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Table of Contents
Year : 2022  |  Volume : 19  |  Issue : 3  |  Page : 463-470

Health – Related quality of life of knee osteoarthritis patients

Department of Medicine, Merjan Medical Teaching City, Babil, Iraq

Date of Submission30-May-2022
Date of Acceptance15-Jun-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Sabreen Jasim Abbas
Department of Medicine, Merjan Medical Teaching City, Babil
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/MJBL.MJBL_82_22

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Background: Osteoarthritis (OA) is by far the most common form of arthritis and is a major cause of pain and disability in older people. Knee OA as a disabling disease affecting all aspects of patients’ life. Health – related quality of life (HRQOL) is increasingly being acknowledged as a valid health indicator in many diseases especially chronic processes. Objective: To assess the impact of Knee OA on HRQOL of Knee OA patients. Materials and Methods: A cross sectional descriptive study assessed HRQOL of 100 knee OA patients without significant comorbidity, were interviewed at Rheumatology consultant clinic of Baghdad Teaching Hospital by using 14 questions of CDC Health Related Quality of Life Questionnaire between September, 2020 to March 2021. Results: From 100 participants (21% male, 79% female), 96% of them said that knee pain made usual things hard to do with mean of 19 days according to the last 30 days before the interview. 89% of them said that they were limited in any way in any activities because of knee OA. Conclusion: The overall results of this study reflect the negative impact of Knee OA on HRQOL of the patients and, we found that the higher BMI (body mass index), age, disease duration and bilateral involvement, the lower the quality of life.

Keywords: BMI, health – related quality of life, knee osteoarthritis

How to cite this article:
Abbas SJ. Health – Related quality of life of knee osteoarthritis patients. Med J Babylon 2022;19:463-70

How to cite this URL:
Abbas SJ. Health – Related quality of life of knee osteoarthritis patients. Med J Babylon [serial online] 2022 [cited 2023 May 29];19:463-70. Available from: https://www.medjbabylon.org/text.asp?2022/19/3/463/357279

  Introduction Top

Health-related quality of life (HRQOL) is increasingly being acknowledged as a valid health indicator in many diseases especially chronic processes. It encompasses emotional, physical, social, and subjective feelings of well-being that reflect an individual’s subjective evaluation and reaction to his/ her illness.[1]

Analysis of HRQOL surveillance data can identify subgroups with relatively poor perceived health and help to guide interventions to improve their situations and avert more serious consequences. Interpretation and publication of these data can help identify needs for health policies and legislation, help to allocate resources based on unmet needs, guide the development of strategic plans, and monitor the effectiveness of broad community interventions.

In brief, HRQOL refers to an individual’s satisfaction or happiness with aspects of life, as they affect or are affected by their health.[2]

Osteoarthritis (OA) is the most common type of arthritis found worldwide especially in the elderly. It is a major cause of disability in both the developed and developing world.[3]

Osteoarthritis is the third most common diagnosis made by general practitioners in older patients and OA is the most common arthropathy to affect the knee.[4]

According to the American College of Rheumatology this disease is considered a heterogeneous group of conditions involving a broad range of symptoms and joint signs, which in combination with defective articular cartilage integrity and structural changes in the subchondral bone and in the joint margins, account for the key clinical–anatomopathological characteristics of the disease.[5]

The pathogenesis of OA is poorly understood. Repetitive trauma to articular cartilage may lead to damage and subsequent activation of the innate immune system. This tends to occur in joints that bear excessive loads such as lower extremity joints or in joints are used repetitively like hand joints.[6]

Risk factors for developing OA include age, joint location, obesity, genetic predisposition, joint malalignment, trauma and gender (Female: Male 3:1).

