1
|
Cijs B, Stekelenburg R, Veenhof C, Knoop J, Boymans T, de Rooij M, Kloek C. Prognostic Factors and Changes in Pain, Physical Functioning, and Participation in Patients With Hip and/or Knee Osteoarthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2024. [PMID: 39228051 DOI: 10.1002/acr.25428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 08/01/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024]
Abstract
OBJECTIVE This study aimed to systematically synthesize literature on prognostic factors of changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation in patients with knee and/or hip osteoarthritis (OA). METHODS Studies included in two preceding reviews underwent full-text screening for inclusion in the current review. Additionally, an extensive literature search was conducted in five databases. Title/abstract screening was performed using an active learning program. Inclusion criteria comprised patients diagnosed with knee and/or hip OA, with the dependent variable assessing pain, physical functioning, or participation. Potential associated prognostic factors were measured as independent variables. The methodologic quality of studies was assessed with the Hayden criteria. RESULTS A total of 31 studies were included in this systematic review. In patients with knee OA, pain worsening was associated with lower physical functioning (strong evidence) and with higher body mass index, ethnicity, and a higher comorbidity count (moderate evidence). Also, in patients with knee OA, pain improvement was associated with less pain at baseline (moderate evidence). In patients with knee and/or hip OA, worsening of physical functioning exhibited associations with higher body mass index, more pain, more hip pain, a higher comorbidity count, higher avoidance of activities (strong evidence), and ethnicity (moderate evidence). In patients with knee OA, improvement in physical functioning showed an association with higher vitality (moderate evidence). Regarding the remaining prognostic factors, there is weak, inconclusive, or inconsistent evidence for an association with the outcomes. In patients with hip OA, only weak evidence was found for three factors predicting a change in physical functioning. CONCLUSION This review encompasses prognostic factors associated with changes in either direction (ie, worsening or improvement) in pain, physical functioning, and participation. The results are consistent with other reviews. Future research should place a stronger emphasis on patients with hip OA and participation as an outcome.
Collapse
Affiliation(s)
- Bastiaan Cijs
- University Medical Centre Utrecht and Hogeschool Utrecht (HU) University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | | | - Cindy Veenhof
- University Medical Centre Utrecht and HU University of Applied Sciences Utrecht, Utrecht, and Reade, Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| | - Jesper Knoop
- University of Applied Sciences, Nijmegen, and Vrije Universiteit, Amsterdam, The Netherlands
| | - Tim Boymans
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mariëtte de Rooij
- University Medical Centre Utrecht, and Reade, Center for Rehabilitation and Rheumatology, Amsterdam, The Netherlands
| | - Corelien Kloek
- HU University of Applied Sciences Utrecht and Leidsche Rijn Julius Health Care Centers, Utrecht, The Netherlands
| |
Collapse
|
2
|
Runhaar J, van Berkel AC, Agricola R, van Meurs J, Bierma-Zeinstra SMA. Risk Factors and Population-Attributable Fractions for Incident Hip Osteoarthritis. HSS J 2023; 19:407-412. [PMID: 37937087 PMCID: PMC10626934 DOI: 10.1177/15563316231192461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 11/09/2023]
Abstract
Background Despite the huge burden of hip osteoarthritis (OA) and the lack of effective treatment, research into the primary prevention of hip OA is in its infancy. Purpose We sought to evaluate risk factors for incident clinical and incident radiographic hip OA among middle-aged and older adults, to evaluate the importance of risk factors from a preventive perspective, and to estimate the percentage of new cases attributable to these risk factors. Methods We retrospectively reviewed data from the Rotterdam study, an open-population cohort study of individuals aged 55 years or older. Data including baseline age, sex, body mass index, smoking status, education level, diagnosis of diabetes, C-reactive protein (CRP), cam morphology, acetabular dysplasia, radiographic thumb OA, radiographic hip OA, and hip pain were assessed for their association with incident clinical hip OA and incident radiographic hip OA separately, after 11 years of follow-up. The population-attributable fractions (PAFs) of statistically significant modifiable risk factors were calculated, as well. Results New onset of clinical hip OA was seen in 19.9% (544 of 2729) and incident radiographic hip OA in 9.9% (329 of 3309). Female sex, education level below average (PAF 21.4%), and radiographic hip OA (PAF 3.4%) were statistically significantly associated with incident clinical hip OA. Female sex, age, overweight (PAF 20.0%), cam morphology (PAF 7.9%), acetabular dysplasia (PAF 3.6%), and radiographic thumb OA (PAF 4.7%) were statistically significantly associated with radiographic hip OA. Conclusions Our retrospective analysis suggests that, from a primary prevention perspective, the most important modifiable risk factors among middle-aged and older individuals may be low educational level for incident clinical hip OA and overweight for incident radiographic hip OA. Further study is warranted.
