Impact of knee and low back pain on health-related quality of life in Japanese women: the Research on Osteoarthritis Against Disability (ROAD)

Osteoporosis, spinal degenerative disorders, and their association with low back pain, activities of daily living, and physical performance in a general population

Osteoporosis, vertebral fractures, and spinal degenerative diseases are common conditions that often coexist in older adults. This study aimed to determine the factors influencing low back pain and its impact on activities of daily living (ADL) and physical performance in older individuals with multiple comorbidities. This cross-sectional study was part of a large-scale population-based cohort study in Japan, involving 1009 participants who underwent spinal magnetic resonance imaging (MRI) to assess cervical cord compression, radiographic lumbar spinal stenosis, and lumbar disc degeneration. Vertebral fractures in the thoracolumbar spine were evaluated using sagittal MRI with a semi-quantitative method. Bone mineral density was measured using dual-energy X-ray absorptiometry. Low back pain, Oswestry Disability Index (ODI), and physical performance tests, such as one-leg standing time, five times chair-stand time, maximum walking speed, and maximum step length, were assessed. Using clinical conditions as objective variables and image evaluation parameters as explanatory variables, multiple regression analysis showed that vertebral fractures were significantly associated with low back pain and ODI. Vertebral fractures and osteoporosis significantly impacted physical performance, whereas osteoporosis alone did not affect low back pain or ODI. Our findings contribute to new insights into low back pain and its impact on ADL and physical performance.

Biomechanical and clinical relationships between lower back pain and knee osteoarthritis: a systematic review

BACKGROUND

Osteoarthritis (OA) and lower back pain (LBP) are most common health problems which lead to pain and disability. This study aimed to systematically review the evidence to find any relationship between knee osteoarthritis (KOA) and LBP or any potential causation.

METHODS

The databases of Scopus, MEDLINE, and Embase were searched from inception to 01 October 2022. Any study published in English assessing live humans over 18 years with KOA and LBP was eligible to be included. Studies were independently screened by two researchers. Data of the included studies were extracted based on the participants, outcomes related to knee and lumbar spine, reported association or causation between LBP and KOA, and study design. Data were narratively analyzed and presented as graphs and table. Methodology quality was assessed.

RESULTS

Of 9953 titles and abstracts, duplicates were removed, and 7552 were screened. Altogether, 88 full texts were screened, and 13 were eligible for the final inclusion. There were some biomechanical and clinical causations were observed for the concurrent presence of LBP and KOA. Biomechanically, high pelvic incidence is a risk factor for development of spondylolisthesis and KOA. Clinically, knee pain intensity was higher in KOA when presents with LBP. Less than 20% of studies have justified their sample size during the quality assessment.

DISCUSSION

Development and progression of KOA in patients with degenerative spondylolisthesis may be induced by significantly greater mismatches of lumbo-pelvic sagittal alignment. Elderly patients with degenerative lumbar spondylolisthesis and severe KOA reported a different pelvic morphology, increased sagittal malalignment with a lack of lumbar lordosis due to double-level listhesis, and greater knee flexion contracture than in patients with no to mild and moderate KOA. People with concurrent LBP and KOA have reported poor function with more disability. Both LBP and lumbar kyphosis indicate functional disability and knee symptoms in patients with KOA.

CONCLUSIONS

Different biomechanical and clinical causations were revealed for the concurrent existence of KOA and LBP. Therefore, careful assessment of both back and knee joints should be considered when treating KOA and vice versa.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022238571.

A case of septic arthritis of the hip in Central Plains, China, during the Western Han Dynasty (3rd century BCE-1st century CE)

OBJECTIVE

Septic arthritis is not commonly reported in paleopathology. This study aims to provide a differential diagnosis of septic arthritis by looking at a case from ancient China. We also aim to add to the current literature on septic arthritis in paleopathology.

MATERIALS

One adult male skeleton recovered from the Dapuzi Cemetery, Shaanxi, dating to the Western Han Dynasty (3rd century BCE-1st century CE).

METHODS

Macroscopic observations were conducted.

RESULTS

The lytic appearance and massive new bone formation on the left acetabulum of M142 are compatible with septic arthritis. The hip pathology greatly influenced his stature. The two femur shafts present different degrees of robusticity. He also showed severe osteoarthritis.

CONCLUSIONS

The individual suffered from septic arthritis of the hip, of unknown cause, for a long period, which greatly influenced his daily life. Complications included osteoarthritis, shortened stature, and difficulties in walking.

SIGNIFICANCE

This study offers a new case of septic arthritis and provides insight into the people who guarded the royal tombs in the West Han Dynasty.

LIMITATIONS

The skeleton is not well-preserved, limiting observations of bony changes to other areas of the body.

Health-related quality of life of Malaysian patients with chronic non-malignant pain and its associated factors: a cross-sectional study

Background

Chronic pain has a major impact on a patient’s quality of life, affecting physical and psychological functioning. It has debilitating consequences on social and economic aspects too. This study aimed to explore the status of health-related quality of life (HRQoL) of Malaysian patients suffering from chronic non-malignant pain.