It is usually primary (generalized) but may be secondary to joint disease or other conditions (e.g. haemochromatosis, obesity, occupational)

OA mainly affects weight bearing joints such as knees and hips, which are the most frequently affected areas. Knee osteoarthritis is more disabling than any other orthopedic and musculoskeletal disorder.[7]

As OA and other rheumatic conditions seldom cause death but have a substantial impact on health, HRQOL measures are better indicators of their impact than related mortality rates.[8]

The impact of arthritic conditions is expected to grow while the population both increases ages in the coming decades.[9]

Knee OA is characterized by insidious onset of knee pain with gelling and limited range of motion. People with knee OA often describe pain and limitation with walking, transferring (as from seated to standing) and specially ascending or descending stairs. These reports of pain and limitation are often associated with sensation of instability or “giving out” at the knee. Pain may be elicited by palpation of the medial or lateral joint line or both.[10]

Early and accurate diagnosis of osteoarthritis is necessary so that appropriate treatment option can be considered. History, physical examination aided with radiological imaging remain the tools for diagnosis of osteoarthritis.

The knee is the most clinically significant site affected by osteoarthritis.[11] The age and sex standardized incidence of knee osteoarthritis is put at 240/100000 persons per year.[12]

The prevalence of OA is increasing and will continue to do so as population age and life expectancy increases.

According to American College of Rheumatology (ACR), knee OA can be diagnosed using the clinico-radiological criteria:.[13]

  1. Knee pain for most days of prior month

  2. Osteophytes at joint margins

  3. Synovial fluid typical of osteoarthritis

  4. Age equal or more than 40 years

  5. Morning stiffness lasting equal or less than 30 min

  6. Crepitus with active joint motion

Diagnosis requires 1 + 2, or 1 + 3+5 + 6, or 1 + 4+5 + 6

Bilateral knee OA is very common with time as the majority of sufferers will eventually develop radiographic disease in both knees. Clinicians need to be aware of the (joint at risk) and researchers need to remember to account for both knees when assessing the relationship between physical function, pain and structural disease. The other knee should not be used for comparison, even if it appears to be normal at baseline.[14]

Bilateral knee pain was an independent risk factor for poor physical function in a multicenter knee OA study.[15]

The management of OA can be divided into nonpharmacological interventions, pharmacologic (acetaminophen, oral NSAIDs, topical NSAIDs, intraarticular corticosteroids injection, duloxetine with depressive symptoms or widespread pain, opioids as needed) and surgical options according to severity of pain and limitation in activity functions.[16]

Patients with mild or intermittent pain are likely to need only non-pharmacologic treatment whereas those with more severe symptoms will probably require both non pharmacologic an pharmacologic treatment

The core treatments for all patients are exercise, weight loss, self-management and education.

Late-stage joint replacement is the preferred option for effective treatment to relieve pain and improve quality of life in advanced cases.[17]

Despite the clear goal of treatment mentioned, quality of life is the least considered or often neglected aspect in the overall management of patients with knee osteoarthritis.

Aim of Study was to assess the impact of Knee OA on HRQOL of Knee OA patients.

  Materials and Methods Top

Study design and settings

A cross sectional study that Knee OA patients visited rheumatology consultant clinic at Baghdad Teaching Hospital during period of data collection were interviewed using a CDC HRQOL questionnaire to assess their health - related quality of life.

Period of study, inclusion and exclusion criteria

Interviews were conducted for period from September, 2020 to March 2021.

The patients involved fulfilled the ACR clinico – radiological criteria for diagnosis of knee OA,[13] and had previous documented diagnosis from a consultant rheumatologist at Baghdad Teaching Hospital.

Patients were excluded if they had secondary knee OA, 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 such as heart disease, liver disease, and renal failure as well as Knee OA patient who refuse to participate.

Tools of data collection

The data of this study obtained through direct interview with patients using CDC structured questionnaire for assessing HRQOL which consist of 14 questions in three modules: Healthy Days Core module (4 questions), Activity Limitation Module (5 questions) and Healthy Days Symptoms Module (5 questions), each question had multiple options to answer and the patient must choose one option and the answer should be according to past 30 days(before the interview) time period, the patient asked to tell us how many days in which he/she felt “healthy” or “unhealthy” according to the question of each module from the last 30 days.

Personal information about Knee OA patient included gender, age, BMI, education level, marital status, occupation, type of residence, date of Knee OA diagnosis, involvement of both or one Knee joint at interview time and their estimated monthly income.

According to CDC BMI in kg /m2 classified as follow:

18.5 – Less than 25 normal

25 – Less than 30 overweight

30 – Less than 35 class 1 obesity

35 – Less than 40 class11 obesity

40 or higher morbid obesity

Statistical analysis

Statistical package for social sciences version 24 (SPSS v24) used to analyze data. Continuous variables presented as means with standard deviation and discrete variables presented as numbers and percentages.