Collapse
Affiliation(s)
- Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemaria C van Berkel
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rintje Agricola
- Department of Orthopedics & Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Orthopedic Surgery, St Anna Hospital, Geldrop, the Netherlands
| | - Joyce van Meurs
- Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Orthopedics & Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gløersen M, Kvien TK, Magnusson K, Haugen IK. Comorbidities in people with hand OA and their associations with pain severity and sensitization: Data from the longitudinal Nor-Hand study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100367. [PMID: 37234862 PMCID: PMC10206186 DOI: 10.1016/j.ocarto.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Objective To determine whether the comorbidity burden and co-existing comorbidities are cross-sectionally and/or longitudinally associated with pain and pain sensitization in a cohort study of people with hand OA. Design We examined whether comorbidity burden and individual comorbidities based on the self-administered Comorbidity Index (range: 0-42) at baseline were associated with pain outcomes at baseline and 3 years follow-up. Pain outcomes included hand and overall bodily pain (range: 0-10) as well as pressure pain thresholds at the tibialis anterior muscle (kg/cm2) and temporal summation (distal radioulnar joint) as measures of central pain sensitization. We performed linear regression analyses adjusted for age, sex, body mass index, physical exercise and education. Results We included 300 and 196 participants in cross-sectional and longitudinal analyses, respectively. Using baseline data, the burden of comorbidities was associated with greater pain in hands (beta = 0.61, 95% CI 0.37, 0.85) and overall body (beta = 0.60, 95% CI 0.37, 0.87). Similar strength of associations was found between comorbidity burden (baseline) and follow-up pain. Among the individual comorbidities, back pain and depression were associated with nearly one unit higher pain score in hands and overall body at both baseline and follow-up. Only back pain was related to lower pressure pain thresholds at follow up (beta = -0.24, 95% CI -0.50, -0.001). Conclusion People with hand OA and greater comorbidity burden, co-existing back pain or depression reported greater pain severity than their counterparts, also 3 years later. These results acknowledge the relevance of accounting for comorbidities in the pain experience in people with hand OA.
Collapse
Affiliation(s)
- Elisabeth Mulrooney
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, United States
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille Steen Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Marthe Gløersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K. Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ida K. Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
4
|
Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
Collapse
Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
5
|
Santiago MS, Aidar FJ, dos Santos Moraes TL, de Farias Neto JP, Vieira Filho MC, de Vasconcelos DP, Leite VS, Doria FM, Sobral Porto E, Albuquerque Madruga RETT, de Azevedo DER, Barreto AP, Gomes MV, de Almeida-Neto PF, de Araújo Tinôco Cabral BG, da Silva Júnior WM. The Management between Comorbidities and Pain Level with Physical Activity in Individuals with Hip Osteoarthritis with Surgical Indication: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:890. [PMID: 34577813 PMCID: PMC8470884 DOI: 10.3390/medicina57090890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: The degenerative pathology of the hip joint appears in young age groups, related to fem-oroacetabular impingement, and in advanced age, due to other inflammatory causes, with greater potential for severity in the presence of comorbidities. Objectives: To evaluate the participation of the main causes of osteoarthritis in relation to physical activities, s Body Mass Index (BMI) and television time (TV). Materials and Methods: 54 patients with surgical indication treated at an orthopedic referral university hospital were stratified into groups (Impact: I, Osteonecrosis/rheumatic: II, Infectious/traumatic: III), and the influence of comorbidities on physical activity performance, relative to BMI and TV time. Results: It was observed that the impact group was the most frequent (51.8%), with 79.6% under the age of 60 years. This group followed the general mean (p < 0.05), using the variables of comorbidity and the level of physical activity. Pain intensity, TV time, BMI showed no correlation with physical activity. Conclusion: Morphostructural changes (group I) represented the most frequent etiological group, and severe pain was common in almost the entire sample. Unlike BMI, comorbidity showed a significant relationship with the level of physical activity.
Collapse
Affiliation(s)
- Michael Silveira Santiago
- Program of Physical Education, University Hospital of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.S.S.); (T.L.d.S.M.); (D.P.d.V.); (D.E.R.d.A.); (W.M.d.S.J.)
