A 5-Year Longitudinal Study of Knee Pain Among Natural Disaster Survivors

doi:10.21203/rs.3.rs-959947/v1

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A 5-Year Longitudinal Study of Knee Pain Among Natural Disaster Survivors

https://doi.org/10.21203/rs.3.rs-959947/v1

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Background: Knee pain is a common symptom among natural disaster survivors as well as general population. However, its long-term course is unclear. The purpose of this study was to clarify the course of knee pain, especially focusing on the association between prior and subsequent knee pain, among people living in disaster-stricken areas.

Methods: This was a 5-year longitudinal study of 1,821 participants. Knee pain was assessed at two, four, and seven years after the Great East Japan Earthquake. Multiple logistic regression analyses were examined to assess the association of knee pain at two and five years after the disaster and knee pain at seven years after the disaster.

Results: The prevalence of knee pain was 18.0%, 18.2%, and 19.7% at two, four, and seven years after the disaster, respectively. Throughout the 5-year period, 34.7% of the participants had knee pain at any time point and 6.2% had knee pain at all three time points. Knee pain at two and four years after the disaster was significantly associated with knee pain at seven years after the disaster (adjusted odds ratios (95% confidence intervals): 3.17 (2.32–4.34) for knee pain at either of the two time points and 12.49 (8.42–18.54) for knee pain at both time points (p for trend <0.001)).

Conclusions: In the present 5-year cohort study, the prevalence of knee pain was gradually increased. Among the people with knee pain at any time point, approximately one fifth of them had consistent pain. Prior knee pain was associated with subsequent knee pain, which was stronger in those with more prior knee pain episodes. Clinicians should pay attention to prior knee pain episodes to consider methods to treat knee pain.

Orthopedics

knee pain

longitudinal study

natural disaster

course

Knee pain is a common musculoskeletal problem worldwide [1]. It arises from various disorders of the structures in and around the knee joint (e.g., inflammatory or degenerative arthritis) and cartilage or ligament injuries [2]. Knee pain restricts activities of daily living, and thus identifying its related factors and course is important. Some factors such as older age, being female, high body mass index (BMI), depression, and sleep disturbance have been reported to be associated with knee pain [3–5]. Further, knee pain is considered to be frequently associated with knee osteoarthritis (OA) [6], and some studies have reported the natural course of knee OA. Most of these studies mainly focused on radiographic changes [7–12] although knee pain is a subjective experience and is not always constant. Some studies also showed knee pain trajectories among people with knee OA [13, 14]. However, the course of knee pain has been rarely investigated [3, 15, 16] and not clarified.

Knee pain is also a major musculoskeletal problem after natural disasters [17]. A high incidence of knee pain was reported after the Great East Japan Earthquake (GEJE) that occurred in the northeast coastal areas of Japan on March 11, 2011 [4]. Further, knee pain caused a decline of physical function in elderly survivors after the GEJE [18]. Knowing the long-term course of knee pain is important in developing strategies to treat and prevent knee pain, which is beneficial for general population as well as natural disaster survivors. Thus, this study aimed to clarify the time course of knee pain, particularly the association between prior knee pain and subsequent knee pain, using a 5-year longitudinal data after the GEJE.

Study design and participants

A panel study was performed among people living in disaster-stricken areas in the north-east coastal areas in Japan to assess their health and social problems [19]. The initial survey was conducted 3 months after the GEJE among the residents registered in Ogatsu, Oshika, and Ajishima areas and people living in the temporary prefabricated housing in Wakabayashi ward. The survey was consecutively conducted every year. The current study used the data from that survey. Because the number of participants increased from the initial survey until the survey conducted approximately two years after the GEJE, this study used the data from three points at two, four, and seven years after the GEJE (designated as the first, second, and third time points, respectively) to evaluate the 5-year time course of knee pain. In each time point, residents aged over 18 years in Ogatsu, Oshika, and Ajishima areas and people who had participated in the previous survey in Wakabayashi ward were recruited. At the first time point, 7,007 people were contacted and 2,881 responded (41.1%). Among those, 2,254 responded at the second time point (78.2%). Further, 1,821 (80.8%) of these participants responded at the third time point and were enrolled (Fig. 1). This study was approved by the institutional review board of our institute (approval number: 201192) and was performed in accordance with the Declaration of Helsinki.

