Validity, reliability, and comparison of the WOMAC osteoarthritis index and Lequesne algofunctional index in Turkish patients with hip or knee osteoarthritis

To assess validity and reliability of the Western Ontario and McMaster Universities (WOMAC) osteoarthritis (OA) index and Lequesne algofunctional index in Turkish patients with hip or knee OA and to compare the results of the instruments for these two particular sites of involvement. Two disease-specific instruments: WOMAC LK 3.1 and Lequesne indices were administered to 117 outpatients with OA (44 hip and 73 knee) living in Turkey. These indices were administered twice 7–10 days apart to ensure the test–retest reliability. All patients were asked to reply a generic health-related quality-of-life instrument (Short Form-36, SF-36) and a structured interview assessing demographic and other characteristics. Internal consistency and reliability was evaluated by Cronbach’s alpha and intra-class correlation coefficients (ICC). Construct validity was tested by correlating the WOMAC or Lequesne with each other, and also with SF-36 and visual analog scale (VAS). The Cronbach’s alphas of the WOMAC and Lequesne subscales were ranged 0.78–0.95 and 0.51–0.85 for hip and 0.78–0.94 and 0.61–0.71 for knee OA, respectively. Test–retest reliability of the WOMAC and Lequesne subscales yielded ICCs of 0.77–0.94 and 0.51–0.85 for hip and 0.80–0.98 and 0.61–0.71 for knee OA, respectively. WOMAC and Lequesne showed moderate-good correlations between comparable subscales of SF-36 (physical functioning and bodily pain) and weak-moderate correlations between VAS. All subscales and total WOMAC had better internal consistency and more satisfactory concurrent validity compared with Lequesne. Our results indicated that WOMAC is a more reliable index for use in Turkish patients with hip or knee OA than Lequesne.     

Quality of life and functional capacity are adversely affected in osteoarthritis patients with neuropathic pain

The aim of this study was to examine the neuropathic pain component of knee osteoarthritis (OA) patients and to investigate the relationship between neuropathic pain, disease stage, functional state, depression, anxiety, and quality of life. This study included 60 patients with knee OA. All demographic data and radiological results were recorded. Visual Analog Scale (VAS), Timed Up and Go Test, Chair Stand Test, Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), PainDETECT questionnaire, DN4 questionnaire, Short form-36 questionnaire, and Hospital Anxiety Depression Scale were performed for each patient. Neuropathic pain was detected in 66.7% of patients based on the PainDETECT scale and in 46.7% of patients based on DN4 scale. VAS-resting, OA grade, WOMAC scores, and SF-scores showed a significant difference in patients that detected neuropathic pain with PainDETECT (p < 0.05). Based on the DN4 scale, patients with neuropathic pain had significantly higher WOMAC scores and significantly lower SF-36 scores (p < 0.05). The PainDETECT questionnaire scores showed positive correlations with Timed Up-and-go Test, VAS-resting, WOMAC scores, Hospital Anxiety Depression Scale scores, and a negative correlation with all SF-36 scores (p < 0.05). DN4 questionnaire scores showed a negative correlation with SF-36 scores and positive correlation with WOMAC scores (p < 0.05). To conclude, it should be kept in mind that patients with knee OA who describe intense pain may have a neuropathic component involved in the clinical condition. Quality of life and functional capacity are adversely affected in patients with knee OA who have neuropathic pain. This should be taken into account while planning the treatment of these patients.     

Comparison of the EuroQol and short form 6D in Singapore multiethnic Asian knee osteoarthritis patients scheduled for total knee replacement