- Department of Physical Therapy, University Hospital of Sergipe (UFS), São Cristovão 49060-025, SE, Brazil;
| | - Felipe J. Aidar
- Program of Physical Education, University Hospital of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.S.S.); (T.L.d.S.M.); (D.P.d.V.); (D.E.R.d.A.); (W.M.d.S.J.)
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (V.S.L.); (F.M.D.)
- Department of Physical Education, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil
- Program of Physiological Science, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil
| | - Talita Leite dos Santos Moraes
- Program of Physical Education, University Hospital of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.S.S.); (T.L.d.S.M.); (D.P.d.V.); (D.E.R.d.A.); (W.M.d.S.J.)
| | | | - Mário Costa Vieira Filho
- Department of Medicine, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.C.V.F.); (R.E.T.T.A.M.)
| | - Diego Protásio de Vasconcelos
- Program of Physical Education, University Hospital of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.S.S.); (T.L.d.S.M.); (D.P.d.V.); (D.E.R.d.A.); (W.M.d.S.J.)
| | - Victor Siqueira Leite
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (V.S.L.); (F.M.D.)
| | - Felipe Meireles Doria
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (V.S.L.); (F.M.D.)
| | - Erick Sobral Porto
- Department of Medicine, Tiradentes University (UNIT), Aracaju 49032-490, SE, Brazil;
| | | | - David Edson Ramos de Azevedo
- Program of Physical Education, University Hospital of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.S.S.); (T.L.d.S.M.); (D.P.d.V.); (D.E.R.d.A.); (W.M.d.S.J.)
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (V.S.L.); (F.M.D.)
| | - Adonai Pinheiro Barreto
- Department of Orthopaedics, University Hospital, Federal University of Sergipe (UFS), Aracaju 49060-025, SE, Brazil;
| | - Marcel Vieira Gomes
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
| | - Paulo Francisco de Almeida-Neto
- Health Sciences Center, Federal University of Rio Grande do Norte, CCS-UFRN, Natal 59012-570, RN, Brazil; (P.F.d.A.-N.); (B.G.d.A.T.C.)
- Department of Physical Education, Federal University of Rio Grande do Norte, DEF-UFRN, Natal 59078-970, RN, Brazil
| | - Breno Guilherme de Araújo Tinôco Cabral
- Health Sciences Center, Federal University of Rio Grande do Norte, CCS-UFRN, Natal 59012-570, RN, Brazil; (P.F.d.A.-N.); (B.G.d.A.T.C.)
- Department of Physical Education, Federal University of Rio Grande do Norte, DEF-UFRN, Natal 59078-970, RN, Brazil
| | - Walderi Monteiro da Silva Júnior
- Program of Physical Education, University Hospital of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.S.S.); (T.L.d.S.M.); (D.P.d.V.); (D.E.R.d.A.); (W.M.d.S.J.)
- Department of Physical Therapy, University Hospital of Sergipe (UFS), São Cristovão 49060-025, SE, Brazil;
| |
Collapse
|
6
|
Abstract
Background Patient-reported outcome measures (PROMs) are increasingly integrated into reporting requirements tied to reimbursement. There may be advantages to computer adaptive tests that apply to many different anatomical regions and diseases, provided that important information is not lost. Questions 1) Does the Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF) computer adaptive test correlate with the Hip injury and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR: a hip-specific PROM); 2) Is there any difference in the amount of variation explained by various factors (e.g. age, BMI, presence of concomitant knee pain) for both measures? Methods In this prospective, cross-sectional study of 213 patients, we assessed the Pearson correlation of PROMIS PF and HOOS, JR. To investigate the variation explained by various patient-level factors, we constructed two multivariable linear regression models. Results We found a large correlation between PROMIS PF and HOOS, JR (r 0.58, P < 0.001). Disabled or unemployed status was independently associated with both lower PROMIS PF and HOOS, JR scores (regression coefficient [β] -3.4; 95% confidence interval [CI] -5.8 to -1.0; P = 0.006 and β -11; 95% CI -17 to -5.0; P < 0.001, respectively). Private rather than public insurance was associated with both higher PROMIS PF and HOOS, JR scores (β 4.5; 95% CI 2.2 to 6.8; P < 0.001 and β 6.4; 95% CI 0.49 to 12; P = 0.034, respectively). No floor or ceiling effects were observed for PROMIS PF. HOOS, JR scores showed 4.2% floor and 0.5% ceiling effect. Conclusions This study adds to the evidence that general measures of physical limitations may provide similar information as joint- or region-specific measures. Level of evidence Level III.