Methods

Four hospitals offering pain clinic services were involved in this multicentre cross-sectional study conducted between June and September 2020. Adult patients who had been diagnosed with non-malignant chronic pain lasting for at least three months and able to communicate in English or Malay language were recruited in this study. Participants were informed about the study and were made aware that their participation was entirely voluntary. A battery of questionnaires consists of the EuroQol-5 dimensions-5 levels questionnaire (EQ-5D-5L) and the EuroQol visual analogue scale (EQ VAS), the Pain Self-Efficacy questionnaire (PSEQ) and the Pain Catastrophizing Scale (PCS) were self-administered by the patients. Besides, a structured questionnaire was used to collect their socio-demographic information, pain condition, sleep quality and working status. Participants’ usage of pain medications was quantified using the Quantitative Analgesic Questionnaire (QAQ).

Results

A total of 255 patients participated in this study. A median EQ-5D index value of 0.669 (IQR: 0.475, 0.799) and a median EQ VAS score of 60.0 (IQR: 50.0, 80.0) were recorded. Malay ethnicity (Adj. B: 0.77; 95% CI: 0.029, 0.126; p = 0.002) and a higher level of self-efficacy (Adj. B: 0.008; 95% CI: 0.006, 0.011; p < 0.001) were predictors of a better HRQoL, while suffering from pain in the back and lower limb region (Adj. B: -0.089; 95% CI: − 0.142, − 0.036; p = 0.001), the use of a larger amount of pain medications (Adj. B: -0.013; 95% CI: − 0.019, − 0.006; p < 0.001), and a higher degree of pain magnification (Adj. B: -0.015; 95% CI: − 0.023, − 0.008; p < 0.001) were associated with a poorer HRQoL.

Conclusions

These findings suggested that Malay ethnicity and a higher level of self-efficacy were predictors of a better HRQoL in patients with chronic pain, whereas pain-related factors such as higher usage of medication, specific pain site and pain magnification style were predictors of poorer HRQoL.

Physical and financial impacts caused by the COVID-19 pandemic exacerbate knee pain: A longitudinal study of a large-scale general population

OBJECTIVES

This study aimed to evaluate the changes in knee pain, a dominant cause of physical disability, following the coronavirus disease (COVID-19) pandemic, and to identify factors affecting the changes in knee pain.

METHODS

We analysed the pre- and post-COVID-19 longitudinal data set of the Nagahama Study. Knee pain was assessed using the Knee Society Score (KSS). The estimated KSS from the age and sex using regression model in the pre- and post-COVID-19 data set was compared. Factors including the activity score, educational level, and various impacts of COVID-19 were analysed for correlation analyses with changes in KSS.

RESULTS

Data collected from 6409 participants showed statistically significant differences in KSS, pre- (mean = 22.0; SD = 4.4) and post-COVID-19 (mean = 19.5; SD = 6.4). Low activity score (p = .008), low educational level (p < .001), and undesirable financial impact (p = .030) were independently associated with knee pain exacerbation.

CONCLUSION

The harmful effects of the COVID-19 pandemic on knee pain were suggested. People should be encouraged to engage in physical activities, such as walking, despite the state of emergency. Furthermore, social support for economically disadvantaged groups may improve healthcare access, preventing the acute exacerbations of knee pain.

Is musculoskeletal pain related to locomotive syndrome even in young and middle-aged adults?

OBJECTIVES

Locomotive syndrome (LS) is the leading cause of persons needing long-term care in old age and is characterized by locomotive organ impairment including musculoskeletal pain. The aim was to examine the association between musculoskeletal pain and LS in young and middle-aged persons.

METHODS

A total of 836 participants (male 667, female 169; mean age 44.4 years) were examined in this cross-sectional study. The LS was evaluated by three screening tools: the two-step test, the stand-up test, and the 25-question Geriatric Locomotive Function Scale. Musculoskeletal pain, exercise habits, physical function (walkability and muscle strength), and physical activity were also assessed.

RESULTS

The LS was found in 22.8% of participants. The number with musculoskeletal pain was significantly higher in those with the LS. A significant correlation was found between the degree of musculoskeletal pain and exercise habits. Less regular exercise was significantly associated with higher LS prevalence. Physical activity and function were greater in participants with more regular exercise.

CONCLUSION

Musculoskeletal pain was significantly related to LS even in young and middle-aged persons. The present results suggest that control of musculoskeletal pain and improvement of exercise habits in young and middle-aged persons might help prevent the LS.

Increased recurrent falls experience in older adults with coexisting of sarcopenia and knee osteoarthritis: a cross-sectional study

Background

Sarcopenia and knee osteoarthritis (OA) are two major risk factors for falls in older adults. The coexistence of these two conditions may exacerbate the risk of falls. This cross-sectional study aimed to test the hypothesis that older adults with coexisting sarcopenia and knee OA displayed an increased risk of falls experience.

Methods

Participants recruited from an orthopedic clinic were divided into four groups according to the presence of sarcopenia and radiographic knee OA: isolated sarcopenia, isolated knee OA, sarcopenia + knee OA, and control (i.e., non-sarcopenia with non-OA) groups. We used questionnaires to assess falls experience in the prior 12 months. We performed logistic regression analyses to evaluate the relationship between the four groups and falls experience.

Results

Of 291 participants (age: 60–90 years, 78.7% women) included in this study, 25 (8.6%) had sarcopenia + knee OA. Participants with sarcopenia + knee OA had 4.17 times (95% confidence interval: 0.84, 20.6) higher odds of recurrent falls (≥2 falls) than controls after adjustment for age, sex, and body mass index. The increased recurrent falls experience was not clearly confirmed in participants with isolated sarcopenia and isolated knee OA.

Conclusions

People with coexisting of sarcopenia and knee OA displayed increased recurrent falls experience. This study suggests a new concept, “sarcopenic knee OA”, as a subgroup associated with higher risk of falls, which should be validated in future large cohort studies.

