Similar group mean scores,but large individual variations,in patient-relevant outcomes over 2 years in meniscectomized subjects with and without radiographic knee osteoarthritis

Background

Epidemiological studies have, so far, identified factors associated with increased risk for incident or progressive OA, such as age, sex, heredity, obesity, and joint injury. There is, however, a paucity of long-term data that provide information on the nature of disease progression on either group or individual levels. Such information is needed for identification of study cohorts and planning of clinical trials. The aim of the study was, thus, to assess the variation in pain and function on group and individual level over 2 years in previously meniscectomized individuals with and without radiographic knee osteoarthritis (OA).

Methods

143 individuals (16% women, mean age at first assessment 50 years [range 27–83]) were assessed twice; approximately 14 and 16 years after isolated meniscectomy, with a median interval of 2.3 years (range 2.3–3.0). Radiographic OA (as assessed at the time of second evaluation) was present in the operated knee in 40%, and an additional 19% had a single osteophyte grade 1 in one or both of the tibiofemoral compartments. Subjects completed the self-administered and disease-specific Knee injury and Osteoarthritis Outcome Score (KOOS).

Results

There were no significant changes in the group mean KOOS subscale scores over the 2-year period. However, a great variability over time was seen within individual subjects. Out of 143 subjects, 16% improved and 12% deteriorated in the subscale Pain, and 13% improved and 14% deteriorated in the subscale ADL ≥ 10 points (the suggested threshold for minimal perceptible clinical change). Similar results were seen for remaining subscales.

Conclusion

Group mean scores for this study cohort enriched in incipient and early-stage knee OA were similar over 2 years, but pain, function and quality of life changed considerably in individuals. These results may be valid also for other at risk groups with knee OA, and motivate further careful examination of the natural history of OA, as well as properties of the OA outcome instruments used. Longitudinal outcome data in OA studies need to be analyzed both on an individual and a group level.

     

Relationship between total fruit and vegetable intake and self-reported knee pain in older adults

Objectives

Knee pain is one of the most common symptoms of knee osteoarthritis (OA) that affects the quality of life in the older adults, and identifying the contributing factors of knee pain is important. We hypothesized that higher fruit and vegetable consumption might be associated with the severity of knee pain lower prevalence of severe knee pain by affecting pain perception in the knee joint. Therefore, we investigated the relationship between self-reported knee pain and the consumption of fruits vegetables, carotenoids and vitamin C and self-reported knee pain.

Design

Nationally representative cross sectional study.

Setting

2010-2011 rounds of the Korean National Health and Nutrition Examination Survey.

Participants

A total of 6588 subjects aged ≥50 years were participated.

Methods

Severity of knee pain was estimated using a 10-point numeric rating scale (NRS). Daily intake of fruits, vegetables, and vitamins were estimated using data from 24-hour recalls and food frequency questionnaires.

Results

The NRS scores of knee pain decreased significantly with increasing fruit and vegetable intake quartiles. A multivariate logistic regression analysis showed that the fourth quartile of vegetable and fruit consumption was associated with decreased prevalence of severe knee pain (OR 0.59, 95% CI 0.48-0.73) compared with first quartile of vegetable and fruit consumption; however, carotenoids and vitamin C consumption was not associated with the severity of knee pain.

Conclusions

In conclusion, severe knee pain was independently associated with fruit and vegetable consumption. Our findings suggest that intake of whole fruits and vegetables may help improve knee pain in older adults.

     

Functional capacity of people with early osteoarthritis: a comparison between subjects from the cohort hip and cohort knee (CHECK) and healthy ageing workers

Objective

The prevalence of osteoarthritis (OA) increases, but the impact of the disorder on peoples’ functional capacity is not known. Therefore, the objective of this study was to compare self-reported health status and functional capacity of subjects with early OA of hip and/or knee to reference data of healthy working subjects and to assess whether this capacity is sufficient to meet physical job demands.

Methods

Self-reported health status and functional capacity of 93 subjects from the Cohort Hip and Cohort Knee (CHECK) were measured using the Short-Form 36 Health Survey and 6 tests of the Work Well Systems Functional Capacity Evaluation. Results were compared with reference data from 275 healthy workers, using t-tests. To compare the functional capacity with job demands, the proportions of subjects with OA performing lower than the p₅ of reference data were calculated.