Knee pain

Knee pain was assessed by a self-reported questionnaire [20]. The participants were asked if they had had knee pain in the last few days. Knee pain was assessed at each time point and the pain at the first and second time points was divided into three categories: absence of knee pain at neither time point, presence of knee pain at either of the time point, and presence of knee pain at both time points.

Covariates

The following variables at the first time point were included in the analysis as covariates because they were considered as potential confounding factors: sex, age, BMI, living area and environment, smoking and drinking habits, comorbidities, working status, walking time/day, subjective economic, psychological, and sleep condition, and social network. Psychological condition was assessed by the Kessler Psychological Distress Scale, and a score of ≥ 10/24 was considered to have psychological distress [21]. Sleep condition was assessed by the Athens Insomnia Scale, and a score of ≥ 6/24 was considered to have sleep disturbance. Social network was assessed by the Lubben Social Network Scale, and a score of <12/30 was considered to have social isolation [19]. Variables were divided into categories as seen in Table 1 [22].

Statistical analysis

A chi-square test was performed to compare the covariates according to the presence of knee pain at the first time point. Crude and multiple logistic regression analyses were used to assess the association between knee pain at the first and third time points and the odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. Further, we divided the participants into subgroups by age (<65 and ≥65 years) and sex (male and female) and assess the association in the same manner. For the subgroup analysis, potential multiplicative interactions between knee pain at the first time point and age or sex were tested by the Walt test. In addition, the association of knee pain at the first and second time points with knee pain at the third time point was also assessed. SPSS 24.0 (IBM Corp., Armonk, NY, USA) was used for statistical analyses with statistical significance of <0.05 in a p value.

The variables divided due to the presence of knee pain at the first time point are shown in Table 1. At the first time point, knee pain was prevalent in 18.0% (328/1,821) of the participants. The participants with knee pain were more likely to be female, older, non-smoker, non-drinker, and unemployed. They also had higher BMI, number of comorbidities, shorter walking time, and worse subjective economic condition, psychological distress, and sleep disturbance (Table 1). At the second and third time points, knee pain was prevalent in 18.2% (331/1,821) and 19.7% (357/1,821) of the participants, respectively. Table 2 shows the 5-year time course of knee pain among the participants. Throughout the 5-year period, 65.3% of the participants had no knee pain at any time point, 19.6% had knee pain at one time point, 8.8% had knee pain at two time points, and 6.2% had knee pain at all three time points (Table 2). There was significant association between knee pain at the first and third time points in both crude and adjusted analyses, and the adjusted OR (95% CI) was 4.37 (3.28–5.82) (Table 3). In the subgroup analyses, the prevalence of knee pain was higher in the older participants than the younger ones (26.5% vs12.7%) and in females than males (24.5% vs. 13.6%). There was significant association between knee pain at the first and third time points in all categories. No significant multiplicative interaction was seen between knee pain and age or sex (Table 4). Furthermore, the number of prior knee pain episodes was significantly associated with knee pain at the third time point. The adjusted ORs (95% CIs) for knee pain at the third time point were 3.17 (2.32–4.34) in the presence of knee pain at either of the two time points and 12.49 (8.42–18.54) in the presence of knee pain at both time points (p for trend <0.001) (Table 5).