Trial registration.

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02654-4.

Detailed Subphenotyping of Lumbar Modic Changes and Their Association with Low Back Pain in a Large Population-Based Study: The Wakayama Spine Study

INTRODUCTION

To examine the association between the five types of Modic changes and low back pain (LBP) in a large population-based cohort.

METHODS

Of the 952 participants in the second Wakayama Spine Study, 814 (men, 246; women, 568; mean age, 63.6 years) were included in this study. Endplate changes on magnetic resonance imaging were classified according to the Modic classification system. Low back pain (LBP) was defined as continuous back pain for at least 48 h in the past month that is currently present. The prevalence of Modic changes in the lumbar region was assessed. Multivariate logistic regression analysis was conducted to determine the association between detailed subphenotype of Modic change and LBP comparing no Modic change in the lumbar spine and each level, respectively.

RESULTS

Modic changes throughout the lumbar spine were noted in 63.5% (n = 516) of all participants, with types I, I/II, II, II/III, and III observed in 7.8% (n = 63), 10.8% (n = 88), 40.0% (n = 326), 2.1% (n = 17), and 2.7% (n = 22), respectively. Modic types I/II were associated with LBP [odds ratio (OR): 3.26; 95% confidence interval (CI) 1.9, 5.5]. Furthermore, Modic type I/II changes at L2/3 and L4/5 were significantly associated with LBP (odds ratio: 2.77; 95% CI 1.04, 7.39 at L2/3; odds ratio: 2.86; 95% CI 1.39, 5.90 at L4/5).

CONCLUSIONS

Type I/II Modic changes in the lumbar region are significantly associated with LBP. To the best of our knowledge, this is the first large population-based study on the association between various Modic changes and LBP.

Association between knee symptoms, change in knee symptoms over 6-9 years, and SF-6D health state utility among middle-aged Australians

OBJECTIVES

Health state utilities (HSUs) are an input metric for estimating quality-adjusted life-years (QALY) in cost-utility analyses. Currently, there is a paucity of data on association of knee symptoms with HSUs for middle-aged populations. We aimed to describe the association of knee symptoms and change in knee symptoms with SF-6D HSUs and described the distribution of HSUs against knee symptoms' severity.

METHODS

Participants (36-49-years) were selected from the third follow-up (completed 2019) of Australian Childhood Determinants of Adult Health study. SF-6D HSUs were generated from the participant-reported SF-12. Association between participant-reported WOMAC knee symptoms' severity, change in knee symptoms over 6-9 years, and HSUs were evaluated using linear regression models.

RESULTS

For the cross-sectional analysis, 1,567 participants were included; mean age 43.5 years, female 54%, BMI ± SD 27.18 ± 5.31 kg/m². Mean ± SD HSUs for normal, moderate, and severe WOMAC scores were 0.820 ± 0.120, 0.800 ± 0.120, and 0.740 ± 0.130, respectively. A significant association was observed between worsening knee symptoms and HSUs in univariable and multivariable analyses after adjustment (age and sex). HSU decrement for normal-to-severe total-WOMAC and WOMAC-pain was - 0.080 (95% CI - 0.100 to - 0.060, p < 0.01) and - 0.067 (- 0.085 to - 0.048, p < 0.01), exceeding the mean minimal clinically important difference (0.04). Increase in knee pain over 6-9 years was associated with a significant reduction in HSU.

CONCLUSION

In a middle-aged population-based sample, there was an independent negative association between worse knee symptoms and SF-6D HSUs. Our findings may be used by decision-makers to define more realistic and conservative baseline and ongoing HSU values when assessing QALY changes associated with osteoarthritis interventions.

Low Back Pain as a Risk Factor for Recurrent Falls in People With Knee Osteoarthritis

OBJECTIVE

Knee osteoarthritis (OA) has been suggested to increase the risk of falls. Low back pain (LBP) is a potential risk factor for falls in people with knee OA, but this issue has not been addressed adequately in previous studies. The objective of this study was to investigate the relationship between LBP and falls in people with knee OA in a 12-month period.

METHODS

Participants with knee OA (Kellgren/Lawrence [K/L] grade ≥1) completed questionnaires for LBP and falls that occurred in the preceding 12 months. Binary and ordinal logistic regression analyses were performed to assess the relationship between LBP or moderate-to-severe LBP (numeric rating scale ≥4 points) and any fall (≥1 fall) or recurrent falls (≥2 falls) after adjustment for age, sex, K/L grade, knee pain severity, and quadriceps strength. Sensitivity analyses were performed excluding people with sciatica, nonchronic LBP, K/L grade 1, and those receiving pain medications.

RESULTS

We included 189 participants (ages 61-90 years, 78.3% women) in this study. Of these participants, 41 (21.6%) reported falls in the preceding 12 months. People with any LBP (n = 101) and those with moderate-to-severe LBP (n = 45) had 2.7- and 3.7-times higher odds of recurrent falls, respectively. Sensitivity analyses revealed a strong correlation between moderate-to-severe LBP and recurrent falls.

CONCLUSION

Thorough investigation of LBP as a risk factor for recurrent falls in people with knee OA may provide a novel insight into the pathomechanics of recurrent falls in this population.