Collapse
|
7
|
Teirlinck CH, Dorleijn DMJ, Bos PK, Rijkels-Otters JBM, Bierma-Zeinstra SMA, Luijsterburg PAJ. Prognostic factors for progression of osteoarthritis of the hip: a systematic review. Arthritis Res Ther 2019; 21:192. [PMID: 31443685 PMCID: PMC6708123 DOI: 10.1186/s13075-019-1969-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Predicting which patients with hip osteoarthritis are more likely to show disease progression is important for healthcare professionals. Therefore, the aim of this review was to assess which factors are predictive of progression in patients with hip osteoarthritis. Methods A literature search was made up until 14 March 2019. Included were cohort and case-control studies evaluating the association between factors and progression (either clinical, radiological, or THR). Excluded were studies with a follow-up < 1 year or specific underlying pathologies of osteoarthritis. Risk of bias was assessed using the QUIPS tool. A best-evidence synthesis was conducted. Results We included 57 articles describing 154 different factors. Of these, a best-evidence synthesis was possible for 103 factors, separately for clinical and radiological progression, and progression to total hip replacement. We found strong evidence for more clinical progression in patients with comorbidity and more progression to total hip replacement for a higher Kellgren and Lawrence grade, superior or (supero) lateral femoral head migration, and subchondral sclerosis. Strong evidence for no association was found regarding clinical progression for gender, social support, pain medication, quality of life, and limited range of motion of internal rotation or external rotation. Also, strong evidence for no association was found regarding radiological progression for the markers CTX-I, COMP, NTX-I, PINP, and PIIINP and regarding progression to total hip replacement for body mass index. Conclusion Strong evidence suggested that 4 factors were predictive of progression of hip osteoarthritis, whereas 12 factors were not predictive of progression. Evidence for most of the reported factors was either limited or conflicting. Protocol registration PROSPERO, CRD42015010757 Electronic supplementary material The online version of this article (10.1186/s13075-019-1969-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- C H Teirlinck
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - D M J Dorleijn
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - P K Bos
- Department of Orthopedics, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - J B M Rijkels-Otters
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Orthopedics, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - P A J Luijsterburg
- Department of General Practice, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| |
Collapse
|
8
|
Tateuchi H, Akiyama H, Goto K, So K, Kuroda Y, Ichihashi N. Gait- and Posture-Related Factors Associated With Changes in Hip Pain and Physical Function in Patients With Secondary Hip Osteoarthritis: A Prospective Cohort Study. Arch Phys Med Rehabil 2019; 100:2053-2062. [PMID: 31054296 DOI: 10.1016/j.apmr.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/13/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify gait- and posture-related factors associated with changes in hip pain and physical function in patients with hip osteoarthritis (OA). DESIGN Prospective cohort study. SETTING Clinical biomechanics laboratory of a university. PARTICIPANTS Consecutive sampling of female patients with mild-to-moderate secondary hip OA (N=30). MAIN OUTCOME MEASURES Hip pain (visual analog scale) and physical function (physical component summary of the Medical Outcomes Study 36-Item Short-Form Health Survey) were measured at baseline and 12 months later. With changes in hip pain and physical function as dependent variables, linear regression analyses were performed with gait- and posture-related factors as independent variables with and without adjustment for age, joint space width, and hip pain or physical function at baseline. Posture-related factors included angles of thoracic kyphosis, lumbar lordosis, sacral inclination, spinal inclination, and spinal mobility. Gait-related factors were walking speed, steps per day, joint angles, external hip joint moment impulses, and daily cumulative hip moments. RESULTS Multiple linear regression analyses showed that limited hip extension (adjusted standardized B coefficient [95% confidence interval]: -0.52 [-0.88 to -0.17]) and limited external rotation angles (-0.51 [-0.85 to -0.18]) during walking were associated with the worsening of hip pain. An increased thoracic kyphosis (-0.54 [-0.99 to -0.09]), less sacral anterior tilt (0.40 [0.01-0.79]), reduced thoracic spine mobility (0.59 [0.23-0.94]), less steps per day (0.53 [0.13-0.92]), and a slower walking speed (0.45 [0.04-0.86]) were associated with deterioration in physical function. CONCLUSIONS Gait- and posture-related factors should be considered when assessing risk and designing preventive interventions for the clinical progression of secondary hip OA.