OBJECTIVE: To compare the EuroQol (EQ-5D) and Short Form 6D (SF-6D) among multiethnic Asian patients with knee osteoarthritis (OA) scheduled for total knee replacement in Singapore. METHODS: Patients were asked to complete questionnaires including the EQ-5D, Short Form 36, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne knee index. EQ-5D and SF-6D utility scores were calculated using the scoring algorithms developed from the UK general population. Agreement between the 2 instruments was assessed by comparing their score distributions, means, medians, intraclass correlation coefficients (ICCs), and a Bland-Altman plot. Correlations of the EQ-5D and SF-6D with WOMAC and Lequesne knee index scores were also examined. RESULTS: A consecutive sample of 258 knee OA patients (127 English-speaking and 131 Chinese-speaking) participated. The mean +/- SD EQ-5D utility score was 0.49 +/- 0.31 (range -0.25-1.00) and the mean SF-6D utility score was 0.63 +/- 0.12 (range 0.32-0.89). In a hypothetical example, this 0.14-point difference in mean utility scores yielded a difference of $10,000/quality-adjusted life year (QALY) in cost-effectiveness ratios. The score distribution was bimodal for the EQ-5D and normal for the SF-6D. This poor agreement was also demonstrated by the Bland-Altman plot and the low ICC (range 0.18-0.54). Correlations of the WOMAC and Lequesne index with the EQ-5D were higher than with the SF-6D. CONCLUSION: Using different preference-based health-related quality of life instruments may yield different utility scores, which could have a great impact on QALY estimates. This highlights the importance of selecting appropriate instruments for economic evaluation. Additional research is needed to determine which instrument (the EQ-5D or the SF-6D) should be used in OA patients.     

Body composition and clinical symptoms in patients with hip or knee osteoarthritis: Results from the KHOALA cohort

ObjectiveTo analyze the associations between body composition, notably low lean mass, and clinical symptoms [pain, physical function, quality of life (QoL)] in patients with symptomatic hip and/or knee OA.MethodsCross-sectional study using data from the 3-year follow-up visit of the Knee and Hip OsteoArthritis Long-term assessment (KHOALA) cohort. Skeletal muscle and fat mass were measured by dual X-ray absorptiometry (DXA). Fat mass index (FMI) was defined as total fat mass/height². Appendicular lean mass was adjusted on body mass index (ALM/BMI), and low lean mass was defined according to the definition of FNIH Sarcopenia Project recommendations. Pain and function were measured by the WOMAC index and QoL by the SF-36.ResultsIn total, 358 patients underwent DXA (67% women, mean [SD] age 63.4 [8.4] years, mean BMI 29.5 [5.6] kg/m²). The visual analog scale (0–100) pain score was 38.0 [24.7] and 25.4% had hip and 74.6% knee OA. Low lean mass and ALM/BMI were associated with impaired QoL and WOMAC scores on bivariate analysis (all p ≤ 0.001) but not on multivariate analysis after adjustment for FMI. For patients with normal BMI, mean [SD] WOMAC scores were higher (greater impairment) with low lean mass than normal body composition (WOMAC function 33.4 [23.3] and 24.0 [17.4], p = 0.02), and mean SF-36 physical component score was lower (greater impairment) 40.3 [10.2] and (44.3 [8.4], p = 0.04). Among patients with obesity, low lean mass had no additional effect.ConclusionFor patients with OA and normal BMI, QoL and function were more impaired for those with than without low lean mass. Conserving muscle mass in people with OA could have functional and antalgic benefits especially for those with normal BMI.     

Validity and reliability of the Persian versions of WOMAC Osteoarthritis Index and Lequesne Algofunctional Index

The WOMAC Osteoarthritis Index and Lequesne Algofunctional Index have not been translated and validated for Iranian patients with osteoarthritis (OA) of the knee or hip. The aim of this study was to validate the Persian form of WOMAC OA Index and Lequesne Algofunctional Index and to assess their test-retest reliability and convergent validity. Forward/backward translations and consensus panels were conducted to obtain the Persian versions of WOMAC OA Index and Lequesne Algofunctional Index. A non-probability sample of 116 patients with knee/hip osteoarthritis was asked to complete the WOMAC OA Index and Lequesne Algofunctional Index as well as Medical Outcomes Study-20-Item Short Form (SF-20) questionnaires, a visual analogue scales (VAS) of pain and demographic information form. Internal consistency (using Cronbach's alpha) and convergent validity (by examining the Pearson's correlation coefficients) were evaluated to determine the psychometric properties of the questionnaires. In order to evaluate test-retest reliability, 20 randomly selected patients completed the questionnaires, on a second occasion, 7-10 days later. Cronbach's alpha coefficients and intraclass correlation coefficients for the WOMAC OA Index and Algofunctional Index subscales ranged from 0.63 to 0.94 and from 0.53 to 0.96, respectively. Statistically significant correlations were found between WOMAC OA Index, Algofunctional Index and SF-20 subscales and VAS for pain. The Persian version of WOMAC demonstrated a more acceptable validity, internal consistency and reliability compared with the Lequesne Algofunctional Index. However, both indices are valid and reliable instruments for evaluating the OA severity of knee/hip in Iran.     