The effect of low back pain and neck-shoulder stiffness on health-related quality of life: a cross-sectional population-based study

BACKGROUND

This cross-sectional study sought to determine the neck-shoulder stiffness/low back pain (NSS/LBP) comorbidity rate in a Japanese community population and to compare the quality of life (QOL) in individuals with comorbid NSS/LBP, asymptomatic individuals, and those with symptoms of NSS or LBP alone.

METHODS

The sample included 1122 subjects (426 men; 696 women) with NSS and LBP symptoms in the previous 3 months, and were grouped according to NSS, LBP, comorbid NSS and LBP symptoms (Comorbid), or no symptoms (NP). They completed the MOS 36-Item Short-Form Health Survey (SF-36). Health QOL was evaluated by the eight domain scores and the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores after adjusting for age. The primary outcome was to examine the association between NSS/LBP, NSS, or LBP and bodily pain of the eight domains of SF-36. Secondary outcome was to compare health-related QOL among the four groups.

RESULTS

Morbidity was 45.6% for NSS and 51.9% for LBP. Comorbidity affected 23% of men and 33% of women. Comorbid NSS/LBP, NSS, and LBP alone were independently associated with bodily pain after adjusting for potential confounders. Men who exhibited comorbidity had significantly lower MCS scores than asymptomatic men. Women who exhibited comorbidity and LBP had significantly lower MCS scores than those with no symptoms or NSS alone. Women who exhibited comorbidity had significantly lower MCS scores than those with no symptoms or LBP alone.

CONCLUSIONS

Comorbidity of the two diseases is prevalent in 23% of the men and 33% of women in the Japanese sample. Although NSS, LBP, and comorbidity were independently associated with QOL in terms of pain, QOL was worse in individuals who exhibited comorbidity than in those without symptoms or with NSS alone.

Low back pain precedes the development of new knee pain in the elderly population; a novel predictive score from a longitudinal cohort study

Background

To investigate the association between knee pain and risk factors including low back pain and to develop a score to predict new knee pain in an older population, using population-based longitudinal cohort data.

Methods

We collected a questionnaire on self-reported knee pain and demographic data in a systematic manner from community residents aged ≥ 50 years twice, at baseline, and after 5 years. Multivariate logistic regression analyses were performed to investigate the association between knee pain and risk factors and to build a predictive model that would enable calculation of the risk of the development of knee pain within 5 years. The model is presented in the form of score charts.

Results

A total of 5932 residents aged ≥ 50 years from the cohort of 9764 that completed the first questionnaire were enrolled in the second survey. After exclusions, paired data for the two time points an average of 5.4 years apart were analyzed for 4638 participants. Multivariate analyses showed older age, female sex, higher BMI, weight increase, lower mental health score, and higher back pain/disability score were independent risk factors for knee pain. The predictive score comprised six factors: age, sex, BMI, weight increase, mental health, and low back pain/disability. The risk of developing knee pain ranged from 11.0 to 63.2% depending on the total score.

Conclusion

This study demonstrated a significant association between knee and low back pain/disability along with other risk factors. The score we developed can be used to identify a population without any imaging modality who are at high risk of developing knee pain.

Electronic supplementary material

The online version of this article (10.1186/s13075-019-1884-0) contains supplementary material, which is available to authorized users.

Interaction between low back pain and knee pain contributes to disability level in individuals with knee osteoarthritis: a cross-sectional study

OBJECTIVE

To test the hypothesis that the interaction between low back pain (LBP) and knee pain intensity contributes to the disability level of individuals with knee osteoarthritis (OA).

DESIGN

Community-dwelling participants with knee OA (Kellgren/Lawrence [K/L] grade ≥1) were enrolled. LBP and its severity were identified using questionnaires. Knee pain severity and disability level were evaluated using the Japanese Knee Osteoarthritis Measure (JKOM) subscale. Multiple linear regression analyses were performed to examine the effect of the LBP-knee pain interaction, an independent variable, on disability, a dependent variable.

RESULTS

A total of 260 participants (age, 48-88 years; 77.7% women) were included. Of them, 151 (58.1%) had LBP. The LBP-knee pain interaction was significantly associated with disability after the adjustment for covariates. A post-hoc subgroup analysis revealed that the relationship between knee pain intensity and disability level was higher in individuals with LBP (beta: 0.621 points; 95% confidence interval [CI]: 0.511 to 0.731 points) than in those without LBP (beta: 0.402 points; 95% CI: 0.316 to 0.487 points).

CONCLUSIONS

LBP interacts with knee pain intensity and contributes to disability level in individuals with knee OA. Coexisting LBP and knee pain had a stronger impact on disability level than LBP or knee pain alone. These findings highlight the potential deteriorative effects of the LBP-knee interaction on disability. Maximal treatment effects for disability might be achieved when LBP and knee pain are targeted simultaneously, rather than separately.

MRI-defined paraspinal muscle morphology in Japanese population: The Wakayama Spine Study

OBJECTIVE

This study aimed to establish sex- and age-dependent distributions of the cross sectional area and fatty infiltration ratio of paraspinal muscles, and to examine the correlation between paraspinal muscle degeneration and low back pain in the Japanese population.

METHODS

In this cross-sectional study, data from 796 participants (241 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross sectional area and fatty infiltration ratio of the erector spinae and multifidus from the level of T12/L1 to L4/5 and psoas major at the level of T12/L1 was performed using axial T2-weighted magnetic resonance imaging. Multivariate logistic regression analysis was used to estimate the association between fatty infiltration of the paraspinal muscles and the prevalence of low back pain.

