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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 29  |  Issue : 1  |  Page : 111-114

Quality of life in patients with primary knee osteoarthritis


1 Department of Orthopedics, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Physical Medicine and Rehabilitation, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission11-Nov-2014
Date of Acceptance18-Jan-2015
Date of Web Publication18-Mar-2016

Correspondence Address:
Aml A Salama
MD, Department of Family Medicine, Faculty of Medicine, Shbeen El-koom District, Menoufia Governorate
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.178999

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  Abstract 

Objectives
The aim of this study was to assess the quality of life (QoL) in patients with primary knee osteoarthritis (OA).
Background
OA is the most common degenerative joint disorder and a major public health problem worldwide. OA of the knee is a major cause of mobility impairment, which has an unpredictable and negative impact on health and QoL.
Patients and methods
This was a cross-sectional analytical study involving 116 patients with primary knee OA, who were admitted to the outpatient clinic of rheumatology and orthopedics in Menoufia University Hospital during the period of the study. Patients were included if they had radiographic evidence of hip or knee OA. QoL in these patients was assessed using the OAKHQOL questionnaire, which includes 43 items and describes QoL in five domains: physical activities (16 items), mental health (13 items), pain (four items), social support (four items), social functioning (three items), and three independent items. Each item is scored on a scale from 0 to 10.
Results
This cross-sectional study was carried out on 116 of patients with primary knee OA; 74.1% of these patients were women and 25.9% were men. The mean age of the studied population was 51.37 ± 8.85 years. For the KHOAQOL score, a statistically significant correlation was reported with the duration of the disease. Age, sex, BMI, site of OA, and regular use of drug showed no statistically significant difference in their KHOAQOL score. This study found a significant positive correlation of BMI of patients and their physical activity parameter of KHOAQOL.
Conclusion
The perception of QoL is affected negatively by the duration of the disease, whereas age, sex, site if disease unilateral or bilateral, and socioeconomic status showed no significant correlation. The study also reported that performing daily physical activity is affected by the BMI of the patient.

Keywords: Osteoarthritis, Primary Knee, Quality of life


How to cite this article:
Abd Elstaar TE, Salama AA, Esaily HG, Bolty SA. Quality of life in patients with primary knee osteoarthritis. Menoufia Med J 2016;29:111-4

How to cite this URL:
Abd Elstaar TE, Salama AA, Esaily HG, Bolty SA. Quality of life in patients with primary knee osteoarthritis. Menoufia Med J [serial online] 2016 [cited 2019 Sep 20];29:111-4. Available from: http://www.mmj.eg.net/text.asp?2016/29/1/111/178999


  Introduction Top


Osteoarthritis (OA) refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life (QoL). It is by far the most common form of arthritis and one of the leading causes of pain and disability worldwide [1].

OA is defined as a common complex disorder with multiple risk factors. These risk factors can broadly be divided into genetic factors and constitutional factors (as: age, sex, BMI) [2].

Knee OA is highly variable in its outcome. Improvement in the structure of the joint, as shown by radiographs, is rare once the condition has become established. Hip OA probably has the worst overall outcome of the three major sites [3],[4].

Health-related quality of life is increasingly being acknowledged as a valid health indicator in many diseases. It encompasses emotional, physical, social, and subjective feelings of well-being that reflect an individual's subjective evaluation and reaction to his/her illness [5].

Most patients with OA are assessed and treated within primary care settings, but there seems to be a discrepancy between how doctors and patient define the importance of an illness. As OA and other rheumatic conditions seldom cause death, but have a major impact on health, health-related quality of life measures are better indicators of their impact than related mortality rates [6].


  Patients and methods Top


A cross-sectional analytical study involving 116 patients with primary knee OA were randomly chosen from the outpatient rheumatology and orthopedic clinic in Menoufia University Hospital during the period of the study. The Menoufia Faculty of Medicine committee for medical ethics of research formally approved the study before it began. By framing the population of the study as confirmed cases of primary knee OA obtained from a hospital-based sample, who fulfilled the inclusion criteria (with radiographic evidence of primary knee OA), we used the time random sample technique by classifying the working days in both clinics into 4 days per week using a simple random sample; 4 out of 5 days were chosen (2 days for each clinic) for the entire period of the study (6 months). Informed consent was signed by all participants after a simple and clear explanation of the research objectives and procedures was provided. The patients involved fulfilled inclusion criterion of having radiographic evidence of primary knee OA. Patients were excluded if they had secondary knee OA, that is, post-traumatic knee OA, patients has severe psychiatric or physical illness that made it difficult to complete the questionnaire, patients had undergone surgery of the knee joint, and had disabling comorbidities, that is, heart disease, liver disease, and renal failure. Socioeconomic status was assessed on the basis of their education, occupation, income, number of individuals per room, type of housing, material possessions, etc. [7], Out of a total score, each patient was assigned a score and then classified as low, middle, and high socioeconomic.