Results

Compared to healthy workers, the subjects (mean age 56) from CHECK at baseline reported a significantly worse physical health status, whereas the women (n = 78) also reported a worse mental health status. On the FCE female OA subjects performed significantly lower than their healthy working counterparts on all 6 tests. Male OA subjects performed lower than male workers on 3 tests. A substantial proportion of women demonstrated functional capacities that could be considered insufficient to perform jobs with low physical demands.

Conclusions

Functional capacity and self-reported health of subjects with early OA of the hips and knees were worse compared to healthy ageing workers. A substantial proportion of female subjects did not meet physical job demands.     

Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability,validity and responsiveness

Purpose

To study the psychometric properties, including reliability, validity and responsiveness, of the Spanish EQ-5D-5L questionnaire for patients with hip or knee osteoarthritis (OA).

Methods

We included 758 patients with hip or knee OA who completed the EQ-5D-5L and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, of whom 644 also did 6 months later. The EQ-5D-5L contains five questions from which a utility index is derived. The WOMAC covers three dimensions: pain, stiffness and physical function. Floor and ceiling effects were calculated. Reliability was assessed using Cronbach’s alpha. Convergent validity was tested using the Spearman correlation coefficient between EQ-5D-5L and WOMAC. We examined known-groups validity by comparing the EQ-5D-5L between subgroups defined by WOMAC scores using ANOVA or the Kruskal–Wallis test. Effect sizes were calculated to assess responsiveness, and minimal clinically important difference (MCID) was estimated.

Results

The EQ-5D-5L showed minimal floor and ceiling effects (<?3%). Cronbach’s alpha was 0.86. The EQ-5D-5L index was strongly correlated with WOMAC pain and function scores (??0.688 and ??0.782). Patients with higher WOMAC scores had significantly (p?<?0.0001) lower EQ-5D-5L index. The 20.19% had hip or knee replacement during the follow-up. Effect sizes were small among non-surgical patients, but >?0.80 among “improved” surgical patients, being the MCID for improvement 0.32 points.

Conclusions

The results support the reliability, validity and responsiveness of the EQ-5D-5L, overcoming the limitations of the EQ-5D-3L in these patients. Therefore, the EQ-5D-5L could be very useful as an outcome measure, at least in patients with hip or knee OA.

     

Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial

OBJECTIVE: The objective of this study was to evaluate the effectiveness of an exercise program conducted as part of community health services to improve pain and physical function in elderly people with osteoarthritis of the knee (knee OA). METHODS; The subjects were 88 (12 males aged 77.8 +/- 5.4 years and 76 females aged 73.2 +/- 5.3 years) community-dwelling independent elderly people with knee OA who participated voluntarily in exercise classes sponsored by Musashino city of Tokyo. They were allocated randomly to the intervention group (n = 44) and the control group (n = 44). For the intervention group, exercise classes of 90 min duration were held 8 times over 3 months. The exercise program comprised flexibility exercises (stretching of knee and ankle joints), resistance exercises (strengthening of quadriceps, extension and flexion of the knee joint with an elastic band), and movement exercises (turning over, getting up, standing up). The subjects were instructed to perform these exercises at home every day. Knee pain scores (Western Ontario and McMaster Universities OA Index; WOMAC), peak torque of joint during knee flexion and extension, range of motion (ROM) of the knee joint, and functional fitness (standing and walking ability) were evaluated before and after the intervention period. RESULTS: Significant inter-group differences were observed for peak torque during knee flexion and standing and walking ability of females. Assessment of interactions between time and group by repeated measure ANOVA adjusted for age and sex revealed significance differences for the WOMAC score (P = 0.031), the peak torque during knee extension (P = 0.016) and knee flexion (P = 0.000), ROM (P = 0.037), standing ability (P = 0.000)and walking ability (P = 0.000). The effect of the intervention was 0.44 for WOMAC score, 0.23 for peak torque during knee extension, 0.64 for knee flexion, 0.32 for ROM, 0.81 for standing ability, and 1.13 for walking ability. CONCLUSIONS: These results suggested that the exercise program for elderly people with knee OA improved knee pain and physical function.     

The role of cumulative physical work load in symptomatic knee osteoarthritis – a case-control study in Germany

Objectives  

To examine the dose-response relationship between cumulative exposure to kneeling and squatting as well as to lifting and carrying of loads and symptomatic knee osteoarthritis (OA) in a population-based case-control study.     