Table 1

Baseline characteristics of the participants at the first time point
		Knee pain at the first time point
		n (%)	Absent	Present	P value
		n=1821	n=1,493	n=328
Sex	Male	799 (43.9)	699 (46.8)	100 (30.5)	< 0.001
	Female	1,022 (56.1)	794 (53.2)	228 (69.5)
Age, years	< 65	897 (49.3)	793 (53.1)	104 (31.7)	< 0.001
	≥65	924 (50.7)	700 (46.9)	224 (68.3)
BMI	≥18.5, <25	1,073 (58.9)	911 (61.0)	162 (49.4)	0.001
	<18.5	36 (2.0)	31 (2.1)	5 (1.5)
	≥25	628 (34.5)	483 (32.4)	145 (44.2)
Area of residence	Ogatsu	794 (43.6)	651 (43.6)	143 (43.6)	n.s.
	Oshika	599 (32.9)	500 (33.5)	99 (30.2)
	Ajishima	102 (5.6)	75 (5.0)	27 (8.2)
	Wakabayashi	326 (17.9)	267 (17.9)	59 (18.0)
Smoking habits	Non-smoker	1,383 (75.9)	1,115 (74.7)	268 (81.7)	0.001
	Smoker	320 (17.6)	286 (19.2)	34 (10.4)
Drinking habits	Non-drinker	1,055 (57.9)	832 (55.7)	223 (68.0)	< 0.001
	<45.6 g of alcohol/day**	383 (21.0)	338 (22.6)	45 (13.7)
	≥45.6 g of alcohol/day**	189 (10.4)	165 (11.1)	24 (7.3)
Comorbid conditions	Hypertension	732 (40.2)	556 (37.2)	176 (53.7)	< 0.001
	Diabetes mellitus	167 (9.2)	132 (8.8)	35 (10.7)	n.s.
	Myocardial infarction	114 (6.3)	74 (5.0)	40 (12.2)	< 0.001
	Cerebral stroke	22 (1.2)	19 (1.3)	3 (0.9)	n.s.
Working status	Unemployed	944 (51.8)	743 (49.8)	201 (61.3)	< 0.001
	Employed	834 (45.8)	716 (48.0)	118 (36.0)
Walking time/day	≥ 1 h	542 (29.8)	461 (30.9)	81 (24.7)	0.02
	30 min to < 1 h	644 (35.4)	534 (35.8)	110 (33.5)
	< 30 min	605 (33.2)	473 (31.7)	132 (40.2)
Living environment	Same house as before the disaster	533 (29.3)	432 (28.9)	101 (30.8)	n.s.
	Prefabricated house	726 (39.9)	594 (39.8)	132 (40.2)
	New house	159 (8.7)	134 (9.0)	25 (7.6)
	Other	355 (19.5)	294 (19.7)	61 (18.6)
Economic hardship	Normal	796 (43.7)	668 (44.7)	128 (39.0)	0.045
	A little hard	481 (26.4)	394 (26.4)	87 (26.5)
	Hard	343 (18.8)	273 (18.3)	70 (21.3)
	Very hard	172 (9.4)	131 (8.8)	41 (12.5)
Psychological distress	Absent	1,409 (77.4)	1,188 (79.6)	221 (67.4)	< 0.001
	Present	246 (13.5)	184 (12.3)	62 (18.9)
Sleep disturbance	Absent	1,042 (57.2)	893 (59.8)	149 (45.4)	< 0.001
	Present	591 (32.5)	456 (30.5)	135 (41.2)
Social isolation*	Absent	1,240 (68.1)	1,027 (68.8)	213 (64.9)	n.s.
	Present	497 (27.3)	397 (26.6)	100 (30.5)

Table 2

Patterns of knee pain in the 5-year time course
Presence of knee pain
First time point	Second time point	Third time point	Number of knee pain episodes	n (%)
No	No	No	0	1,190 (65.3)
No	No	Yes	1	141 (7.7)
No	Yes	No	1	101 (5.5)
No	Yes	Yes	2	61 (3.3)
Yes	No	No	1	115 (6.3)
Yes	No	Yes	2	44 (2.4)
Yes	Yes	No	2	56 (3.1)
Yes	Yes	Yes	3	113 (6.2)