Collapse
Affiliation(s)
- Hiroshige Tateuchi
- Department of Preventive Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, School of Medicine, Gifu University, Gifu, Japan
| | - Koji Goto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka So
- Department of Orthopaedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Yutaka Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
9
|
Carlton L, Maccio JR, Maccio JG, McGowan C. The application of mechanical diagnosis and therapy on hip osteoarthritis: A case report. Physiother Theory Pract 2018; 36:347-357. [PMID: 29924661 DOI: 10.1080/09593985.2018.1485194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: The prevalence and cost of hip osteoarthritis (OA) is rising. Mechanical diagnosis and therapy (MDT) is an orthopedic classification and treatment system based on mechanical and symptomatic response to repeated and sustained end-range movements. There has been no investigation of the association between MDT and patients diagnosed with hip OA. Case Description: This case report presents a 71-year-old female diagnosed with hip OA and matching the currently accepted clinical prediction rule (CPR) for symptomatic hip OA. The patient was classified and treated by a Diplomat of MDT and co-examiner using MDT. Outcomes: Short- and long-term (13 months) outcomes were excellent, demonstrating rapid abolishment of symptoms and improvement in function in 5 visits over 21 days. The patient demonstrated the ability to prevent and manage reoccurrence of symptoms independently; nevertheless, she received a total hip replacement which was not in accordance with current guidelines and recommendations. Conclusion: This case report raises questions about whether or not pathologies traditionally associated with the etiology of hip OA are actually at fault. Moreover, it raises questions about the utility of special tests and CPRs typically utilized to identify those structures. The case report provides preliminary evidence from one patient that MDT may be capable of providing effective short- and long-term outcomes in the management of hip OA.
Collapse
|
10
|
Presence of comorbidities and prognosis of clinical symptoms in knee and/or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 47:805-813. [DOI: 10.1016/j.semarthrit.2017.10.016] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/26/2017] [Accepted: 10/23/2017] [Indexed: 02/06/2023]
|
11
|
Kolber MJ, Hanney WJ, Cheatham SW, Salamh PA. Risk Factors for Hip Osteoarthritis: Insight for the Strength and Conditioning Professional. Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Ernstgård A, PirouziFard M, Thorstensson CA. Health enhancing physical activity in patients with hip or knee osteoarthritis - an observational intervention study. BMC Musculoskelet Disord 2017; 18:42. [PMID: 28122519 PMCID: PMC5267429 DOI: 10.1186/s12891-017-1394-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 01/11/2017] [Indexed: 01/04/2023] Open
Abstract
Background Osteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity. Methods An observational study was conducted using data from a National Quality Registry in which 6810 patients in primary care with clinically verified hip or knee osteoarthritis with complete data at baseline, 3 and 12 months follow-up before December 31st 2013 were included. HEPA was defined as self-reported physical activity of at least moderate intensity either a) at least 30 min per day on four days or more per week, or b) at least 150 min per week. HEPA was assessed at baseline, and again at 3 and 12 months follow-up. Cochran’s Q test was used to determine change in physical activity over time. The association between reaching the level of HEPA and time, age, BMI, gender, and Charnley classification was investigated using the generalized estimation equation (GEE) model. Results The proportion of patients who reached the level of HEPA increased by 345 patients, from 77 to 82%, from baseline to 3 months follow-up. At 12 months, the proportion of patients who reached the level of HEPA decreased to 76%. Not reaching the level of HEPA was associated with overweight, obesity, male gender and Charnley category C, i.e. osteoarthritis in multiple joint sites (hip and knee), or presence of any other disease that affects walking ability. Conclusions Following the supported osteoarthritis self-management programme there was a significant increase in the proportion of patients who reached the recommended level of HEPA after 3 months. Improvements were lost after 12 months. To increase physical activity and reach long-lasting changes in levels of physical activity, more follow-up sessions might be needed.
Collapse
Affiliation(s)
- Anna Ernstgård
- Linneaus University, Kalmar, Sweden. .,Capio Artro Clinic AB, Box 5606, Stockholm, SE-114 86, Sweden.
