Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Nov;26(11):1461-1473.
doi: 10.1016/j.joca.2018.07.013. Epub 2018 Aug 10.

Contribution of Central and Peripheral Risk Factors to Prevalence, Incidence and Progression of Knee Pain: A Community-Based Cohort Study

Free PMC article
Multicenter Study

Contribution of Central and Peripheral Risk Factors to Prevalence, Incidence and Progression of Knee Pain: A Community-Based Cohort Study

A Sarmanova et al. Osteoarthritis Cartilage. .
Free PMC article


Aim: To explore risk factors that may influence knee pain (KP) through central or peripheral mechanisms.

Methods: A questionnaire-based prospective community cohort study with KP defined as pain in or around a knee on most days for at least a month. Baseline prevalence, and one year incidence and progression (KP worsening) were examined. Central (e.g., Pain Catastrophizing Scale (PCS)) and peripheral (e.g., significant injury) risk factors were examined. Adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression. Proportional risk contribution (PRC) was estimated using receiver-operator-characteristic (ROC) analysis.

Results: Of 9506 baseline participants, 4288 (45%) had KP (men 1826; women, 2462). KP incidence was 12% (men 11%, women 13%), and KP progression 19% (men 16%, women 21%) at one year. While both central and peripheral factors contributed to prevalence, central factors contributed more to progression, and peripheral factors more to incidence of KP. For example, although PCS (OR 2.06, 95% CI 1.88-2.25) and injury (5.62, 4.92-6.42) associated with KP prevalence, PCS associated with progression (2.27, 1.83-2.83) but not incidence (1.14, 0.86-1.52), whereas injury more strongly associated with incidence (69.27, 24.15-198.7) than progression (2.52, 1.48-4.30). The PRC of central and peripheral factors were 19% and 23% for prevalence, 14% and 29% for incidence, and 29% and 5% for progression, respectively.

Conclusions: Both central and peripheral risk factors influence KP but relative contributions may differ in terms of development (mainly peripheral) and progression (mainly central). Further study of such relative contributions may inform primary and secondary prevention strategies.

Keywords: Cohort; Incidence; Knee pain; Osteoarthritis; Risk factors.


Fig. 1
Fig. 1
Proportional risk contribution (PRC) to prevalence, incidence and progression of knee pain (KP).
Image 1

Similar articles

See all similar articles

Cited by 1 article

  • Investigating musculoskeletal health and wellbeing; a cohort study protocol.
    Millar B, McWilliams DF, Abhishek A, Akin-Akinyosoye K, Auer DP, Chapman V, Doherty M, Ferguson E, Gladman JRF, Greenhaff P, Stocks J, Valdes AM, Walsh DA. Millar B, et al. BMC Musculoskelet Disord. 2020 Mar 21;21(1):182. doi: 10.1186/s12891-020-03195-4. BMC Musculoskelet Disord. 2020. PMID: 32199451 Free PMC article.


    1. Peat G., McCarney R., Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001;60:91–97. - PMC - PubMed
    1. Neogi T., Felson D., Niu J., Nevitt M., Lewis C.E., Aliabadi P. Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ. 2009;339:b2844. - PMC - PubMed
    1. Staud R. Evidence for shared pain mechanisms in osteoarthritis, low back pain, and fibromyalgia. Curr Rheumatol Rep. 2011;13:513–520. - PubMed
    1. Peat G., Greig J., Wood L., Wilkie R., Thomas E., Croft P. Diagnostic discordance: we cannot agree when to call knee pain ‘osteoarthritis’. Fam Pract. 2005;22:96–102. - PubMed
    1. Hadler N.M. KNee pain is the malady—not osteoarthritis. Ann Intern Med. 1992;116:598–599. - PubMed

Publication types

MeSH terms