Table 3. Association between prior knee pain and knee pain 5 years later

Table 4. Association between prior knee pain and knee pain 5 years later: subgroup analysis by age and sex

		Total	No knee pain at the first time point	Knee pain at the first time point	P value
		Total	No knee pain at the first time point	Knee pain at the first time point	P value
	Age
	< 65 years
Participants		897	793	104
Knee pain at the third time point, n (%)		114 (12.7)	77 (9.7)	37 (35.6)
Adjusted OR (95% CI)			1.00 (Ref.)	4.35 (2.57–7.37)	<0.001
	≥ 65 years
Participants		924	700	224
Knee pain at the third time point, n (%)		245 (26.5)	125 (17.9)	120 (53.6)
Adjusted OR (95% CI)			1.00 (Ref.)	4.48 (3.14–6.40)	<0.001
				P-interaction = 1.0
	Sex
	Male
Participants		799	699	100
Knee pain at the third time point, n (%)		109 (13.6)	66 (9.4)	43 (43.0)
Adjusted OR (95% CI)			1.00 (Ref.)	6.60 (3.83–11.37)	< 0.001
	Female
Participants		1,022	794	228
Knee pain at the third time point, n (%)		250 (24.5)	136 (17.1)	114 (50.0)
Adjusted OR (95% CI)			1.00 (Ref.)	4.12 (2.88–5.90)	<0.001
				P-interaction = 0.18
Adjusted for sex, age, body mass index, living area and environment, smoking and drinking habits, comorbid conditions, working status, walking time, subjective economic, psychological, and sleep condition, and social network. OR: odds ratio; CI: confidence interval

Table 5. Association between the number of prior knee pain episodes and subsequent knee pain

	Total	No knee pain at the first and second time points	Knee pain at either the first or second time point	Knee pain at the first and second time points	P for trend
Participants	1,821	1,331	321	169
Knee pain at the third time point, n (%)	359 (19.7)	141 (10.6)	105 (32.7)	113 (66.9)
Crude OR (95% CI)		1	4.10 (3.07–5.49)	17.03 (11.83–24.53)	<0.001
Adjusted OR (95% CI)		1	3.17 (2.32–4.34)	12.49 (8.42–18.54)	<0.001
Adjusted for sex, age, body mass index, living area and environment, smoking and drinking habits, comorbid conditions, working status, walking time, subjective economic, psychological, and sleep condition, and social network. OR: odds ratio; CI: confidence interval

The long-term course of knee pain is unclear. The present study found that prior knee pain was significantly associated with knee pain five years later among the survivors of the GEJE. Further, the association was stronger in those with more episodes of prior knee pain. To our best knowledge, this study is the first to investigate the association of prior knee pain with subsequent episode of knee pain and to show that prior knee pain was significantly associated with knee pain five years later. Further, the association was significant irrespective of other potential confounding factors.

Some authors have reported the course of knee OA [9, 11, 12]. Most of these reports investigated new-onset or progressive changes of knee OA because OA changes are generally constant or advanced and not recovered. Felson et al. used an 8-year cohort study and showed that the prevalence of new-onset radiographic knee OA was 16.9% and progression of radiographic knee OA was 29.1%. Furthermore, the rate of new onset of symptomatic knee OA was 6.7%, which was lower than that of new-onset or progressive radiographic knee OA [11]. Muraki et al. also indicated that the correlation between knee pain and radiographic severity of knee OA is not as significant as expected [23]. Knee pain should be assessed with distinction from knee OA. However, in contrast with knee OA, the time course of knee pain has rarely been investigated. Miranda et al. investigated knee pain among the working population using a 1-year cohort study. The prevalence of knee pain was 23.4% at baseline and 24.3% 1 year later, and only 16.6% of the participants had knee pain at both points, indicating that knee pain was not always persistent [15]. In the current 5-year cohort study, the prevalence of knee pain gradually increased from 18.0%, 18.2%, and to 19.7%. However, only 6.2% of the participants had knee pain at all three time points. The results also indicated that knee pain in survivors after natural disasters was not consistent. As many as 34.7% of participants had knee pain at each time point, 19.6% had knee pain at one time point, and 8.8% had knee pain at two time points throughout the 5-year study period. Although pain was not consistent, knee pain was a common musculoskeletal symptom after the GEJE.