Improved WOMAC score following 16-week treatment with bromelain for knee osteoarthritis

Treatment with bromelain-containing enzyme preparation for 3–4 weeks is effective for treatment of knee osteoarthritis (OA). Here, we aimed to assess 16-week treatment with bromelain in mild-to-moderate knee OA patients. We performed a randomized, single-blind, active-controlled pilot study. Forty knee OA patients were randomized to receive oral bromelain (500 mg/day) or diclofenac (100 mg/day). Primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) analyzed by Wilcoxon signed rank test. Secondary outcome was the short-form 36 (SF-36). Plasma malondialdehyde (MDA) and nitrite were measured as oxidative stress markers. There was no difference in WOMAC and SF-36 scores compared between bromelain and diclofenac groups after 4 weeks. At week 4, the improvement of total WOMAC and pain subscales from baseline was observed in both groups; however, two patients given diclofenac had adverse effects leading to discontinuation of diclofenac. However, observed treatment difference was inconclusive. At week 16 of bromelain treatment, the patients had improved total WOMAC scores (12.2 versus 25.5), pain subscales (2.4 versus 5.6), stiffness subscales (0.8 versus 2.0), and function subscales (9.1 versus 17.9), and physical component of SF-36 (73.3 versus 65.4) as compared with baseline values. OA patients had higher plasma MDA, nitrite, and prostaglandin E₂ (PGE₂) in lipopolysaccharide (LPS)-stimulated whole blood but lower plasma α-tocopherol than control subjects. Plasma MDA and LPS-stimulated PGE₂ production were decreased at week 16 of bromelain treatment. Bromelain has no difference in reducing symptoms of mild-to-moderate knee OA after 4 weeks when compared with diclofenac.     

A naturalistic study of the determinants of health related quality of life improvement in osteoarthritic patients treated with non-specific non-steroidal anti-inflammatory drugs

OBJECTIVES: To capture changes in the quality of life (QoL) occurring in patients with osteoarthritis (OA) during treatment with non-specific non-steroidal anti-inflammatory drugs (NSAIDs) and to identify factors that predict such changes. METHODS: A naturalistic, prospective follow up of 783 patients with OA in whom primary care physicians decided to start treatment with non-selective NSAIDs. Short Form-36 (SF-36) and the Western Ontario and McMaster Universities OA index (WOMAC) were assessed at baseline and after 3 months. Baseline results were compared with QoL values in 4800 subjects randomly selected from the general population. Multiple regression analysis was performed to identify determinants of QoL at baseline and measures influencing changes in SF-36 or WOMAC during follow up. RESULTS: All QoL dimensions were significantly (p<0.01) decreased in patients with OA compared with controls. Significant improvement (p<0.05) in four dimensions of the SF-36 (vitality, role emotional, role physical, bodily pain) and in all components of the WOMAC was seen between baseline and month 3. Older age, female sex, longer duration of OA, and a higher number of comorbidities were the major determinants of a poor QoL at baseline. Maximal benefit from non-specific NSAIDs was seen in patients with the most severe impairment in QoL and the shortest duration of OA. CONCLUSION: OA negatively impacts all dimensions of the QoL. Non-specific NSAIDs improve the QoL in patients with OA treated in a "real life setting". The profile of patients receiving maximal benefit from such treatment may be of interest for health providers, enabling them to decide who should preferentially be given cytoprotective treatments or coxibs.     