RESULTS

The cross sectional area was larger in men than women, and tended to decrease with age, with the exception of the erector spinae at T12/L1 and L1/2 in women. The fatty infiltration ratio was lower in men than women, except for multifidus at T12/L1 in 70-79 year-olds and psoas major in those less than 50 years-old, and tended to increase with age. Logistic regression analysis adjusted for age, sex, and body mass index showed that the fatty infiltration ratio of the erector spinae at L1/2 and L2/3 was significantly associated with low back pain (L1/2 level: odds ratio, 1.05; 95% confidence interval, 1.005-1.104; L2/3 level: odds ratio, 1.05; 95% confidence interval, 1.001-1.113).

CONCLUSION

This study measured the cross sectional area and fatty infiltration ratio of paraspinal muscles in the Japanese population using magnetic resonance imaging, and demonstrated that the fatty infiltration ratio of the erector spinae in the upper lumbar spine was significantly associated with the presence of low back pain. The measurements could be used as reference values, which are important for future comparative studies.

The Association between the Cross-Sectional Area of the Dural Sac and Low Back Pain in a Large Population: The Wakayama Spine Study

OBJECTIVE

The purpose of this study was to evaluate the relations between the degree of encroachment, measured as the cross-sectional area of the dural sac, and low back pain in a large population.

METHODS

In this cross-sectional study, data from 802 participants (247 men, 555 women; mean age, 63.5 years) were analyzed. The measurement of the cross-sectional area of the dural sac from the level of L1/2 to L4/5 was taken using axial T2-weighted images. The minimum cross-sectional area was defined as the cross-sectional area of the dural sac at the most constricted level in the examined spine. Participants were divided into three groups according to minimum cross-sectional area measurement quartiles (less than the first quartile, between the first and third quartiles, and greater than the third quartile). A multivariate logistic regression analysis was used to estimate the association between the minimum cross-sectional area and the prevalence of low back pain.

RESULTS

The mean minimum cross-sectional area was 117.3 mm2 (men: 114.4 mm2; women: 118.6 mm2). A logistic regression analysis adjusted for age, sex, body mass index, and other confounding factors, including disc degeneration, showed that a narrow minimum cross-sectional area (smaller than the first quartile) was significantly associated with low back pain (odds ratio, 1.78; 95% confidence interval, 1.13-2.80 compared to the wide minimum cross-sectional area group: minimum cross-sectional area greater than the third quartile measured).

CONCLUSION

This study showed that a narrow dural sac cross-sectional area was significantly associated with the presence of low back pain after adjustment for age, sex, and body mass index. Further investigations that include additional radiographic findings and psychological factors will continue to elucidate the causes of low back pain.

Generic Preference-based Measures for Low Back Pain: Which of Them Should Be Used?

STUDY DESIGN

Systematic review.

OBJECTIVE

This systematic review examines validity and responsiveness of three generic preference-based measures in patients with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

LBP is a very common incapacitating disease with a significant impact on health-related quality of life (HRQoL). Health state utility values can be derived from various preference-based HRQoL instruments, and among them the most widely ones are EuroQol 5 dimensions (EQ-5D), Short Form 6 Dimensions (SF-6D), and Health Utilities Index 3 (HUI III). The ability of these instruments to reflect HRQoL has been tested in various contexts, but never for LBP populations.

METHODS

A systematic search on electronic literature databases was undertaken to identify studies of patients with LBP where health state utility values were reported. Records were screened using a set of predefined eligibility criteria. Data on validity (correlations and known group methods) and responsiveness (effect sizes, standardized response means, tests of statistical significance) of instruments were extracted using a customized extraction template, and assessed using predefined criteria.

RESULTS

There were substantial variations in the 37 included papers identified in relation to study design and outcome measures used. EQ-5D demonstrated good convergent validity, as it was able to distinguish between known groups. EQ-5D was also able to capture changes of health states as results of different interventions. Evidence for SF-6D and HUI III was limited to allow an appropriate evaluation.

CONCLUSION

EQ-5D performs well in LBP population and its scores seem to be suitable for economic evaluation of LBP interventions. However, the paucity of information on the other instruments makes it impossible to determine its relative validity and responsiveness compared with them.

Population-based study of the association of osteoporosis and chronic musculoskeletal pain and locomotive syndrome: the Katashina study

BACKGROUND

"Locomotive syndrome", a concept proposed by the Japanese Orthopaedic Association (JOA), refers to risk conditions among the elderly population that may lead to the need for nursing care services. The association between osteoporosis (OP) or chronic musculoskeletal pain (CMSP) and the screening results of locomotive dysfunction identified by the GLFS-25 (a 25-question geriatric locomotive function scale) has not yet been adequately investigated.

MATERIALS AND METHODS

Two hundred eighty-seven Japanese subjects were evaluated for locomotive dysfunction using the GLFS-25 and were also evaluated for their bone status by a quantitative ultrasound (QUS) assessment of the bone status (i.e., the measurement of the speed of sound (SOS) of the calcaneus). Furthermore, a questionnaire survey concerning CMSP persisting for 3 months or longer was given to those subjects. Statistical analyses were conducted to clarify the association between the bone status or CMSP and the screening results for locomotive dysfunction.