Comparative validation of the WOMAC osteoarthritis and Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis

Purpose

To comparatively evaluate the reliability and validity of the Western Ontario and McMaster (WOMAC) and the Lequesne algofunctional indices in Greek patients with hip or knee osteoarthritis (OA).

Methods

The Greek versions of WOMAC LK 3.1 and Lequesne indices were administered to 97 outpatients with OA. Internal consistency reliability was assessed by Cronbach’s alpha and item–scale correlations. Test–retest reliability was examined with intraclass correlations. Patients were also asked to complete the Short Form 36 (SF-36) and a Visual Analog Scale capturing strength of pain, in order to assess construct validity. Additional demographic and clinical data were also recorded to evaluate further associations.

Results

Cronbach’s alpha values of the WOMAC ranged between 0.92 and 0.98 for hip and 0.89–0.97 for knee OA. The respective values for Lequesne were 0.63–0.74 and 0.74–0.80. Item–scale correlations confirmed the superiority of WOMAC with respect to internal consistency reliability. Intraclass correlations were 0.79–0.97 and 0.57–0.98 for hip and 0.86–0.97 and 0.82–0.97 for knee OA, for WOMAC and Lequesne, respectively. The two indices showed high correlations with comparable subscales of SF-36 and the Visual Analog Scale. Significant relationships were identified for age, body mass index, duration of disease, duration of stiffness and radiographic classification.

Conclusions

Our findings, in samples of knee and hip OA patients, indicate that the WOMAC index demonstrates better internal consistency reliability than the Lequesne counterpart, as well as equivalent test–retest reliability and construct validity.     

Osteoarthritis Increases the Risk of Cardiovascular Disease: Data from the Osteoarthritis Initiative

Objectives

Although osteoarthritis (OA) is a common condition in older adults, the role of OA in increasing cardiovascular disease (CVD) incidence is still debated. The aim of this study was to investigate the association between OA and the onset of CVD in a large database of American adults.

Design

Longitudinal.

Setting

Community-dwelling.

Participants

People with OA or at high risk of OA.

Measurements

Osteoarthritis was defined as the presence of OA of the hand, knee, hip, back/neck or of other sites. CVD was defined as self-reported presence of heart attack, heart failure, stroke and other cerebral atherosclerotic conditions, and peripheral artery disease.

Results

A total 4,265 persons without CVD (mean age=60.8 years, females=59.2%) at baseline were analyzed (1,775 with OA versus 2,490 without). Over a mean of 8.2 years, according to an adjusted Cox’s regression analysis for 11 potential baseline confounders, study participants with OA of any joint had a significantly higher risk of developing CVD compared to those without OA (Hazard ratio (HR): =1.27; 95% CI: 1.03-1.56). The presence of hand OA was associated with a higher risk of developing CVD (HR=1.31; 95%CI: 1.01-1.68) with respect to those who had no OA. Knee, hip and back/neck OA did not, instead, increase the risk of developing CVD. The association between OA and CVD was significant in the women, but not in the men.

Conclusions

OA, in particular, when it affects the hand and in women, was associated with a higher risk of developing CVD.

     

Impact of clinical osteoarthritis of the hip,knee and hand on self-rated health in six European countries: the European Project on OSteoArthritis

Purpose

Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person’s self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH.

Methods

Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index.

Results

The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function.

Conclusions

Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.

     

Validity and internal consistency of a Hausa version of the Ibadan knee/hip osteoarthritis outcome measure

Background  

The Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM) was developed for measuring end results of care in patients with knee or hip OA in Nigeria. The purpose of this study was to validate a Hausa translation of IKHOAM in order to promote its use among the Hausa populations of Nigeria and other West African countries.     

Early incidence of occupational asthma among young bakers,pastry-makers and hairdressers: design of a retrospective cohort study

Background  

Occupational exposures are thought to be responsible for 10-15% of new-onset asthma cases in adults, with disparities across sectors. Because most of the data are derived from registries and cross-sectional studies, little is known about incidence of occupational asthma (OA) during the first years after inception of exposure. This paper describes the design of a study that focuses on this early asthma onset period among young workers in the bakery, pastry making and hairdressing sectors in order to assess early incidence of OA in these "at risk" occupations according to exposure duration, and to identify risk factors of OA incidence.     

Importance of patient satisfaction with care in predicting osteoarthritis-specific health-related quality of life one year after total joint arthroplasty

Purpose  

After previous results observed with a generic health-related quality of life (HRQoL) instrument, we aimed to confirm that immediate postoperative patient satisfaction with care predicts self-perceived health 1 year after total hip replacement/total knee replacement (THR/TKR), using an osteoarthritis (OA)-specific HRQoL questionnaire.     