T test for two independent samples was used to test the significance of observed difference in mean. This test is shifted into ANOVA test if groups were more than two.

Chi-square test for independence was used as appropriate to test the significance of association between discrete variables.

Pearson’s correlation coefficient was used to test the significance and magnitude of the relation between continuous variables.

Level of significance was set at P value <0.05.

Ethical considerations

The study was conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki.

It was carried out with patients’ verbal and analytical approval before sample was taken. The study protocol and the subject information and consent form were reviewed and approved by a local ethics committee.

  Results Top

One hundred patients were interviewed according to study inclusion and exclusion criteria. 21% was males and 79% females. 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 studied patient’s was 59.0 ± 8.9 years old. Results are shown in [Table 1][Table 2][Table 3][Table 4][Table 5][Table 6][Table 7][Table 8][Table 9][Table 10], in detail, according to Modules questions.
Table 1: Characteristics of studied patients

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Table 2: Response to questions related to healthy days core module

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Table 3: Response to questions related to activity limitations module

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Table 4: Response to questions related to healthy days Symptoms module

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Table 5: Mean days of absence of physical wellbeing according to studied variables

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Table 6: Mean days of absence of mental wellbeing according to studied variables

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Table 7: Mean days of inability to do usual activities according to studied variables

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Table 8: Mean days of routine things cannot be done due to knee pain according to studied variables

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Table 9: Mean days of poor sleep/rest according to studied variables

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Table 10: Correlations between BMI, age, disease duration, unhealthy days and healthy days

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  Discussion Top

Knee osteoarthritis is a disabling disease affecting all aspects of patients’ life. HRQOL has been receiving greater attention as a result of increasing income levels and life expectancy, which has been brought about by advances in medical technology.

CDC HRQOL questionnaire is a simple and short tool and it is suitable to assess HRQOL of our patients. It is practical for repeated use in clinical trials or routine clinical practice than other tools using for assessment of quality of life as WHOQOL -100 questionnaire and (SF-36) questionnaire and OAKHQOL questionnaire. .

The disease specific instruments, such as the Western Ontario and McMasterUniversities index scale. It is disease-specific, self-administered, health status measure. It is designed to measure functional disability in the context of knee replacement surgery rather than HRQoL.[18]

The overall results of this study reflect the negative impact of Knee OA

on HRQOL of the patients and, we found that the higher BMI, age, disease duration and bilateral knee involvement, the lower the quality of life.

Taher E. et al. study which published in 2016 used KHOAQOL questionnaire also concluded that the perception of QoL is affected negatively by the duration of the disease. However in contrast to our study Age, sex, BMI and site of OA 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.[19]

In fact, 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)[20]

Zamri et al. study which published in 2020 was another study used KHOAQOL questionnaire and showed as our study Age was positively associated with social functioning (P = 0.005). Meanwhile, disease duration was positively associated with physical domain (P = 0.043). BMI was positively associated with physical domain (P = 0.040).[21]

Zakaria et al. study which published in 2009 used the Short Form-36 (SF-36) questionnaire results showed that Patients with higher body mass index (BMI) and existence co-morbidities scored lower in most of the QOL domains.

The physical health status showed lower score as compared to mental health component in this study.

As our study the domain concerning mental health components showed positive correlation with age. There was a significant negative correlation between age and physical functioning (P < 0.0005) which indicated the deterioration of this domain as patients became older.[22]

Compared with healthy controls Salaffi et al. study which published in 2005 concluded that older adults with OA of the lower extremities undergo a significant impact on multiple dimensions of HRQOL.[23]

  Conclusion Top

The overall results of this study reflect the negative impact of Knee OA on HRQOL of the patients and, we found that the higher BMI, age, disease duration and bilateral involvement, the lower the quality of life.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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White DK, Zhang Y, Felson DT, Niu J, Keysor JJ, Nevitt MC, et al. The independent effect of pain in one versus two knees on the presence of low physical function in a multicenter knee osteoarthritis study. Arthritis Care Res (Hoboken) 2010;62:938-43.  Back to cited text no. 15
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]


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