RESULTS

The % young adult mean (%YAM) of the SOS was significantly lower among the 43 subjects with locomotive dysfunction identified by the GLFS-25 than in the 244 subjects without locomotive dysfunction (p < 0.001). Moreover, low back pain (p < 0.01), shoulder pain (p < 0.05) and knee pain (p < 0.001) were significantly more frequently observed in the 43 subjects with locomotive dysfunction than the 244 subjects without locomotive dysfunction. The screening results of the %YAM of the SOS was significantly associated with the population demonstrating locomotive dysfunction screened by the GLFS-25 based on the age-, gender- and BMI-adjusted analysis (OR 0.95, 95 % CI 0.91-0.98). Furthermore, the %YAM of SOS correlated with the GLFS-25 score (β = -0.212, p = 0.001). Furthermore, low back pain (OR 2.60, 95 % CI 1.29-5.24), shoulder pain (OR 2.16, 95 % CI 1.00-4.66), and knee pain (OR 2.97, 95 % CI 1.41-6.28) were found to be associated with locomotive dysfunction based on the results of the age-, gender- and a BMI-adjusted analysis.

CONCLUSIONS

The %YAM of the SOS was associated with the population demonstrating locomotive dysfunction which was identified using the GLFS-25, and the severity of locomotive dysfunction evaluated by the GLFS-25 was found to correlate with the %YAM of the SOS. Furthermore, low back pain, shoulder pain and knee pain were found to be associated with the screening results for locomotive dysfunction by the GLFS-25.

Health-related quality of life in older adults with bilateral knee pain and back pain: data from the Osteoarthritis Initiative

This study's objective was to examine the association of self-reported bilateral knee pain (KP) and back pain (BP) with health-related quality of life (HRQoL) among older adults. In this cross-sectional study, data for 1252 older adults (≥65 years) were included from the Osteoarthritis Initiative project. Self-reported bilateral KP and BP were used to classify participants into four groups: (1) neither bilateral KP nor BP; (2) no bilateral KP with BP; (3) bilateral KP without BP; and (4) both bilateral KP and BP. Health-related quality of life was measured using the health survey short form (SF)-12. We used multiple linear regression analyses to examine the associations of bilateral KP and/or BP with the HRQoL. After controlling for covariates, bilateral KP and BP were associated with poorer HRQoL [physical composite scale (PCS): estimated average (β) = -13.1, SE = 1.15, p < 0.0001; mental composite scale: β = -2.71, SE = 1.09, p = 0.013, respectively] compared with the group with neither bilateral KP nor BP. In conclusion, older adults with coexisting bilateral KP and BP had significantly poorer physical and mental HRQoL when compared to peers without these conditions.

Medial abrasion syndrome: a neglected cause of knee pain in middle and old age

Knee pain is a prevailing health problem of middle and old age. Medial plica-related medial abrasion syndrome (MAS), although a well-known cause of knee pain in younger individuals, has rarely been investigated in older individuals. This prospective study was conducted to investigate the prevalence and clinical manifestations of this syndrome as a cause of knee pain in middle and old age. The outcomes of arthroscopic treatment for this syndrome were also evaluated.A total of 232 knees of 169 patients >40 years of age (41-82, median: 63 years old) suffering from chronic knee pain were analyzed. The clinical diagnosis, predisposing factors, presenting symptoms, and physical signs were investigated. The sensitivity and specificity of each parameter of the clinical presentation for the diagnosis of MAS were evaluated after confirmation by arthroscopy. For patients with MAS, the roentgenographic and arthroscopic manifestations were investigated, and arthroscopic medial release (AMR) was performed. The outcomes were evaluated by the changes in the pain domain of the Knee Society scoring system and by patient satisfaction. The prevalence of medial plica was 95%, and osteoarthritis (OA) was the most common clinical diagnosis. Symptoms of pain and crepitus in motion and local tenderness during physical examination were the most sensitive parameters for the diagnosis. A history of a single knee injury combined with local tenderness and a palpable band found during physical examination were the most specific parameters for the diagnosis. The majority of patients suffering from this syndrome were successfully treated using AMR, yielding a satisfaction rate of 85.5% after a minimum of 3 years.MAS is a common cause of knee pain in middle and old age and can be effectively treated by AMR. Its concomitance with OA warrants further investigation.

The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study

BACKGROUND CONTEXT

Disc degeneration (DD) reportedly causes low back pain (LBP) and is often observed concomitantly with end plate signal change (ESC) and/or Schmorl node (SN) on magnetic resonance imaging.

PURPOSE

The purpose of this study was to examine the association between DD and LBP, considering ESC and/or SN presence, in a large population study.

STUDY DESIGN/SETTING

Cross-sectional population-based study in two regions of Japan.

PATIENT SAMPLE

Of 1,011 possible participants, data from 975 participants (324 men, 651 women; mean age, 66.4 years; range, 21-97 years) were included.

OUTCOME MEASURES

Prevalence of DD, ESC, and SN alone and in combination in the lumbar region and the association of these prevalence levels with LBP.

METHODS

Sagittal T2-weighted images were used to assess the intervertebral spaces between L1-L2 and L5-S1. Disc degeneration was classified using the Pfirrmann classification system (grades 4 and 5 indicated degeneration); ESC was defined as a diffuse high signal change along either area of the end plate, and SN was defined as a small well-defined herniation pit with a surrounding wall of hypointense signal. Logistic regression analysis was used to determine the odds ratios (ORs) and confidence intervals (CIs) for LBP in the presence of radiographic changes in the lumbar region and at each lumbar intervertebral level, compared with patients without radiographic change, after adjusting for age, body mass index, and sex.