A comparison of muscle training methods in patients with knee osteoarthritis

This study sought to compare the efficacy of isokinetic and progressive resistive exercise (PRE) programs in patients with knee osteoarthritis (OA). Forty-four patients with bilateral knee OA were included in the study. The patients in Group 1 (n=21) performed isokinetic exercises and the patients in Group 2 (n=18) performed a PRE program. Disease severity, pain, walking time, WOMAC, Lequesne index, AIMS2 and SF36 were compared before and after the treatments. All the patients were evaluated via a Cybex isokinetic device before and after treatment. Disease severity, pain, Lequesne, WOMAC and walking time improved with treatment in both groups. In SF36 and AIMS2 assessments, pain and social evaluation parameters in the PRE group showed better improvement. On isokinetic assessment flexor and extensor peak torque and peak torque body weight values improved significantly in both groups compared to pretreatment measurements. When the assessed parameters were taken into account no statistical significant difference was observed between the two groups. Our conclusions were that isokinetic and PRE programs are efficient in the treatment of knee OA; no statistically significant differences could be found between the two programs; and the PRE program, as it is cheaper, more easily performed and efficient, may be preferable for the treatment of knee OA.Abbreviations OA Osteoarthritis - PRE Progressive resistive exercise - PT Peak torque - PTBW Peak torque body weight - ROM Range of motion - TW Total work - TWBW Total work body weightAn erratum to this article can be found at     

Predictors of disability among Filipinos with knee osteoarthritis

Aims: This study aims to describe the level of disability of Filipino patients with knee osteoarthritis (OA) in relation to common risk factors. Methodology: This is a cross‐sectional analytic study. Patients with knee osteoarthritis diagnosed using the American College of Rheumatology criteria for the classification of knee OA, seen at East Avenue Medical Center, using the Quezon City, Philippines, were entered by convenient sampling. The Western Ontario and McMaster Universities (WOMAC (va) 3.1 Tagalog Version) osteoarthritis index was used. Self‐reported disability was measured by the function subscale of the WOMAC OA index and used as the dependent variable. Independent variables assessed as possible risk factors affecting disability were age, sex, weight, height, body mass index (BMI), education (in years), number of comorbidities present, smoking status (pack years), duration of knee OA, pain and stiffness. Categories of disability were identified as high, moderate and low. Analyses of the data were performed using Statistical Package for the Social Sciences (SPSS) version 13. Results: Eighty‐five subjects were included in the study. The mean disability score was 674.1 ± 318.81 (moderate disability). Chi‐square tests showed that the categories or levels of disability are not significantly dependent on the categorical variables. Significant direct correlations were seen between mean disability and weight (r = 0.260, P = 0.016), pain (r = 0.574, P = 0.000), and stiffness (r = 0.616, P = 0.000). Conclusion: This is the first study analysing the relationship between disability and specific risk factors among Filipino patients with knee OA. Self‐reported disability of knee OA in the population studied was strongly related to pain scores, weight and joint stiffness scores.     

Association of knee osteoarthritis with onset and resolution of pain and physical functional disability: The ROAD study

Abstract

Objectives. To examine the onset and resolution of pain and physical functional disability using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and their association with knee osteoarthritis (OA) in the longitudinal large-scale population of the nationwide cohort study, Research on Osteoarthritis/osteoporosis Against Disability (ROAD).

Methods. Subjects from the ROAD study who had been recruited during 2005–2007 were followed up 3 years later. A total of 1,578 subjects completed the WOMAC questionnaire at baseline and follow up, and the onset and resolution rate of pain and physical functional disability were examined. We also examined the association of onset of pain and physical functional disability and their resolution with severity of knee OA as well as age, body–mass index and grip strength.

Results. After a 3.3-year follow-up, the onset rate of pain was 35.0% and 35.3% in men and women, respectively, and the onset rate of physical functional disability was 38% and 40%, respectively. Resolution rate of pain was 20.3% and 26.2% in men and women, respectively, and resolution rate of physical functional disability was 16% and 14% in men and women, respectively. Knee OA was significantly associated with onset and resolution of pain and physical functional disability in women, but there was no significant association of knee OA with onset of pain and resolution of physical functional disability in men.