The Dutch version of the knee injury and osteoarthritis outcome score: A validation study

Background  

The Knee Injury and Osteoarthritis Outcome Score (KOOS) was constructed in Sweden. This questionnaire has proved to be valid for several orthopedic interventions of the knee. It has been formally translated and validated in several languages, but not yet in Dutch. The purpose of the present study was to evaluate the clinimetric properties of the Dutch version of the KOOS questionnaire in knee patients with various stages of osteoarthritis (OA).     

Knee pain and future self-reliance in older adults: evidence from a community-based 3-year cohort study in Japan

Background

Although knee pain is common in older persons and can cause ambulatory limitation, its impact on self-reliance has rarely been examined in Japan, particularly in a community setting. The aim of this 3-year cohort study was to investigate the association of knee pain with dependence in activities of daily living (ADL) and mortality in community-dwelling older Japanese adults.

Methods

In 2005, presence of knee pain was assessed by a home visit survey of 1391 older adults aged 65 years or older (participation proportion = 97.3%). A total of 1265 participants who were ADL-independent at baseline were followed for 3 years, and information on outcomes, namely death and dependence in ADL, was collected.

Results

Participants who always had knee pain were more likely to become dependent in ADL than those who reported no knee pain (multivariate-adjusted OR, 1.98; 95% CI, 1.03–3.83); however, always having knee pain was not associated with mortality or a composite outcome of ADL dependence and death. Further analyses of each component of ADL dependence revealed that knee pain was associated with a need for assistance at home (long-term care eligibility, bathing, dressing, and transferring), but not with institutionalization.

Conclusions

The participants were highly representative of the target population and the rate of follow-up was almost perfect (99.4%). The results suggest that knee pain is associated with future dependence in ADL, particularly a need for assistance at home.Key words: joint diseases, activities of daily living, mortality, cohort studies, aged     

The role of orthoses in knee osteoarthritis

Objectives: Taking into account that the role of orthoses in patients with knee osteoarthritis (OA) is unclear and controversial, the purpose of this article is to review recent literature with the aim of answering the following question: What is the current role of orthoses in the treatment of knee OA?

Methods: A Cochrane Library and PubMed (MEDLINE) search related to the role of orthoses in knee OA was performed.

Results: Unloader braces decrease the adduction moment of the knee. In patients with varus medial compartment knee OA bracing is beneficial for pain, stiffness, function and quality of life (low grade of evidence). Lateral wedge arch support insoles seem not to decrease knee load. Lateral wedge insoles appear inefficacious at attenuating structural changes in patients with medial knee OA.

Conclusions: The ideal option for an orthosis in patients with knee OA keeps on indeterminate, and long-run inferences are lacking.     

Health-related quality of life among older adults with arthritis

Background

Health-related quality of life (HRQOL) is a key outcome in arthritis, but few population-based studies have examined the relationship of specific arthritic conditions, such as osteoarthritis (OA) and rheumatoid arthritis (RA) with HRQOL.

Methods

Older adults in Pennsylvania completed a mail version of the Centers for Disease Control and Prevention (CDC) HRQOL modules. Medicare data were used to identify subjects with OA, RA, and no arthritis diagnosis. We compared HRQOL responses among these groups, and we also examined relationships of demographic characteristics to HRQOL among subjects with arthritis.

Results

In analyses controlling for demographic characteristics and comorbidity, subjects with OA and RA had poorer scores than those without arthritis on all HRQOL items, including general health, physical health, mental health, activity limitation, pain, sleep, and feeling healthy and full of energy. HRQOL scores were also lower for those with RA compared to OA. Among individuals with arthritis, all subject characteristics (including age, race, sex, nursing home residence, marital status, income, and comorbid illnesses) were significantly related to at least one HRQOL item. Older age, nursing home residence, and greater comorbidity were the most consistently associated with poorer HRQOL.

Conclusions

Results of this study show that both OA and RA have a significant impact on multiple dimensions of HRQOL among older adults. Results also suggest the CDC HRQOL items are suitable for use among older adults and in mail surveys. Due to the rising number of older adults in many countries, the public health burden of arthritis is expected to increase dramatically. Efforts are needed to enhance access to medical care and disseminate self-management interventions for arthritis.

