{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:35:08Z","timestamp":1791333308283,"version":"4.3.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2020,5,26]],"date-time":"2020-05-26T00:00:00Z","timestamp":1590451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"The Osteoarthritis Initiative","award":["N01-AR-2-2258"],"award-info":[{"award-number":["N01-AR-2-2258"]}]},{"name":"The Osteoarthritis Initiative","award":["N01-AR-2-2259"],"award-info":[{"award-number":["N01-AR-2-2259"]}]},{"name":"The Osteoarthritis Initiative","award":["N01-AR-2-2260"],"award-info":[{"award-number":["N01-AR-2-2260"]}]},{"name":"The Osteoarthritis Initiative","award":["N01-AR-2-2261"],"award-info":[{"award-number":["N01-AR-2-2261"]}]},{"name":"The Osteoarthritis Initiative","award":["N01-AR-2-2262"],"award-info":[{"award-number":["N01-AR-2-2262"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000016","name":"Department of Health and Human Services","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000016","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain scale quantifies knee pain severity with activities of daily living, but the potential impact of pain in other body regions on WOMAC pain scores has not been explored using a causal modeling approach. The purpose of this study was to determine if pain in other areas of the body impact WOMAC pain scores, a phenomenon referred to as \u201ccrosstalk.\u201d<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Cross-sectional datasets were built from public use data available from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST). The WOMAC Pain Scale and generic hip, knee, ankle, foot and back pain measures were included. Three nested regression models grounded in causally based classical test theory determined the extent of crosstalk. Improvements in the coefficient of determination across the 3 models were used to determine the presence of crosstalk.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Causal modeling provided evidence of crosstalk in both OAI and MOST datasets. For example, in OAI, multiple statistical models demonstrated significant increases in coefficient of determination values (P\u00a0&amp;lt;\u00a0.0001) as additional pain areas were added to the models.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Crosstalk appears to be a clinically important source of error in the WOMAC Pain Scale, particularly for patients with a larger number of painful body regions and when contralateral knee joint pain is more severe.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Impact Statement<\/jats:title>\n                  <jats:p>This study has important implications for arthritis research. It also should raise clinician awareness of the threat to score interpretation and the need to consider the extent of pain in other body regions when interpreting WOMAC pain scores.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ptj\/pzaa098","type":"journal-article","created":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T11:07:42Z","timestamp":1590059262000},"page":"1872-1881","source":"Crossref","is-referenced-by-count":29,"title":["The WOMAC Pain Scale and Crosstalk From Co-occurring Pain Sites in People With Knee Pain: A Causal Modeling Study"],"prefix":"10.1093","volume":"100","author":[{"given":"Daniel L","family":"Riddle","sequence":"first","affiliation":[{"name":"Department of Biostatistics , Virginia Commonwealth University, Richmond, VA 23298\u20130224 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Biostatistics , Virginia Commonwealth University, Richmond, VA 23298\u20130224 USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,5,26]]},"reference":[{"issue":"12","key":"2023011804593328900_ref1","first-page":"1833","article-title":"Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee","volume":"15","author":"Bellamy","year":"1988","journal-title":"J Rheumatol"},{"key":"2023011804593328900_ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1477-7525-1-1","article-title":"Knee injury and osteoarthritis outcome score (KOOS) - validation and comparison to the WOMAC in total knee replacement","volume":"1","author":"Roos","year":"2003","journal-title":"Health Qual Life Outcomes"},{"issue":"2","key":"2023011804593328900_ref3","first-page":"231","article-title":"Psychometric properties of the OARSI\/OMERACT osteoarthritis pain and functional impairment scales: ICOAP","volume":"29","author":"Ruyssen-Witrand","year":"2011","journal-title":"KOOS-PS and HOOS-PS Clin Exp Rheumatol"},{"key":"2023011804593328900_ref4","volume-title":"Oxford English Dictionary"},{"key":"2023011804593328900_ref5","volume-title":"Test Theory. 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