 85 (27.60%) | 11 (22.92%) | 24 (24.24%) | |
> 2 daily | 72 (7.14%) | 2 (4.17%) | 4 (4.04%) | |
Qualifications | 0.006** | |||
Higher education | 103 (33.44%)c | 10 (20.83%) | 14 (14.14%)a | |
Secondary education | 74 (24.03%) | 16 (33.33%) | 20 (20.20%) | |
Foreign/other | 28 (9.09%) | 6 (12.50%) | 12 (12.12%) | |
None | 103 (33.44%) | 16 (33.33%) | 53 (53.54%) | |
Ever smoked | 198 (64.29%) | 25 (52.08%) | 65 (65.66%) | 0.26 |
Current smoker | 40 (12.99%) | 8 (16.67%) | 16 (16.16%) | 0.67 |
Type of cancer | 0.26 | |||
Lung | 5 (1.62%) | 1 (2.08%) | 7 (7.07%) | |
Breast | 95 (30.84%) | 18 (37.50%) | 30 (30.30%) | |
Colon, bowel or rectum | 37 (12.01%) | 6 (12.50%) | 14 (14.14%) | |
Lymphoma | 14 (4.55%) | 1 (2.08%) | 2 (2.02%) | |
Leukaemia | 0 | 1 (2.08%) | 1 (1.01%) | |
Melanoma | 27 (8.77%) | 3 (6.25%) | 9 (9.09%) | |
Other | 130 (42.21%) | 18 (37.50%) | 36 (36.37%) | |
Years since cancer diagnosis | 8.21 (8.35) | 8.06 (8.20) | 8.33 (8.25) | 0.98 |
Holidays | 1.87 (1.00) | 1.78 (0.94) | 1.70 (1.08) | 0.45 |
Civic engagement | 0.75 (0.92) | 0.70 (0.81) | 0.53 (0.83) | 0.26 |
Social engagement | 0.65 (0.85) | 0.43 (0.62) | 0.49 (0.69) | 0.23 |
Social activities | 2.21 (1.19)c | 2.29 (1.21)c | 1.56 (1.09)a, b | 0.006** |
Wishing to do more social activities | 1.01 (1.30) | 1.41 (1.50) | 1.38 (1.33) | 0.24 |
Voted, 2001 | 254 (89.12%) | 33 (82.62%) | 66 (81.48%) | 0.24 |
Voted, 2005 | 158 (91.28%)b, c | 19 (76.00%)a | 33 (78.57%)a | 0.031* |
Political membership | 36 (13.09%) | 2 (4.35%) | 11 (14.67%) | 0.26 |
Social life analyses
Whole sample | |||||
Effect | Parameter | Age | Increasing | Decreasing | Severe |
Holidays | Intercept |
–
|
–
|
–
|
–
|
Slope |
–
|
–
| ns |
–
| |
Civic engagement | Intercept |
+
|
–
|
–
|
–
|
Slope |
–
| ns | ns | ns | |
Social engagement | Intercept | ns |
–
|
–
|
–
|
Slope |
–
| ns | ns |
–
| |
Social activities | Intercept |
–
|
–
|
–
|
–
|
Slope |
–
| ns | ns | ns | |
Wishing to do more social activities | Intercept |
–
|
+
|
+
|
+
|
Slope |
+
| ns |
–
|
–
| |
Arthritis | |||||
Effect | Parameter | Age | Increasing | Decreasing | Severe |
Holidays | Intercept |
–
| ns |
–
|
–
|
Slope |
–
| ns | ns | ns | |
Civic engagement | Intercept |
+
| ns | ns |
–
|
Slope | ns | ns | ns | ns | |
Social engagement | Intercept | ns |
–
|
–
| ns |
Slope | ns | ns | ns |
–
| |
Social activities | Intercept | ns |
–
|
–
|
–
|
Slope | ns | ns | ns | ns | |
Wishing to do more social activities | Intercept |
–
|
+
| ns | ns |
Slope |
+
| ns | ns | ns | |
Cancer | |||||
Effect | Parameter | Age | Moderate | Severe | |
Holidays | Intercept |
–
| ns |
–
| |
Slope |
–
| ns | ns | ||
Civic engagement | Intercept | ns | ns |
–
| |
Slope | ns | ns | ns | ||
Social engagement | Intercept | ns | ns | ns | |
Slope | ns | ns | ns | ||
Social activities | Intercept |
–
| ns |
–
| |
Slope |
–
| ns | ns | ||
Wishing to do more social activities | Intercept | ns | ns |
+
| |
Slope | ns | ns | ns |