0910 Sleep-pain Behaviors Predict Insomnia, Pain, and Physical Function over One Year Following Total Knee Arthroplasty in Individuals with Knee Osteoarthritis
Bibliographic record
Abstract
Cognitive behavioral theory for insomnia posits that maladaptive efforts to cope with pain, such as retiring to the bed/bedroom when in pain and taking extra pain medications to promote sleep, paradoxically contribute to persistent insomnia, a known risk factor for pain chronification. The present study evaluated sleep-pain behaviors and their concurrent and longitudinal associations with insomnia, pain, and physical function in individuals with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA). Secondary analyses examined insomnia as a mediator between sleep-pain behaviors and functional outcomes. Participants were 109 individuals (Age: M=63.9; SD=8.8; 54% female) with KOA scheduled to undergo TKA. Measures were collected at baseline and at 6 (n=73), 13 (n=73), 26 (n=87), and 52 (n=107) weeks following TKA. Measures included: the 3-item Sleep-Pain Behaviors Survey (SPBS); the Insomnia Severity Index (ISI); actigraphy (sleep onset latency [SOL], sleep efficiency [SE%], wake after sleep onset [WASO], and total sleep time [TST]); the Brief Pain Inventory (BPI); and the Physical Function subscale from the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Analyses used linear mixed-effects regression analyses, controlling for time, concurrent depression, and concurrent levels of each outcome. Beyond its concurrent association with ISI (B=1.12, p<.001), WASO (B=2.50, p=.02), BPI (B=0.32, p<.001), and WOMAC (B=3.39, p<.001), the SPBS was a longitudinal predictor of ISI (B=0.42, p=.03), SOL (B=3.19, p=.04), BPI (B=0.16, p<.01), and WOMAC (B=1.71, p<.01). ISI significantly mediated the relationship between SPBS and both pain (BPI: concurrent 95% CI [0.04, 0.11]; longitudinal: 95% CI [0.01, 0.07]) and physical function (WOMAC: concurrent 95% CI [0.52, 1.36]; longitudinal 95% CI: [.04,0.74]). For individuals with KOA, behavioral interventions focused on reducing sleep-pain behaviors may offer the potential to reduce insomnia, thereby improving pain and physical function outcomes following TKR. R01AG034982 (PI: RR Edwards).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".