QoL in those patients was assessed using the OAKHQOL [8] questionnaire, which includes 43 items in five domains: physical activities (16 items), mental health (13 items), pain (four items), social support (four items), social functioning (three items), and three independent items. Each item is scored on a scale from 0 to 10. A separate interview was held for each patient by the researcher to fill OAKHQOL questionnaire (was explained by easy language for the patients to understand to avoid missing items).

  1. Physical activity was assessed through 16 questions asking about the following: walking, bending, or straightening, carrying heavy things, going down stairs, climbing stairs, taking bath, dressing, cutting toe-nails, moving after remaining in the same position, getting in and out of a car, using public transport, take longer time in doing things, staying for a long time in the same position, requirement of a stick to walk, and requiring help.
  2. Pain was assessed through four questions asking about the following: frequency of pain, intensity of pain, having difficulties in going to sleep because of pain, and waking up at night because of pain.
  3. Mental health was assessed through 13 questions asking about the following: feeling depressed because of pain, afraid of being dependent on others, afraid of becoming an invalid, embarrassed when people see them, worry, feel depressed, family life is affected, unable to expect what is going to happen, feel aggressive and irritable, feel that they are a burden on close relatives, worried about the side-effects of treatment, feel older than their years, and feel embarrassed to ask for help.
  4. Social function was assessed through three questions asking about the following: able to plan for the future, going out whenever they like, and have friends in whenever they like.
  5. Social support was assessed through four questions asking about the following: talking about problems of arthritis, feel that others understand the problems of arthritis, feel supported by individuals close to them, and feel supported by individuals around.
  6. Three independent items asked about: relation with partner is affected, restrictions in sexual life, and restrictions in professional life. The score was obtained by computing the mean of the item score for each domain and normalized to a scale from 0 (the worst) to 100 (the best).


The weight of the patients was measured using an ordinary weighing scale. Height of patients was measured on bare feet in an erect position from the heel to the top of the crown. BMI was calculated for each patient using the formula weight (kg)/[height (m)] 2 . BMI was graded as underweight, normal, overweight, and obese.

Statistical management of the collected data

The data were tabulated and analyzed using the Statistical Package of Social Science program (SPSS) version 20 (SPSS INC, Chicago, IL, USA); personal computer qualitative data were expressed as number and percentage and analyzed using ν2 -test. Quantitative data were expressed as mean ± SD and analyzed using a t-test.


  Results Top


This cross-sectional study was carried out on 116 patients with primary knee OA (86 of these patients were women, 74.1%, and 30 were men, 25.9%). The mean age of the studied population was 51.37 ± 8.85 years. The sociodemographic characteristics of the studied group were graded as high, middle, and low, represented by 49.1, 35.3, and 15.5% of the patients studied, respectively [Table 1].
Table 1: Demographic data of the studied group

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For the KHOAQOL score, the duration of disease showed a statistically significant difference as the mean score of patients with less than a 5-year duration of disease was 55.09 ± 11.8, whereas that of patients with more than or equal to a 5-year duration of disease was 49.04 ± 11. Age, sex, BMI, site of OA, and regular use of drugs showed no statistically significant difference in the KHOAQOL score [Table 2].
Table 2: Effect of patients' characteristics on their KHOAQOL score

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A highly statistically significant positive correlation was detected between duration of disease and physical activity parameters of KHOAQOL (P < 0.001), whereas duration of disease showed no statistically significant correlation with pain, mental health, social function, and social support parameters of KHOAQOL [Table 3].
Table 3: Correlation of duration of osteoarthritis and KHOAQOL parameters of the studied group

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The study showed a significant positive correlation of BMI of patients and their physical activity parameter of KHOAQOL [Figure 1].
Figure 1: Correlation of BMI of patients and their physical activity parameter of KHOAQOL.

