• Ali Kiadaliri, Helena Hörder, L Stefan Lohmander, and Leif E Dahlberg.
• Department of Clinical Sciences Lund, Orthopaedics, Lund University, 221 85 Lund, Sweden.
• Pain Med. 2024 Apr 3; 25 (4): 291299291-299.

ObjectiveDigital self-management programs are increasingly used in the management of osteoarthritis (OA). Little is known about heterogeneous patterns in response to these programs. We describe weekly pain trajectories of people with knee or hip OA over up to 52-week participation in a digital self-management program.MethodsObservational cohort study among participants enrolled between January 2019 and September 2021 who participated at least 4 and up to 52 weeks in the program (n = 16 274). We measured pain using Numeric Rating Scale (NRS 0-10) and applied latent class growth analysis to identify classes with similar trajectories. Associations between baseline characteristics and trajectory classes were examined using multinomial logistic regression and dominance analysis.ResultsWe identified 4 pain trajectory classes: "mild-largely improved" (30%), "low moderate-largely improved" (34%), "upper moderate-improved" (24%), and "severe-persistent" (12%). For classes with decreasing pain, the most pain reduction occurred during first 20 weeks and was stable thereafter. Male sex, older age, lower body mass index (BMI), better physical function, lower activity impairment, less anxiety/depression, higher education, knee OA, no walking difficulties, no wish for surgery and higher physical activity, all measured at enrolment, were associated with greater probabilities of membership in "mild-largely improved" class than other classes. Dominance analysis suggested that activity impairment followed by wish for surgery and walking difficulties were the most important predictors of trajectory class membership.ConclusionsOur results highlight the importance of reaching people with OA for first-line treatment prior to developing severe pain, poor health status and a wish for surgery.© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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