TY - JOUR
T1 - Exploring the pain and disability continuum in adolescents with non-traumatic anterior knee pain
T2 - a mediation analysis using individual participant data of prospective studies
AU - Holden, Sinead
AU - Lee, Hopin
AU - van Middelkoop, Marienke
AU - Rathleff, Michael Skovdal
AU - Adolescent knee health group
A2 - Roos, Ewa M.
A2 - Olesen, Jens Lykkegaard
A2 - Graven-Nielsen, Thomas
A2 - Arendt-Nielsen, Lars
A2 - Hölmich, Per
A2 - Thorborg, Kristian
A2 - Rasmussen, Sten
A2 - Madeleine, Pascal
A2 - Selhorst, Mitchell
N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/11
Y1 - 2023/11
N2 - OBJECTIVE: To use individual patient data (IPD) to investigate if the effect of pain on sports-related disability is mediated through physical (lower extremity isometric strength) or psychological (depression/anxiety and knee confidence) factors in adolescents with non-traumatic anterior knee pain.METHODS: This study included four datasets from a previously harmonised IPD dataset. Prior to analysis, the protocol and analysis approach were predefined and published on Open Science Framework. Potential mediators were pre-sepcified as isometric knee and hip strengths, self-reported anxiety/depression and confidence in the knee, allmeasured at 12 weeks after baseline evaluation. Mediation analyses were undertaken using the CMAVerse package in RStudio using the regression-based approach to decompose the total effect of the exposure (pain at baseline evaluation) on the outcome (sports-related disability at 6 months) into the 'indirect effect' (the portion of the total effect acting through the mediators) and the 'direct effect'.RESULTS: Two-hundred and seventy-nine adolescents with non-traumatic knee pain were included in the analysis. Median age was 13 (range 10-19), and 72% were women. Baseline pain was associated with sports-related disability at 6 months. There was no evidence of the association being mediated by any of the proposed mediators (total natural indirect effect for strength 0.01 (-1.14 to 1.80) and psychological factors 0.00 (-0.66 to 2.02)).CONCLUSION: We found an effect of pain on sports-related disability at 6 months which appears to be independent of lower extremity muscle strength, or depression/anxiety and knee confidence in adolescents with non-traumatic anterior knee pain.
AB - OBJECTIVE: To use individual patient data (IPD) to investigate if the effect of pain on sports-related disability is mediated through physical (lower extremity isometric strength) or psychological (depression/anxiety and knee confidence) factors in adolescents with non-traumatic anterior knee pain.METHODS: This study included four datasets from a previously harmonised IPD dataset. Prior to analysis, the protocol and analysis approach were predefined and published on Open Science Framework. Potential mediators were pre-sepcified as isometric knee and hip strengths, self-reported anxiety/depression and confidence in the knee, allmeasured at 12 weeks after baseline evaluation. Mediation analyses were undertaken using the CMAVerse package in RStudio using the regression-based approach to decompose the total effect of the exposure (pain at baseline evaluation) on the outcome (sports-related disability at 6 months) into the 'indirect effect' (the portion of the total effect acting through the mediators) and the 'direct effect'.RESULTS: Two-hundred and seventy-nine adolescents with non-traumatic knee pain were included in the analysis. Median age was 13 (range 10-19), and 72% were women. Baseline pain was associated with sports-related disability at 6 months. There was no evidence of the association being mediated by any of the proposed mediators (total natural indirect effect for strength 0.01 (-1.14 to 1.80) and psychological factors 0.00 (-0.66 to 2.02)).CONCLUSION: We found an effect of pain on sports-related disability at 6 months which appears to be independent of lower extremity muscle strength, or depression/anxiety and knee confidence in adolescents with non-traumatic anterior knee pain.
KW - Adolescent
KW - Knee
KW - Meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85172300995&partnerID=8YFLogxK
U2 - 10.1136/bjsports-2023-107177
DO - 10.1136/bjsports-2023-107177
M3 - Journal article
C2 - 37699655
SN - 0306-3674
VL - 57
SP - 1388
EP - 1394
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 21
M1 - 107177
ER -