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  Discussion Top


This is a cross-sectional study that presents data on QoL on primary knee OA as a disabling disease affecting all aspects of patients' life. The study population included 116 patients with primary knee OA that was confirmed by radiograph (86 of these patients were women, 74.1%, and 30 were men, 25.9%). This can be attributed to the high prevalence of knee OA among women and the high adherence of women to follow-up visits.

The mean age of the studied population was 51.37 ± 8.85 years. The sociodemographic characteristics of the studied group were graded as high, middle, and low, represented by 49.1, 35.3, and 15.5% of the studied groups, respectively, which showed a nonstatistically significant difference in the KHOAQOL score.

The study showed that there was a highly statistically significant effect of duration of OA and total scores of KHOAQOL, but not with age, sex, site of OA, socioeconomic score, living alone, or type of management [Table 2].

A previous study [9] reported a significant correlation between QoL in patients with OA and age, and socioeconomic status.

The study shows a highly significant negative correlation of the duration of OA and QoL in performing daily physical activities [Table 3]. These results are not in agreement with those of another study [9] that reported no correlation of duration of OA with QoL of the patient.

The present study showed a significant negative correlation of the BMI of patients and their QoL in performing daily physical activities [Figure 1]. On the basis of these results, we concluded that BMI is associated with the incidence and progression of knee OA. Thus, being overweight is a clear risk factor for the development of knee OA and is also an important determinant of progression of knee OA. Obesity increases the mechanical stress in a weight-bearing joint. It has been linked strongly to OA of the knees.

These results are in agreement with those of Wills et al. [10], who suggested that the risk of knee OA increases with a high BMI through adulthood. Another study [11] reported that high BMI increases the risk of knee OA and severe OA. However, Chacón et al. [9], reported no significant correlation between BMI and QoL in patients with OA in Venezuela.


  Conclusion Top


The perception of QoL in patients with knee OA is affected negatively by the duration of the disease, whereas age, sex, site of disease, unilateral or bilateral, and socioeconomic status showed no significant correlation. Performance of daily physical activities is affected by BMI of these patients.


  Acknowledgements Top


The authors thank the patients who agreed to participate in this work.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bjordal JM, Klovning A, Ljunggren AE, Slørdal L Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: a meta-analysis of randomised placebo-controlled trials. Eur J Pain 2007; 11 :125-138.  Back to cited text no. 1
    
2.
Altman RD, Zinsenheim JR , Temple AR, Schweinle JE Three-month efficacy and safety of acetaminophen extended-release for osteoarthritis pain of the hip or knee: a randomized, double-blind, placebo-controlled study. Osteoarthritis Cartilage 2007; 15 :454-461.  Back to cited text no. 2
    
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AK, Clayton RA, Patton JT, Gaston M, Cook RE, Brenkel IJ Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg Br 2006; 88 :1321-1326.  Back to cited text no. 3
    
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K, Clarke AM, Symmons DP, Fleming D, Porcheret M, Kadam UT, Croft P Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases. Br J Gen Pract 2007; 57 :7-14.  Back to cited text no. 4
    
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Dziedzic K, Thomas E, Hill S, Wilkie R, Peat G, Croft PR The impact of musculoskeletal hand problems in older adults: findings from the North Staffordshire Osteoarthritis Project (NorStOP). Rheumatology (Oxford) 2007; 46 :963-967.  Back to cited text no. 5
    
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RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al.National Arthritis Data Workgroup Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 :26-35.  Back to cited text no. 6
    
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Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18 :962-968.  Back to cited text no. 7
    
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AC, Coste J, Pouchot J, Baumann M, Spitz E, Retel-Rude N, et al. OAKHQOL: a new instrument to measure quality of life in knee and hip osteoarthritis. J Clin Epidemiol 2005; 58 :47-55.  Back to cited text no. 8
    
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ón JG, González NE, Véliz A, Losada BR, Paul H, Santiago LG, et al. Effect of knee osteoarthritis on the perception of quality of life in Venezuelan patients. Arthritis Rheum 2004; 51 :377-382.  Back to cited text no. 9
    
10.
Wills A, Black S, Coppack R, et al. Life course BMI and risk of knee osteoarthritis at age 53. J Epidemiol Community Health 2011; 65 :A50.  Back to cited text no. 10
    
11.
Mork PJ, Holtermann A, Nilsen TI. Effect of body mass index and physical exercise on risk of knee and hip osteoarthritis: longitudinal data from the Norwegian HUNT Study. J Epidemiol Community Health 2012; 6:678-683.  Back to cited text no. 11
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Patients and methods
Results
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Acknowledgements
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