A multistate transition model for osteoarthritis pain change

Pain severity of knees is assessed using an ordinal scale in patients with musculoskeletal diseases and often changes over time. Assessment of the effect of a particular risk factor on the change in pain severity will shed light on our understanding of biological mechanisms and provide guidance for rational clinical intervention for recurrent pain. The multistate transition model allows transitions between several different states of pain severity and estimates the transitional intensity using an extension of the Cox proportional hazards model. Using data from a longitudinal study, we applied this model to assess the relation of two psychological factors to the change in knee pain severity over time among patients with osteoarthritis and demonstrated that the multistate transition model can be a valuable tool for rheumatic disease studies.