RESULTS

The prevalence of lumbar structural findings was as follows: DD alone, 30.4%; ESC alone, 0.8%; SN alone, 1.5%; DD and ESC, 26.6%; DD and SN, 12.3%; and DD, ESC, and SN, 19.1%. These lumbar structural findings were significantly associated with LBP in the lumbar region overall, as follows: DD, ESC, and SN, OR 2.17, 95% CI 1.2-3.9; L1-L2, OR 6.00, 95% CI 1.9-26.6; L4-L5, OR 2.56, 95% CI 1.4-4.9; and L5-S1, OR 2.81, 95% CI 1.1-2.3. The combination of DD and ESC was significantly associated with LBP as follows: L3-L4, OR 2.43, 95% CI 1.5-4.0; L4-L5, OR 1.82, 95% CI 1.2-2.8; and L5-S1, OR 1.60, 95% CI 1.1-2.3.

CONCLUSIONS

Our data suggest that DD alone is not associated with LBP. By contrast, the combination of DD and ESC was highly associated with LBP.

Influence of Knee Pain and Low Back Pain on the Quality of Life in Adults Older Than 50 Years of Age

OBJECTIVES

To investigate the impact of knee pain and low back pain (LBP) on quality of life (QoL) in people ≥50 years of age.

DESIGN

Cross-sectional study.

SETTING

A nationwide survey.

PARTICIPANTS

A total of 1295 men and 1658 women aged ≥50 years from the Fifth Korea National Health and Nutrition Examination Survey, conducted in 2010.

METHODS

Knee pain and LBP were assessed by a questionnaire, and QoL was assessed by the EuroQol (EQ)-5D, consisting of the EQ-5D descriptive system and the EuroQol visual analogue scale (EQ-VAS). Multiple linear regression models were used to evaluate associations between knee pain or LBP and the EQ-5D index or EQ-VAS score.

MAIN OUTCOME MEASUREMENTS

Standardized coefficient (β) for QoL according to the presence of knee pain or LBP.

RESULTS

Both men and women with knee pain or LBP had a lower QoL than those without them in all dimensions of the EQ-5D, EQ-5D index, and EQ-VAS scores. Compared with most other chronic diseases, knee pain and LBP showed stronger negative correlations with the EQ-5D index and EQ-VAS score. In men, LBP showed a stronger negative correlation with the EQ-VAS score than knee pain. The relative impact of LBP on knee pain was greater in people aged ≥65 years than in people aged 50-64 years, especially men.

CONCLUSIONS

These results suggest that knee pain and LBP are important factors affecting QoL in middle-aged and elderly people and that LBP may be relatively more important than knee pain in elderly people, especially men. Proper management and prevention of these conditions can help to improve QoL.

Differences in health-related quality of life among subjects with frequent bilateral or unilateral knee pain: data from the Osteoarthritis Initiative study

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

To examine associations between frequent bilateral knee pain (BKP) and unilateral knee pain (UKP) and health-related quality of life (QoL). We hypothesized that frequent BKP would be associated with poorer health-related QoL than would frequent UKP and no knee pain.

BACKGROUND

Knee pain is one of the most frequently reported types of joint pain among adults in the United States. It is the most frequent cause of limited physical function, disability, and reduced QoL.

METHODS

Data were collected from the Osteoarthritis Initiative public-use data sets. Health-related QoL was assessed in 2481 participants (aged 45-79 years at baseline). The Knee injury and Osteoarthritis Outcome Score QoL subscale (knee-specific measure) and the physical component summary and mental component summary (MCS) scores of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) (generic measure) were used to assess health-related QoL. Multiple regression analyses were used to examine the relationships between frequent knee pain and health-related QoL, adjusted for sociodemographic and health covariates.

RESULTS

Compared with subjects with no knee pain, subjects with frequent BKP and UKP had significantly lower scores on the Knee injury and Osteoarthritis Outcome Score QoL subscale (mean difference, -35.2; standard error [SE], 0.86; P<.001 and mean difference, -29.2; SE, 0.93; P<.001; respectively) and the SF-12 physical component summary score (mean difference, -6.25; SE, 0.41; P<.001 and mean difference, -4.10; SE, 0.43; P<.001; respectively), after controlling for sociodemographic and health covariates. The SF-12 MCS score was lower among those with BKP (-1.29; SE, 0.42; P<.001). Frequent UKP was not associated with the SF-12 MCS.

CONCLUSION

Subjects with frequent BKP had lower health-related QoL than those with frequent unilateral or no knee pain, as reflected in lower Knee injury and Osteoarthritis Outcome Score QoL subscale and SF-12 physical component summary and MCS scores.

Association between "loco-check" and EuroQol, a comprehensive instrument for assessing health-related quality of life: a study of the Japanese general population

BACKGROUND

The concept of "locomotive syndrome" (LS) was proposed by the Japanese Orthopaedic Association (JOA) in 2007 to refer to the risk of elderly individuals becoming bedridden because of reduced function of locomotive organs, for example muscles, bones, and joints. The purpose of this study was to clarify the association between LS screening results based on "loco-check" and health-related quality of life (HRQoL) assessed by use of EuroQol.

MATERIALS AND METHODS

Four-hundred and forty-two Japanese subjects (183 males and 259 females) were evaluated for LS and HRQoL by use of "loco-check," EuroQol-5 dimensions (EQ-5D), and EuroQol-VAS (EQ-VAS). If the subjects answered "yes" to one or more of the seven items of "loco-check," they were assigned to a locomotive syndrome suspected group (L group). If they answered "no" to all seven items, they were assigned to a locomotive syndrome not suspected group (NL group). We investigated the association between the screening LS results obtained by use of "loco-check" and HRQoL status determined by use of EQ-5D utility value and EQ-VAS score.