| | | | - Carina A Thorstensson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,BOA-registry, Centre of Registers Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
13
|
Wetterholm M, Turkiewicz A, Stigmar K, Hubertsson J, Englund M. The rate of joint replacement in osteoarthritis depends on the patient's socioeconomic status. Acta Orthop 2016; 87:245-51. [PMID: 26982799 PMCID: PMC4900082 DOI: 10.3109/17453674.2016.1161451] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Assessment of potential disparities in access to care is a vital part of achieving equity in health and healthcare. We have therefore studied the effect of socioeconomic status (SES) on the rates of knee and hip replacement due to osteoarthritis. Methods - This was a cohort study in Skåne, Sweden. We included all residents aged ≥ 35 years with consultations between 2004 and 2013 for hip or knee osteoarthritis. We retrieved individual information on income, education, and occupation and evaluated the rates of knee and hip replacement according to SES, with adjustment for age and sex. Professionals, legislators, senior officials, and managers, and individuals with the longest education, served as the reference group. Results - We followed 50,498 knee osteoarthritis patients (59% women) and 20,882 hip osteoarthritis patients (58% women). The mutually adjusted rate of knee replacement was lower in those with an elementary occupation (hazard ratio (HR) = 0.81, 95% CI: 0.72-0.92), in craft workers and those with related trades (HR = 0.88, CI: 0.79-0.98), and in skilled agricultural/fishery workers (HR = 0.83, CI: 0.72-0.96), but higher in the 2 least educated groups (HR = 1.2 in both). The rate of hip replacement was lower in those with an elementary occupation (HR = 0.77, 95% CI: 0.68-0.87), in plant and machine operators/assemblers (HR = 0.83, CI: 0.75-0.93), and service workers/shop assistants (HR = 0.88, CI: 0.80-0.96). The rate of hip replacement was higher in the highest income group (HR = 1.1, 95% CI: 1.0-1.2). Interpretation - There was a lower rate of joint replacement in osteoarthritis patients working in professions often associated with lower socioeconomic status, suggesting inequity in access to care. However, the results are not unanimous, as the rate of knee replacement was higher in the least educated groups.
Collapse
Affiliation(s)
- Malin Wetterholm
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,,Correspondence:
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,
| | | | - Jenny Hubertsson
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University,,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| |
Collapse
|
14
|
Steinhilber B, Haupt G, Miller R, Grau S, Janssen P, Krauss I. Stiffness, pain, and hip muscle strength are factors associated with self-reported physical disability in hip osteoarthritis. J Geriatr Phys Ther 2015; 37:99-105. [PMID: 24406707 DOI: 10.1519/jpt.0b013e3182abe7b5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Physical disability (PD) is common among patients with osteoarthritis (OA) of the hip. Exercise therapy is proposed to be a potential intervention to reduce PD. However, the optimal targets of an exercise program are not known. PURPOSE The aim of the present study was to identify factors that explain the level of self-reported PD in patients with hip OA. Knowledge of these factors will help develop specific and effective exercise programs. METHODS Data from 149 patients with hip OA (85 men and 64 women) were analyzed. Self-reported PD was quantified using the physical function subscale of the Western Ontario and McMaster index. A stepwise regression analysis was conducted to identify significant factors associated with self-reported PD. RESULTS Stiffness, pain, and hip muscle strength were found to be significant factors related to the level of self-reported PD in hip OA. These factors explained 59% (r adjusted = 0.59) of the variance. Body mass index, gender, age, and passive internal hip rotation and flexion range of motion explained only minor parts of the dependent variable self-reported PD. DISCUSSION AND CONCLUSION Stiffness, pain, and hip muscle strength are associated with self-reported PD in hip OA. It is imperative that exercise treatments for hip OA include strategies to modify these factors. Further research should evaluate their role in preventing hip OA.
Collapse
Affiliation(s)
- Benjamin Steinhilber
- 1Medical Clinic, Department of Sports Medicine, University of Tübingen, Tuebingen, Germany. 2University of Gothenburg, Department of Food and Nutrition, and Sport Science Biomechanics, Göteborg, Schweden
| | | | | | | | | | | |
Collapse
|
15
|
Zeni J, Abujaber S, Pozzi F, Raisis L. Relationship between strength, pain, and different measures of functional ability in patients with end-stage hip osteoarthritis. Arthritis Care Res (Hoboken) 2015; 66:1506-12. [PMID: 24664893 DOI: 10.1002/acr.22329] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Performance tests and self-reported questionnaires capture different domains of function in patients with lower extremity osteoarthritis, but the impairments related to each of these domains have not been elucidated. The purpose of this study was to determine how strength and joint pain influence performance-based tests and self-reported questionnaires of functional ability of individuals with end-stage hip osteoarthritis. METHODS Fifty-six patients scheduled to undergo unilateral total hip arthroplasty were included in this cross-sectional analysis. Subjects completed the Hip Outcome Survey (HOS) and pain in the affected hip was quantified on a scale from 0-10. Performance-based tests included the Six-Minute Walk Test (6MWT), the Timed Up & Go (TUG), and the Stair Climbing Test (SCT). Isometric strength of the hip abductors and knee extensors was tested and recorded. Hierarchical linear regressions were created to determine the contributions of pain, knee extensor strength, and hip strength for each outcome measure (TUG, 6MWT, SCT, and HOS). Height and body mass index were entered first, followed by pain, then knee extensor strength, and then hip abduction strength. RESULTS Greater pain significantly predicted lower HOS scores, but hip strength did not significantly improve the model. Hip pain was also significantly related to TUG, SCT, and 6MWT values, but hip and knee strength explained additional variance for these performance-based measures. CONCLUSION Self-report and performance-based measures capture different aspects of disability and are influenced by different underlying impairments. Both types of outcome measures should be used in studies that evaluate functional changes in patients with hip osteoarthritis.