The present study showed that prior knee pain was associated with knee pain 5 years later. In a previous 1-year cohort study, 70.1% of the participants with knee pain at baseline had knee pain 1 year later [15]. Knee pain is frequently related to knee OA, especially in the elderly. It is often accompanied with pain and structural changes and is considered to be chronic [5, 24]. Further, OA changes are often seen in the bilateral knee, and these changes are related to lifestyle, indicating that mechanical stress on the knee depends on individuals [12]. The perception of pain severity is also subjective and varies among individuals [25]. Although the pain severity is rarely consistent, people who experience knee pain are presumed to have recurrent pain thereafter. In addition, our stratified analysis by age and sex showed a higher prevalence of knee pain among older and female individuals, consistent with previous studies [3, 5]. Furthermore, similar association between prior knee pain and knee pain 5 years later was seen among the groups, supporting the robustness of the results in this study. In addition, there have been no reports showing an association of the number of prior knee pain episodes with subsequent knee pain. This study demonstrated that higher episodes of prior knee pain had a stronger effect on subsequent knee pain. People with more knee pain episodes are considered to have a higher risk of knee pain thereafter. Although knee pain is associated with several factors, including psychosocial factors [24, 25], prior knee pain episodes are considered an important predictor of knee pain. Clinicians should pay attention to the risk of future knee pain when treating people with knee pain and consider preventive measures even if the present knee pain improves.

This study had some limitations. First, the response rate was not high. It was possible that responders were highly conscious of their health, which could have affected the results. Second, the intensity and cause of pain were not assessed. The recurrence rate of knee pain may depend on pain severity or the cause of pain, which should be considered in future studies. Finally, the participants of the present study lived in disaster-stricken areas. We did not compare them with those living in non-disaster areas and thus could not assess the effect of the natural disaster on knee pain.

In conclusion, prior knee pain was associated with subsequent knee pain. Further, the effect was stronger with more episodes of prior knee pain.

GEJE: Great East Japan Earthquake, OA: osteoarthritis, BMI: body mass index, OR: odds ratio, 95% CI: 95% confidence interval

Ethics approval and consent to participate:

This study was approved by the institutional review board of our institute (approval number: 201192). Written informed consent was obtained from all the participants.

Consent to publish:　

Not applicable

Availability of data and materials:

All relevant data are contained in this article.

Competing interests:

The authors declare no conflict of interest.

Funding statement:

Not applicable

Authors’ contributions:

YY, YH, and IT designed the study. YS, MT, and SY contributed to data collection. TS and YY performed statistical analysis. YY and YH wrote the manuscript. YS, MT, and IT helped to analyze the data.

Acknowledgements

This work was supported by the Health Sciences Research Grants (H24, 25-Kenki-Shintei-002 [Fukkou]) from the Ministry of Health, Labor, and Welfare of Japan.

Authors’ details:

¹Department of Orthopaedic Surgery, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. ²Division of Epidemiology, Department of Health informatics and Public Health, Tohoku University, Graduate School of Public Health, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan. ³Department of Nursing, Faculty of Health Science, Tohoku Fukushi University, 1-8-1, Kunimi, Aoba-ku, Sendai, Miyagi 981-8522, Japan.

