Are pain, functional limitations and quality of life associated with objectively measured physical activity in patients with end-stage osteoarthritis of the hip or knee?

C.S Leichtenberg,F.R Van Tol,M.G.J Gademan,T Krom,C Tilbury,H.L.D Horemans,J.B.J Bussmann,S.H.M Verdegaal,W.J.C.M Marijnissen,R.G.H.H Nelissen,T.P.M Vliet Vlieland

doi:10.1016/j.knee.2020.12.019

Abstract

ObjectivesPhysical activity is promoted in patients with hip or knee osteoarthritis (OA), yet little is known about its relationship with symptoms, functional limitations and Quality of Life (QoL). We investigated if OA-associated pain, functional limitations and QoL are associated with objectively measured physical activity in patients with end-stage hip/knee OA. MethodsCross-sectional study including patients scheduled for primary total hip/knee arthroplasty. Patients wore an accelerometer (Activ8) with physical activity assessed over waking hours, and expressed as number of activity daily counts (ADC) per hour, %time spent on physical activity i.e. walking, cycling or running (%PA), and %time spent sedentary (%SB). Pain, functional limitations and joint-specific and general QoL were assessed with the Hip disability/Knee Injury and Osteoarthritis Outcome Score (HOOS/KOOS) and the Short Form (SF)-12. Multivariate linear regression models with the three to Z-scores transformed parameters of physical activity as dependent variables and adjusted for confounding, were conducted. Results49 hip and 48 knee OA patients were included. In hip and knee OA patients the mean number of ADC, %PA and %SB were 18.79 ± 7.25 and 21.19 ± 6.16, 14 ± 6.4 and 15 ± 5.0, and 66 ± 10.5 and 68 ± 8.7, respectively. In hip OA, better joint-specific and general QoL were associated with more ADC, (β 0.028; 95%CI:0.007–0.048, β0.041; 95%CI:0.010–0.071). Also, better general QoL was associated with the %PA (β 0.040, 95%CI:0.007–0.073). No other associations were found. ConclusionWhereas QoL was associated with physical activity in hip OA, pain and functional limitations were not related to objectively measured physical activity in patients with end-stage hip or knee OA.

Highlights

Osteoarthritis (OA) of the hip or knee joint is among the most common musculoskeletal conditions in adults worldwide, in particular in the elderly
In patients with knee OA, after adjusting for confounding factors no associations were found for pain, joint specific Quality of Life (QoL) or HrQOL with physical activity outcomes (Table A.3). In this cross-sectional analysis of patients with end-stage hip and knee OA scheduled for THA or TKA, joint pain and functional limitations did not show any association with objectively measured physical activity; QoL was associated with accelerometer-measured parameters of physical activity only in hip OA patients
The finding that joint-specific pain or functional limitations were not associated with physical activity as measured with an accelerometer in end-stage OA is in accordance with three previous studies [12,16,20], but is contradictory to one other study [32]

Summary

Introduction

Osteoarthritis (OA) of the hip or knee joint is among the most common musculoskeletal conditions in adults worldwide, in particular in the elderly. Whether perceived hip or knee related pain and physical functioning are associated with objectively measured physical activity has been investigated in a number of studies [11,12,13,14,15,16,17,18,19,20,21,22]. These studies had contradictive outcomes, presumably due to the heterogeneity in study populations (i.e. some included only women or patients above 65 years old) and the used physical activity outcome measures. QoL is a potential target for interventions to maintain or improve physical activity in patients with severe hip or knee osteoarthritis

Objectives

Methods

Results

Discussion

Conclusion