RESULTS

LS was suspected among 39.6% of the subjects on the basis of "loco-check." In univariate analysis, significantly higher age, higher female-to-male ratio, and more reduced HRQoL were observed in the L group than in the NL group, according to EQ-5D and EQ-VAS. Logistic regression analysis showed that EQ-5D utility value and EQ-VAS score were associated with LS and the difference was statistically significant. Furthermore, correlations were found between the number of items with a "yes" answer on "loco-check", EQ-5D, or EQ-VAS. That is, a larger number of items with a "yes" answer on "loco-check" was associated with reduced HRQoL assessed by use of EQ-5D and EQ-VAS.

CONCLUSIONS

We demonstrated that a finding of LS on the basis of "loco-check" is significantly associated with EQ-5D utility value and EQ-VAS score, and that a population identified as having LS by use of "loco-check" also had reduced HRQoL. Furthermore, it is speculated that the severity of reduced HRQoL because of locomotive dysfunction can be determined by use of "loco-check".

Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama Spine Study

OBJECTIVES

The purposes of this study were to investigate the prevalence and distribution of intervertebral disc degeneration (DD) over the entire spine using magnetic resonance imaging (MRI), and to examine the factors and symptoms potentially associated with DD.

DESIGN

This study included 975 participants (324 men, mean age of 67.2 years; 651 women, mean age of 66.0 years) with an age range of 21-97 years in the Wakayama Spine Study. DD on MRI was classified into Pfirrmann's system (grades 4 and 5 indicating DD). We assessed the prevalence of DD at each level in the cervical, thoracic, and lumbar regions and the entire spine, and examined DD-associated factors and symptoms.

RESULTS

The prevalence of DD over the entire spine was 71% in men and 77% in women aged <50 years, and >90% in both men and women aged >50 years. The prevalence of an intervertebral space with DD was highest at C5/6 (men: 51.5%, women: 46%), T6/7 (men: 32.4%, women: 37.7%), and L4/5 (men: 69.1%, women: 75.8%). Age and obesity were associated with the presence of DD in all regions. Low back pain was associated with the presence of DD in the lumbar region.

CONCLUSION

The current study established the baseline data of DD over the entire spine in a large population of elderly individuals. These data provide the foundation for elucidating the causes and mechanisms of DD.

Impact of low back pain, knee pain, and timed up-and-go test on quality of life in community-living people

BACKGROUND

The Japanese Orthopaedic Association (JOA) has proposed the term "locomotive syndrome" (LS) to designate a condition in people from high-risk groups with musculoskeletal disease who are highly likely to require nursing care at some point. This syndrome is caused by weakening of the musculoskeletal organs such as bone, joint, and muscle. The current study investigated factors that influence quality of life (QOL) loss caused by LS, which builds upon our previous study showing that LS affects individuals' QOL.

METHODS

We enrolled 386 subjects >50 years old. Sex, age, body mass index and bone mineral density, plus physical function tests of grip strength, back muscle strength, maximum stride, 10-m gait time, functional reach (cm), timed up-and-go test (TUG) (s) and one-leg standing time (s), and the visual analogue scale assessments for leg numbness and knee, low back and leg pain were selected as independent variables in a multiple regression model for the JOA Back Pain Evaluation Questionnaire (JOABPEQ), the Short Form-36 (SF-36), and the Roland Morris Disability Questionnaire (RDQ) scores.

RESULTS

Low back pain contributed significantly to all JOABPEQ scores. Knee pain and TUG contributed significantly to 4/5 and 3/5 of the JOABPEQ scores, respectively. Age, TUG, knee pain, and low back pain contributed significantly to the RDQ and the physical component summary of the SF-36.

CONCLUSIONS

Low back and knee pain proved to be significant contributors to individuals' QOL. TUG might be the most valuable function test for effectively evaluating an individual's QOL.

Incidence and risk factors for radiographic lumbar spondylosis and lower back pain in Japanese men and women: the ROAD study

OBJECTIVE

To determine the incidence of radiographic lumbar spondylosis (LS)and lower back pain, and their risk factors in Japan using a large-scale population from the nationwide cohort Research on Osteoarthritis/osteoporosis Against Disability (ROAD) Study.

METHODS

Participants in the ROAD study who had been recruited between 2005 and 2007 were followed up with lumbar spine radiography for 3 years. A total of 2,282 paired radiographs (75% of the original sample) were scored using Kellgren and Lawrence (KL) grades, and the incidence and progression rate of radiographic LS was analyzed. The incidence of lower back pain was also examined. In addition, associations between risk factors and incident and progressive radiographic LS as well as incident lower back pain were tested.

RESULTS

Given a 3.3-year follow-up, the incidence of KL≥2 radiographic LS was 50.0% and 34.4% (15.3% and 10.5% per year), while that of KL≥3 LS was 15.3% and 23.7% (4.6% and 7.2% per year) in men and women, respectively. The progression rate of LS was 20.5% and 27.4% (6.2% and 8.3% per year) in men and in women, respectively. In addition, the incidence of lower back pain was 28.3% and 31.2% (8.6% and 9.5% per year) in men and women. Lower back pain was not significantly associated with incident radiographic LS, while a more severe KL grade at baseline was associated with incident lower back pain.

CONCLUSION

The present longitudinal study revealed a high incidence of radiographic LS in Japan.