Conclusions. The present longitudinal study revealed the onset rate of pain and physical functional disability as well as their resolution, and their association with knee OA.     

Health-related quality of life (Nottingham Health Profile) in knee osteoarthritis: correlation with clinical variables and self-reported disability

The aims of this study were to assess the health-related quality of life (HRQoL) in patients with knee osteoarthritis (OA) using the Nottingham Health Profile (NHP) and to determine its relationships with conventional clinical measures and self-reported disability. One hundred and forty patients with knee OA (104 female, 36 male, mean age 59.39 ± 7.62 years, mean disease duration 58.56 ± 56.78 months) and 40 sex and age-matched controls were included in the study. HRQoL, disability and pain were assessed using NHP, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), respectively. Results showed that the six subgroups of the NHP revealed higher scores in the knee OA patients compared with controls (p < 0.001). All subgroups of the NHP significantly correlated to VAS-rest, VAS-activity, 15-m walk test and WOMAC scores (p < 0.05, p < 0.01, p < 0.005, p < 0.001, respectively). The knee flexion or restricted extension range of motion was significantly correlated with the pain, energy and physical mobility subgroups of the NHP (p < 0.05, p < 0.005). Although there were statistically significant correlations between the NHP pain, emotional reaction, and physical mobility subgroup scores and body mass index (BMI) (p < 0.01, p < 0.05, p < 0.05, respectively), there were no correlations between all the NHP scores and duration of disease (p > 0.05). We conclude that patients with knee osteoarthritis undergo a significant impact on multiple dimensions of HRQoL, compared with healthy controls. The NHP is related to the clinical status and functional ability of patients with knee OA, and it can be used as a sensitive health status measure for clinical evaluation.     

Impact of osteoarthritis on quality of life in a Hong Kong Chinese population

OBJECTIVE: To measure the impact of osteoarthritis (OA) on quality of life in the Hong Kong Chinese population. METHODS: This was a cross sectional, retrospective, non-random, cohort design stratifying disease severity and presence or absence of joint prostheses. Patients with OA (n = 574; 136 men and 438 women) were recruited from rheumatology, family medicine, orthopedics, and geriatric medicine clinics. They were divided into 2 equal groups based upon disease severity (either American College of Rheumatology functional classes I and II, or III and IV). The 36-item Medical Outcomes Study Short-Form Health Survey (SF-36) and Western Ontario and McMaster Universities (WOMAC) OA Index were used. RESULTS: Patients with severe disease had lower mean scores in all SF-36 domains and higher mean scores in all WOMAC domains, indicating poorer quality of life. Scores in patients who had had arthroplasty were better than those with severe disease only in certain domains: role physical, general health, vitality, and mental health (SF-36); and pain (WOMAC). Women with OA had poorer scores compared to men for bodily pain, general health, and mental health after adjusting for age and disease severity. Low educational attainment was independently associated with poorer scores when disease severity was taken into account. CONCLUSION: OA has a significant impact on quality of life, only partly ameliorated by arthroplasty, as assessed by the SF-36 and WOMAC in this population.     

Responsiveness of the WOMAC osteoarthritis index as compared with the SF-36 in patients with osteoarthritis of the legs undergoing a comprehensive rehabilitation intervention

