{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:47:15Z","timestamp":1791802035177,"version":"4.3.4"},"reference-count":0,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care & Research"],"abstract":"\n Objective<\/jats:title>\n \n High body mass index (BMI\u226527 kg\/m\n 2<\/jats:sup>\n ) and aberrant gait biomechanics are primary risk factors for knee osteoarthritis (KOA), yet the specific loading patterns linked to clinical disease features remain unclear. Unsupervised machine learning (ML) was used to identify vertical ground reaction force (vGRF) waveform modes of variation and characterize the shared and individual variation between vGRF profiles and clinical features in individuals with KOA and high BMI.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Baseline gait and clinical data from the Intensive Diet and Exercise for Arthritis (IDEA) trial (n=431; 29% male; 65\u00b16 years; 34\u00b14 kg\/m\n 2<\/jats:sup>\n ) were analyzed. vGRF waveforms (n=2,394) were represented using three functional data analysis methods: time\u2010 and bodyweight\u2010normalization; elastic shape analysis; and optimal transport (OT). Principal component analysis extracted the dominant vGRF modes of variation, and Data Integration Via Analysis of Subspaces (DIVAS) quantified shared and individual variation among vGRF profiles and 40 clinical features.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A sustained loading phenotype emerged across all vGRF representations (lesser early and late stance vGRF; greater midstance vGRF). DIVAS identified shared variation between sustained loading and higher BMI, elevated inflammatory biomarkers, greater pain, worse KL grade, and slower walking speed. OT identified a temporal loading phenotype that shared variation with female sex.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Unsupervised ML identified a sustained loading biomechanical phenotype that shared variation with greater BMI, increased inflammation, worse radiographic severity, and slower walking speed. These data highlight the complex interplay among gait biomechanics and clinical KOA features in individuals with high BMI and may help to guide future work evaluating targeted gait retraining interventions.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/acr.80186","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:09:47Z","timestamp":1791799787000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unsupervised Machine Learning Identifies Shared Biomechanical and Clinical Variation in Individuals with Knee Osteoarthritis and High BMI: A Secondary Analysis of the IDEA Trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1811-612X","authenticated-orcid":false,"given":"Ashley N.","family":"Buck","sequence":"first","affiliation":[{"name":"University of Wisconsin\u2010Madison Madison WI USA"},{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Elyse","family":"Borgert","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeon","family":"Lee","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5004-419X","authenticated-orcid":false,"given":"Liubov","family":"Arbeeva","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1205-2759","authenticated-orcid":false,"given":"Yvonne M.","family":"Golightly","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"},{"name":"University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2832-6144","authenticated-orcid":false,"given":"Richard F.","family":"Loeser","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh F.","family":"Callahan","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7033-8459","authenticated-orcid":false,"given":"Stephen P.","family":"Messier","sequence":"additional","affiliation":[{"name":"Wake Forest University Winston\u2010Salem NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Pietrosimone","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9344-7877","authenticated-orcid":false,"given":"Amanda E.","family":"Nelson","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Marron","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill Chapel Hill NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"container-title":["Arthritis Care & Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.80186","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.80186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T10:09:47Z","timestamp":1791799787000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.80186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":0,"alternative-id":["10.1002\/acr.80186"],"URL":"https:\/\/doi.org\/10.1002\/acr.80186","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"assertion":[{"value":"2026-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"acr.80186"}}