     

Inverse association between serum phospholipid oleic acid and insulin resistance in subjects with primary dyslipidaemia

Background & aims

Data on intake of oleic acid (OA) and insulin resistance (IR) are inconsistent. We investigated whether OA in serum phosphatidylcholine relates to surrogate measures of IR in dyslipidaemic subjects from a Mediterranean population.

Methods

Cross-sectional study of 361 non-diabetic subjects (205 men, 156 women; mean age 44 and 46 y, respectively; BMI 25.7 kg/m²). IR was diagnosed by BMI and HOMA values using published criteria validated against the euglycemic clamp. Alternatively, IR was defined by the 75th percentile of HOMA-IR of our study population. The fatty acid composition of serum phosphatidylcholine was determined by gas-chromatography.

Results

The mean (±SD) proportion of OA was 11.7 ± 2.0%. Ninety-two subjects (25.5%) had IR. By adjusted logistic regression, including the proportions of other fatty acids known to relate to IR, the odds ratios (OR) (95% confidence intervals) for IR were 0.75 (0.62–0.92) for 1% increase in OA and 0.84 (0.71–0.99) for 1% increase in linoleic acid. Other fatty acids were unrelated to IR. When using the alternate definition of IR, OA remained a significant predictor (0.80 [0.65–0.99]).

Conclusions

Higher phospholipid proportions of OA relate to less IR, suggesting an added benefit of increasing olive oil intake within the Mediterranean diet.     

北京地区1858名老年人下蹲与膝关节骨关节炎患病率的回顾性调查

目的研究北京地区老年人下蹲与膝关节骨关节炎(OA)患病率之间的关系。方法随机抽取北京地区年龄≥60岁的老年人,回答有关关节症状的调查问卷,行双侧膝关节X线照相(前后位和冠状位),并回忆其年轻时(25岁±)平均每天的下蹲时间。结果40%的男性和68%的女性年轻时平均每天的下蹲时间≥1 h。随着每天下蹲时间的延长,胫股骨关节OA的患病率增加。与年轻下蹲时间<30 min比较,男性中不同的下蹲时间胫股骨关节OA的OR值分别为:1.1(30- 59 min/d)、1.0(60-119 min/d)、1.7(120-179 min/d)、2.0(≥180 min/d)(P=0.074),女性的OR值相应为1.4、1.3、1.2、2.4(P=0.077)。髌股骨关节OA与下蹲的相关性弱于胫股骨关节OA与下蹲的关系。结论下蹲时间的延长可能是北京地区老年人胫股骨关节OA发生的高危险因素之一。     

A prospective cohort study on musculoskeletal risk factors for long-term sickness absence among healthcare workers in eldercare

Purpose

The socioeconomic burden of sickness absence from musculoskeletal disorders is considerable. However, knowledge about the risk of sickness absence from pain in different body regions among specific job groups is needed to more efficiently target preventative strategies. This study estimates the risk of long-term sickness absence (LTSA) from pain in different body regions among healthcare workers.

Methods

Prospective cohort study among 8,952 Danish healthcare workers responding to a questionnaire in 2004–2005 and followed for 1?year in a national register of social transfer payments (DREAM). Using Cox regression hazard ratio (HR) analysis controlled for age, gender, BMI, smoking, seniority, leisure physical activity and psychosocial working conditions, we modeled risk estimates of sub-chronic (1–30?days last year) and chronic pain (>30?days last year) in the low back, neck/shoulder and knees for onset of LTSA (receiving sickness absence compensation for at least eight consecutive weeks) during one-year follow-up.

Results

At baseline, the prevalence of chronic pain was 23% (low back), 28% (neck/shoulder) and 12% (knees). During follow-up, the 12-month prevalence of LTSA was 6.3%. Chronic pains in the low back (HR 1.47 [95% CI 1.17–1.85]), neck/shoulder (HR 1.60 [95% CI 1.27–2.02]) and knees (HR 1.92 [95% CI 1.52–2.42]) were significant risk factors for LTSA. However, only chronic neck/shoulder (HR 1.41 [95% CI 1.09–1.82]) and knee pain (HR 1.69 [95% CI 1.32–2.16]) remained significant with mutual adjustment for all three musculoskeletal pain regions.

Conclusion

Musculoskeletal pain is a risk factor for LTSA among healthcare workers. Future research among healthcare workers in eldercare should include the management of neck/shoulder and knee pain in addition to the management of back pain.