OBJECTIVE: To compare the responsiveness of the condition-specific Western Ontario and McMaster Universities osteoarthritis (OA) index (WOMAC) and the generic Short Form-36 (SF-36) in patients with OA of the legs undergoing a comprehensive inpatient rehabilitation intervention. METHODS: A prospective follow up study of consecutively referred inpatients of a rehabilitation clinic was made. The patients included fulfilled the American College of Rheumatology criteria for knee or hip OA and underwent both passive and, particularly, active physical therapy for three to four weeks. Responsiveness assessment was performed using the standardised response mean (SRM), effect size, and Guyatt's responsiveness statistic between admission and discharge (end of rehabilitation) and then again between admission and three months later. For pain and function the SRMs were stratified by sex and OA joint. Effects were tested by the t test and SRMs of different scales were compared by the jack knife test. RESULTS: At the three month follow up, complete data were obtained for 223 patients. In general, the three responsiveness statistics showed a similar order of responsiveness. For both instruments, the pain scales were more responsive than the function scales. The responsiveness of the pain scale of both instruments was comparable (SRM=0.723 for WOMAC and SRM=0.528 for SF-36 at the end of rehabilitation; SRM=0.377 for WOMAC and SRM=0.468 for SF-36 at the three month follow up). In the measurement of function, the WOMAC was significantly more responsive than the SF-36 (SRMs, end of rehabilitation: 0.628 v 0.249; three month follow up: 0.235 v -0.001). Responsiveness tended to be higher in women and in knee OA than in men and hip OA. CONCLUSIONS: Both instruments, the WOMAC and the SF-36, capture improvement in pain in patients undergoing comprehensive inpatient rehabilitation intervention. Functional improvement can be detected better by the WOMAC than by the SF-36. All the other scales of both instruments were more weakly responsive.     

Validation of the Comprehensive ICF Core Set for Osteoarthritis (OA) in patients with knee OA: a Singaporean perspective

OBJECTIVE: To evaluate content validity and construct validity of the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for Osteoarthritis (OA) in Singapore. METHODS: Patients with knee OA completed case report forms, which included the SF-36, Self-administered Comorbidity Questionnaire (SCQ), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health professionals completed the ICF Comprehensive Core Set for OA. Content validity was evaluated using frequency and percentage of patients with a reported problem for each ICF category, while construct validity was evaluated using Spearman correlation between the ICF categories and SF-36 and the WOMAC. RESULTS: A consecutive sample of 122 patients completed this study. In body functions, 12 categories were documented as a problem by more than 10% of the patients, of which 7, 12, and 10 categories correlated significantly with the SF-36 Physical Component Summary (PCS), WOMAC pain, and physical function, respectively. Only s750 (Structure of lower extremity) in body structures was reported as a problem and correlated significantly with SF-36 and WOMAC. In activities and participation, 12 categories were reported as a problem by more than 10% of the patients, of which, 11, 11, and 12 correlated significantly with SF-36 PCS, WOMAC pain, and physical function, respectively. In environmental factors, 2 and 14 categories were documented as barrier and facilitator, respectively, by more than 10% of the patients, but none correlated significantly with SF-36 and WOMAC. CONCLUSION: The content and construct validity of the Comprehensive Core Set for OA could be supported. Some categories, especially in environmental factors, need to be studied further in different sociocultural contexts.     

Health-related quality of life in patients with hip or knee osteoarthritis: comparison of generic and disease-specific instruments

Health-related quality of life (HRQL) assessment is receiving increased attention as an outcome measure in osteoarthritis (OA). The aims of the study were to assess the health status impact of hip and knee OA in the general older population and to compare the metric properties of the WOMAC disease-specific questionnaire (Western Ontario and McMaster Universities) with generic measures [i.e., the Short Form 36 (SF-36) in patients with OA of the lower extremities]. This cross-sectional survey included a total of 244 patients (99 male, 145 female), aged 50 years and over, with symptomatic OA of the hips (107 patients) and knees (137 patients). All patients completed the WOMAC and the SF-36 questionnaires and were assessed for radiographic damage and for the presence of specific comorbid conditions. The overall impact on health was substantial for both groups of patients with OA of the lower extremities. The most striking impact was seen in OA of the hip for SF-36 physical function (p=0.03) and physical role (p=0.04), as well as WOMAC physical function (p=0.001). Furthermore, impairment of HRQL was only weakly associated with increasing radiographic changes. The SF-36 overall scores showed a better gradient with comorbidities than the WOMAC. This investigation has confirmed that WOMAC is the instrument of choice for evaluating patients with lower limb OA. For a more general insight into patients health and in particular cross-sectional studies of the elderly, where comorbidity is common, the SF-36 should also be used. This study also provides an estimate of the impact of OA of the hip and knee on HRQL.     

Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls

BACKGROUND AND AIMS: Health-related quality of life (HRQOL) assessment is receiving increasing attention as an outcome measure in osteoarthritis (OA). The aims of this study were to compare HRQOL among older adults aged 55 to 78 years with hip and/or knee OA with those without OA, and to assess the influence of selected variables (sex, body mass index, radiographic OA severity, educational level, comorbidities) on HRQOL. METHODS: The generic Medical Outcome Study Short Form-36 item health status questionnaire (SF-36) was administered to a cohort of 264 OA patients (105 with hip OA alone, 108 with knee OA alone, and 51 with both hip and knee OA) and 112 healthy controls. RESULTS: Compared with the healthy controls, OA of the lower extremities has a detrimental effect on the eight-scale profile score, as well as on physical and mental summary measures of the SF-36. The most striking impact was seen in the physical measures "physical functioning", "physical role" and "pain" (p<0.0001). No statistically significant differences in SF-36 scores were found among the three groups of OA patients. The physical and mental summary scales of the SF-36 were closely correlated (p<0.0001). One hundred and forty-five patients (54.9%) reported at least one chronic coexisting disease. There was a significant inverse association with measures of comorbidity (number of comorbidities and comorbidity index score) and both physical and mental summary scores of the SF-36 questionnaire. In patients with OA of the knee alone (but not in hip OA alone or hip and knee OA), the SF-36 pain score was inversely correlated with years of formal education (p=0.016). In addition, the impact of hip and knee SF-36 dimensions was not influenced by the degree of radiographic severity. CONCLUSIONS: Older adults with OA of the lower extremities undergo a significant impact on multiple dimensions of HRQOL, compared with healthy controls. The use of a generic measure of HRQOL such as the SF-36, in studies of OA where comorbidity is common, should be useful in characterizing the global burden of this disease.     

Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee

Osteoarthritis (OA) is the commonest cause of locomotor disability and forms a major element of the workload of the primary care team. There is evidence that patient education may improve quality of life, physical functioning, mental health and coping as well as reducing health service use. The aim of this study was to evaluate the effectiveness of a primary care-based patient education programme (PEP) using a randomised controlled trial. A cluster randomised controlled trial, involving 22 practices, was used to determine the efficacy of a nurse-led education programme. The programme consisted of a home visit and four 1-h teaching sessions. Patients were assessed at baseline and then 1, 3, 6 and 12 months post intervention using 36-item Short Form (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), arthritis helplessness index and a patient knowledge questionnaire. Direct interviews were used at baseline and at the 12-month follow-up. There were no differences in depression, OA knowledge, pain or physical ability at either 1 month or 1 year between the two groups. Control practices (65 patients from 12 practices) recruited significantly fewer patients than intervention practices (105 patients from ten practices, p=0.02). Control practices had more doctors (p=0.02), more non-white patients (p=0.007), fewer patients living alone (p=0.005) and lower levels of disability (p=0.008). We detected a lack of benefit of PEP for people with OA of the knee. This was thought to be due in part to the short intervention time employed and the heterogeneous nature of the disease and the population studied.     

Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis

Abstract

Objective. The aim of this study was to assess the ultrasonographic (US) findings of pes anserinus tendon and bursa in patients with knee osteoarthritis (OA) with or without clinical pes anserinus tendinitis bursitis syndrome (PATBS).

