Effect of BMI and Race on Clinical Outcomes and Spatio-Temporal Gait Characteristics in Adults With Knee Osteoarthritis: Analysis of the Baseline Data from the WE-CAN Randomized Clinical Trial

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Abstract

Introduction: In individuals with knee osteoarthritis (OA), higher body mass index (BMI) is associated with greater pain, reduced function, and poor health-related quality of life (HRQOL). Blacks with knee OA report worse clinical outcomes than whites with knee OA. Purpose: To determine the influence of BMI and race on clinical outcomes and spatio-temporal gait characteristics in older, overweight, and obese adults with knee OA.

Methods: This is a cross-sectional analysis of 823 overweight and obese adults with knee OA. ANOVAs, pairwise comparisons, and t-tests were used to compare means between obesity categories and racial groups. General linear models were used to examine if differences in pain and function remained after adjusting for covariates.

Results: The class III obese participants (BMI>40.0 kg/m²) compared to the class II (BMI=35.0- 39.9 kg/m²) and overweight/class I (BMI=27.0-34.9 kg/m²) participants had worse mean WOMAC pain (p<0.001), worse mean WOMAC function (p<0.001), and shorter mean 6-minute walk distance (p<0.001). Class III obese participants also had distinct spatio-temporal gait characteristics including slower walking velocity (p<0.001), decreased stride length (p< 0.001), wider base of support (p<0.001), increased stance time (p<0.001), decreased swing time (p<0.001), and greater foot abduction (p<0.001). Black participants had worse mean WOMAC pain (p<0.001), worse mean WOMAC function (p=0.005), and shorter mean 6-minute walk distance (p<0.001) than whites. Black participants had slower walking velocity (p<0.001), decreased stride length (p<0.001), wider base of support (p<0.001), increased stance time (p<0.001), and greater foot abduction (p<0.001). Racial differences in WOMAC pain and function were not significant when controlling for BMI (p = 0.06).

Conclusions: Patients in the highest BMI category had the highest pain levels, poorest function, and worst mobility. Racial differences in clinical outcomes were explained by BMI, education level, depressive symptoms, and age (function only) but not by gender or clinical OA symptoms.

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