Calmbach WL, Hutchens M: Evaluation of patients presenting with knee pain: Part I. History, physical examination, radiographs, and laboratory tests. Am Fam Physician. 2003;68(5):907–912. https://www.aafp.org/afp/2003/0901/p907.html.
Baker P, Reading I, Cooper C, Coggon D: Knee disorders in the general population and their relation to occupation. Occup Environ Med. 2003: 60(10):794–797. doi: 10.1136/oem.60.10.794.
Herquelot E, Bodin J, Petit A, Ha C, Leclerc A, Goldberg M, Zins M, Roquelaure Y, Descatha A: Long-term persistence of knee pain and occupational exposure in two large prospective cohorts of workers. BMC Musculoskelet Disord. 2014;15(1):411. doi: 10.1186/1471-2474-15-411.
Hagiwara Y, Sekiguchi T, Sugawara Y, Yabe Y, Koide M, Itaya N, Yoshida S, Sogi Y, Tsuchiya M, Tsuji I et al: Association between sleep disturbance and new-onset subjective knee pain in Great East Japan Earthquake survivors: A prospective cohort study in the Miyagi prefecture. J Orthop Sci. 2018;23(2):334–340. doi: 10.1016/j.jos.2017.10.011.
Blagojevic M, Jinks C, Jeffery A, Jordan KP: Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage. 2010;18(1):24–33. doi: 10.1016/j.joca.2009.08.010.
Sakakibara H, Zhu S-K, Furuta M, Kondo T, Miyao M, Yamada Sy, Hideaki T: Knee pain and its associations with age, sex, obesity, occupation and living conditions in rural inhabitants of Japan. Environ Health Prev Med. 1996;1(3):114–118. https://doi: 10.1007/BF02931201.
Lankhorst NE, Damen J, Oei EH, Verhaar JAN, Kloppenburg M, Bierma-Zeinstra SMA, van Middelkoop M: Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis Cartilage. 2017;25(5):647–653. doi: 10.1016/j.joca.2016.12.006.
Massardo L, Watt I, Cushnaghan J, Dieppe P: Osteoarthritis of the knee joint: an eight year prospective study. Ann Rheum Dis. 1989;48(11):893–897. doi: 10.1136/ard.48.11.893.
Muraki S, Akune T, Nagata K, Ishimoto Y, Yoshida M, Tokimura F, Tanaka S, Kawaguchi H, Nakamura K, Oka H et al: Does osteophytosis at the knee predict health-related quality of life decline? A 3-year follow-up of the ROAD study. Clin Rheumatol. 2015;34(9):1589–1597. https://doi: 10.1007/s10067-014-2687-y.
Thorstensson C, Andersson M, Jönsson H, Saxne T, Petersson I: Natural course of knee osteoarthritis in middle-aged subjects with knee pain: 12-year follow-up using clinical and radiographic criteria. Ann Rheum Dis. 2009;68(12):1890–1893. doi: 10.1136/ard.2008.095158.
Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman BN, Aliabadi P, Levy D: The incidence and natural history of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1995;38(10):1500–1505. doi: 10.1002/art.1780381017.
Muraki S, Akune T, Oka H, Ishimoto Y, Nagata K, Yoshida M, Tokimura F, Nakamura K, Kawaguchi H, Yoshimura N: Incidence and risk factors for radiographic knee osteoarthritis and knee pain in Japanese men and women: a longitudinal population-based cohort study. Arthritis Rheum. 2012;64(5):1447–1456. doi: 10.1002/art.33508.
Bastick AN, Wesseling J, Damen J, Verkleij SP, Emans PJ, Bindels PJ, Bierma-Zeinstra SM: Defining knee pain trajectories in early symptomatic knee osteoarthritis in primary care: 5-year results from a nationwide prospective cohort study (CHECK). Br J Gen Pract. 2016;66(642):e32-39. doi: 10.3399/bjgp15X688129.
Collins JE, Katz JN, Dervan EE, Losina E: Trajectories and risk profiles of pain in persons with radiographic, symptomatic knee osteoarthritis: data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2014;22(5):622–630. doi: 10.1016/j.joca.2014.03.009.