Collapse
|
16
|
|
17
|
Greene ME, Rolfson O, Nemes S, Gordon M, Malchau H, Garellick G. Education attainment is associated with patient-reported outcomes: findings from the Swedish Hip Arthroplasty Register. Clin Orthop Relat Res 2014; 472:1868-76. [PMID: 24549772 PMCID: PMC4016468 DOI: 10.1007/s11999-014-3504-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 02/03/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Age, sex, and medical comorbidities may be associated with differences in patient-reported outcome scores after THA. Highest level of education may be a surrogate for socioeconomic status, but the degree to which this is associated with patient-reported outcomes after THA is not known. QUESTIONS/PURPOSES We investigated the national Swedish Hip Arthroplasty Register for the association of education attainment on patient-reported outcomes 1 year after THA; specifically, we evaluated level of education attainment against health-related quality of life (HRQoL), pain reduction, and satisfaction with treatment 1 year after THA. METHODS All THAs for osteoarthritis performed from 2005 through 2007 with complete patient-reported outcome measures (representing 49% of the THAs performed for this diagnosis) were selected from the Swedish Hip Arthroplasty Register. These cases were merged with national databases containing education attainment, marital status, and comorbidities (n = 11,464; mean age of patients, 64 years). The patient-reported outcome measure protocol included the HRQoL measure EuroQol five-dimension scale (EQ-5D), a VAS for pain, the Charnley classification survey, and a VAS addressing THA satisfaction. Linear regression analyses determined the association of preoperative patient factors with patient-reported outcomes. RESULTS High education attainment was associated with higher HRQoL (EQ-5D index ß(high) = 0.03 ± 0.01; EQ VAS ß(high) = 2.6 ± 0.5) after THA, whereas those with low and medium education were at risk for lower HRQoL. High education was associated with less pain after treatment (ß(high) = -3.3 ± 0.05). Individuals with low or medium education were at risk for less satisfaction with THA (p < 0.001). CONCLUSIONS Our results suggest clinicians should support patients with low and medium education to a greater extent. Identification of patients who will benefit most from THA and educating those at risk for poorer outcomes, like patients with low and medium education, ultimately may improve patient satisfaction, HRQoL, pain, and the cost utility of THA. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Meridith E. Greene
- />Swedish Hip Arthroplasty Register, Gothenburg, Sweden , />Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA 02114 USA , />Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Rolfson
- />Swedish Hip Arthroplasty Register, Gothenburg, Sweden , />Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Szilard Nemes
- />Swedish Hip Arthroplasty Register, Gothenburg, Sweden
| | - Max Gordon
- />Swedish Hip Arthroplasty Register, Gothenburg, Sweden , />Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Henrik Malchau
- />Swedish Hip Arthroplasty Register, Gothenburg, Sweden , />Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA 02114 USA , />Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Garellick
- />Swedish Hip Arthroplasty Register, Gothenburg, Sweden , />Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
18
|
Cleveland RJ, Luong MLN, Knight JB, Schoster B, Renner JB, Jordan JM, Callahan LF. Independent associations of socioeconomic factors with disability and pain in adults with knee osteoarthritis. BMC Musculoskelet Disord 2013; 14:297. [PMID: 24134116 PMCID: PMC3906978 DOI: 10.1186/1471-2474-14-297] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/11/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study is to explore the relationship between function, pain and stiffness outcomes with individual and community socioeconomic status (SES) measures among individuals with radiographic knee osteoarthritis (rOA). METHODS Cross-sectional data from the Johnston County Osteoarthritis Project were analyzed for adults age 45 and older with knee rOA (n = 782) and a subset with both radiographic and symptomatic knee OA (n = 471). Function, pain and stiffness were measured using the Western Ontario and McMasters Universities Index of Osteoarthritis (WOMAC). Individual SES measures included educational attainment (<12 years, ≥12 years) and occupation type (managerial, non-managerial), while community SES was measured using Census block group poverty rate (<12%, 12-25%, ≥25%). SES measures were individually and simultaneously examined in linear regression models adjusting for