Methods. A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study. PATBS was clinically diagnosed. US evaluation parameters were the measurement of the thickness of pes anserinus tendon insertion region (PA) and examination of the morphologic intratendinous PA tissue characteristics and pes anserinus bursitis (PAB). Radiographic knee osteoarthritis graded I-IV according to Kellgren and Lawrence (KL) for each knee was recorded. Pain and functional status were assessed by the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results. There were 183 PATBS (58.3%) clinical diagnoses among the 314 knees with OA. The mean thickness of PA in the patients with knee OA graded 1,2,3,4 with/without PATBS was significantly greater than the controls (p = 0.001). The mean thickness of PA in knees with OA KL graded 3 and 4 with/without PATBS, was greater than knees with OA KL graded 1 and 2 with/without PATBS (p < 0,05) (except knee OA KL graded 2 with PATBS versus knee OA KL graded 4 without PATBS).The knee OA KL graded 1,2,3,4 with PATBS had significantly more PAB and less loss of normal fibrillar echotexture of PA compared to controls and knees with OA KL graded 1,2,3,4 without PATBS (p < 0.05). The VAS scores of knees with OA KL graded 3, 4 with PATBS were significantly greater than those of knees with OA KL graded 3,4 without PATBS (p < 0.05). PA thickness was significantly associated with the KL grade (r: 0.336, p:0.001) and PATBS (r: 0.371, p < 0.001).

Conclusion. It is concluded that the mean thickness of PA in knees with OA with/without PATBS was significantly greater than the controls. The mean thickness of PA in knees with OA, KL graded 3 and 4 with/without PATBS, was greater than in knees with OA KL graded 1 and 2 with/without PATBS. The knee OA with PATBS had significantly more PAB, less loss of normal fibrillar echotexture of PA, and higher VAS scores compared to the knees with OA without PATBS. US can serve as a useful diagnostic tool for detection of PATBS in knee OA.     

A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee.

OBJECTIVE: The purpose of this study was to investigate the efficacy of acupuncture as an adjunctive therapy to standard care for the relief of pain and dysfunction in elderly patients with osteoarthritis (OA) of the knee. METHODS: Seventy-three patients with symptomatic OA of the knee were randomly assigned to treatment (acupuncture) or standard care (control). Analysis was performed on last score carried forward to account for patients who dropped out before completion. Patients self-scored Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne indices at baseline and at 4, 8 and 12 weeks. Patients in the control group were offered acupuncture treatment after 12 weeks. The data for these patients are pooled with those from the original acupuncture group for within-group analysis. RESULTS: Patients randomized to acupuncture improved on both WOMAC and Lequesne indices compared to those who received standard treatment alone. Significant differences on total WOMAC Scale were seen at 4 and 8 weeks. There appears to be a slight decline in effect at 4 weeks after cessation of treatment (12 weeks after first treatment). No adverse effects of acupuncture were reported. CONCLUSION: These data suggest that acupuncture is an effective and safe adjunctive therapy to conventional care for patients with OA of the knee.     

Relationship between radiological severity and clinical and psychological factors in knee osteoarthritis

This study was designed to investigate the relationship between radiological severity and clinical and psychological factors in patients with knee osteoarthritis (OA). Patients with knee OA (n = 100) were included in the study. Radiographic staging was done using Kellgren–Lawrence (KL) radiological rating scale. Stage 1–2 changes according to KL were grouped as ‘early’ and stage 3–4 as ‘late’ radiological OA. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used for self-reported disability. Performance-based functional assessments were measured as time needed to walk 15 m and time needed to climb ten steps. Health-related quality of life was assessed by Nottingham Health Profile (NHP). Beck Depression Inventory (BDI) was used to assess the presence and severity of depression. Social isolation was assessed by a related NHP subscale. Significantly higher scores were found in the late stage group for NHP pain, physical mobility and social isolation subscales and all WOMAC subscales. Mean BDI score was significantly higher (p = 0.001) and performance-based functional score was significantly worse (p < 0.001) in the late stage group compared to the early stage. In logistic regression analysis, NHP social isolation subscore was found to be associated with WOMAC pain subscore (p = 0.013, odds ratio [OR] = 1.163; 95% confidence interval [CI], 1.032–1.309) and radiological severity (p = 0.018, OR = 2.924; 95% CI, 1.198–7.136). Radiological severity is an important indicative factor for pain, disability, depression and social isolation. We believe that assessment of psychological involvement in addition to pain and disability might provide benefit in the management of patients with advanced radiological knee OA.