Miranda H, Viikari-Juntura E, Martikainen R, Riihimäki H: A prospective study on knee pain and its risk factors. Osteoarthritis Cartilage. 2002;10(8):623–630. doi: 10.1053/joca.2002.0796.
Gooberman-Hill R, Woolhead G, Mackichan F, Ayis S, Williams S, Dieppe P: Assessing chronic joint pain: lessons from a focus group study. Arthritis Rheum. 2007;57(4):666–671. doi: 10.1002/art.22681.
Yabuki S, Ouchi K, Kikuchi S, Konno S: Pain, quality of life and activity in aged evacuees living in temporary housing after the Great East Japan earthquake of 11 March 2011: a cross-sectional study in Minamisoma City, Fukushima prefecture. BMC Musculoskelet Disord. 2015;16:246. doi: 10.1186/s12891-015-0711-2.
Yabe Y, Hagiwara Y, Sekiguchi T, Sugawara Y, Tsuchiya M, Itaya N, Yoshida S, Sogi Y, Yano T, Onoki T et al: Musculoskeletal pain and new-onset poor physical function in elderly survivors of a natural disaster: a longitudinal study after the great East Japan earthquake. BMC Geriatr. 2019;19(1):274. doi: 10.1186/s12877-019-1283-z.
Sone T, Nakaya N, Sugawara Y, Tomata Y, Watanabe T, Tsuji I: Longitudinal association between time-varying social isolation and psychological distress after the Great East Japan Earthquake. Soc Sci Med. 2016;152:96–101. https://doi: 10.1016/j.socscimed.2016.01.037.
Yabe Y, Hagiwara Y, Sekiguchi T, Sugawara Y, Tsuchiya M, Koide M, Itaya N, Yoshida S, Sogi Y, Yano T et al: Higher Incidence of Sleep Disturbance among Survivors with Musculoskeletal Pain after the Great East Japan Earthquake: A Prospective Study. Tohoku J Exp Med. 2018;244(1):25–32. doi: 10.1620/tjem.244.25.
Suzuki Y, Fukasawa M, Obara A, Kim Y: Mental health distress and related factors among prefectural public servants seven months after the great East Japan Earthquake. J Epidemiol. 2014;24(4):287–294. doi: 10.2188/jea.je20130138.
Yabe Y, Hagiwara Y, Sekiguchi T, Sugawara Y, Tsuchiya M, Yoshida S, Sogi Y, Yano T, Onoki T, Takahashi T et al: Preceding Poor Physical Function Is Associated with New-Onset Musculoskeletal Pain among Older Natural Disaster Survivors: A Longitudinal Study after the Great East Japan Earthquake. Tohoku J Exp Med. 2020;251(1):19–26. doi: 10.1620/tjem.251.19.
Muraki S, Oka H, Akune T, Mabuchi A, En-yo Y, Yoshida M, Saika A, Suzuki T, Yoshida H, Ishibashi H et al: Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: the ROAD study. Osteoarthritis Cartilage. 2009;17(9):1137–1143. doi: 10.1016/j.joca.2009.04.005.
Zhang Y, Zhang B, Wise B, Niu J, Zhu Y: Statistical approaches to evaluating the effect of risk factors on the pain of knee osteoarthritis in longitudinal studies. Curr Opin Rheumatol. 2009;21(5):513–519. doi: 10.1097/BOR.0b013e32832ed69d.
Hutchings A, Calloway M, Choy E, Hooper M, Hunter DJ, Jordan JM, Zhang Y, Baser O, Long S, Palmer L: The Longitudinal Examination of Arthritis Pain (LEAP) study: relationships between weekly fluctuations in patient-rated joint pain and other health outcomes. J Rheumatol. 2007;34(11):2291–2300. https://www.jrheum.org/content/34/11/2291.long

No competing interests reported.

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A 5-Year Longitudinal Study of Knee Pain Among Natural Disaster Survivors

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Study design and participants

Knee pain

Covariates

Statistical analysis

Results

Discussion

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