age, gender, race, body mass index (BMI), occupational physical activity score (PAS), comorbidity count, and presence of hip symptoms. RESULTS In analyses among all individuals with rOA, models which included individual SES measures were observed to show that occupation was significantly associated with WOMAC Function (β =2.91, 95% Confidence Interval (CI) = 0.68-5.14), WOMAC Pain (β =0.93, 95% CI = 0.26-1.59) and WOMAC Total scores (β =4.05, 95% CI = 1.04-7.05), and education was significantly associated with WOMAC Function (β =3.57, 95% CI = 1.25-5.90) and WOMAC Total (β =4.56, 95% CI = 1.41-7.70) scores. In multivariable models including all SES measures simultaneously, most associations were attenuated. However, statistically significant results for education remained between WOMAC Function (β =2.83, 95% CI = 0.38-5.28) and WOMAC Total (β =3.48, 95% CI = 0.18-6.78), as well as for the association between occupation and WOMAC Pain (β =0.78, 95% CI = 0.08-1.48). In rOA subgroup analyses restricted to those with symptoms, we observed a significant increase in WOMAC Pain (β =1.36, 95% CI = 0.07-2.66) among individuals living in a block group with poverty rates greater than 25%, an association that remained when all SES measures were considered simultaneously (β =1.35, 95% CI = 0.06-2.64). CONCLUSIONS Lower individual and community SES are both associated with worse function and pain among adults with knee rOA.
Collapse
Affiliation(s)
- Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - My-Linh N Luong
- Department of Health Behavior, Gillings School of Global Public Health, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua B Knight
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Britta Schoster
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center and Departments of Medicine and Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center and Departments of Medicine and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
19
|
Judd DL, Thomas AC, Dayton MR, Stevens-Lapsley JE. Strength and functional deficits in individuals with hip osteoarthritis compared to healthy, older adults. Disabil Rehabil 2013; 36:307-12. [PMID: 23659184 DOI: 10.3109/09638288.2013.790491] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Hip osteoarthritis (OA) compromises quality of life for many individuals. This study quantified deficits in functional capacity for use in rehabilitation goal setting by combining assessments of muscle strength, function and physical activity in patients with hip OA and healthy adults. METHOD Twenty-six patients with end-stage hip OA and 18 healthy adults participated. Isometric muscle strength around the hip and knee was measured. Function was assessed using stair climbing, five-time-sit-to-stand, timed-up-and-go and 6-minute walk tests. The UCLA activity rating scale assessed physical activity. Analyses of covariance (ANCOVA) were used to assess differences between groups. RESULTS Patients had 30% less knee extensor (p < 0.001), 38% less knee flexor (p < 0.001), 10% less hip flexor (p = 0.47), 23% less hip extensor (p = 0.24) and 17% less hip abductor strength (p = 0.23) than healthy adults. Hip adductor strength was equal between groups (p = 0.93). Patients were 50% slower on the stair climbing test (p = 0.001), 34% slower on the timed-up-and-go test (p = 0.004), 34% slower on the five-time-sit-to-stand test (p = 0.001), and walked 28% less during the 6-min walk test (p < 0.001). Patients were less physically active (p = 0.001). CONCLUSIONS Patients had deficits in muscle strength, function and physical activity compared to healthy adults. Quantifying these deficits provides benchmarks for improvement during rehabilitation. IMPLICATIONS FOR REHABILITATION Hip osteoarthritis (OA) affects up to 28% of adults over the age of 65 and many individuals report functional and activity limitations directly related to their arthritic condition, posing a risk for future morbidity Total hip arthroplasty (THA) is the treatment of choice for decreasing pain and improving function, however, some individuals suffering from end-stage hip OA are not candidates for THA, and effective rehabilitation interventions to improve physical function are crucial Establishing estimates of the deficits in muscle strength, physical function and physical activity in people with and without hip OA can aid rehabilitation professionals in their goal setting and intervention planning Rehabilitation interventions should not only consist of muscle strengthening and functional training, but interventions to improve physical activity levels are required to improve overall physical functioning and to decrease risks for additional health complications.
Collapse
|