Eight-year trajectories of changes in health-related quality of life in knee osteoarthritis: Data from the Osteoarthritis Initiative (OAI)

Abstract

Background Knee osteoarthritis (OA) worsens health-related quality of life (HRQoL) but the symptom pathway varies from person to person. We aimed to identify groups of people with knee OA or at its increased risk whose HRQoL changed similarly. Our secondary aim was to evaluate if patient-related characteristics, incidence of knee replacement (KR) and prevalence of pain medication use differed between the identified HRQoL trajectory groups. Methods Eight-year follow-up data of 3053 persons with mild knee OA or at increased risk were obtained from the public Osteoarthritis Initiative (OAI) database. Group-based trajectory modeling was used to identify patterns of experiencing a decrease of ≥10 points (Minimal Important Change, MIC) in the Quality of Life subscale of the Knee injury and Osteoarthritis Outcome Score compared to baseline. Multinomial logistic regression, Cox regression and generalized estimating equation models were used to study secondary aims. Results Four HRQoL trajectory groups were identified. Persons in the ‘no change’ group (62.9%) experienced no worsening in HRQoL. ‘Rapidly’ (9.5%) and ‘slowly’ worsening (17.1%) groups displayed an increasing probability of experiencing the MIC in HRQoL. The fourth group (10.4%) had ‘improving’ HRQoL. Female gender, higher body mass index, smoking, knee pain, and lower income at baseline were associated with belonging to the ‘rapidly worsening’ group. People in ‘rapidly’ (hazard ratio (HR) 6.2, 95% confidence interval (CI) 3.6–10.7) and ‘slowly’ worsening (HR 3.4, 95% CI 2.0–5.9) groups had an increased risk of requiring knee replacement. Pain medication was more rarely used in the ‘no change’ than in the other groups. Conclusions HRQoL worsening was associated with several risk factors; surgical and pharmacological interventions were more common in the poorer HRQoL trajectory groups indicating that HRQoL does reflect the need for OA treatment. These findings may have implications for targeting interventions to specific knee OA patient groups.

Improving Patient Outcomes Following Total Knee Arthroplasty: Identifying Rehabilitation Pathways Based on Modifiable Psychological Risk and Resilience Factors

“…Due to the confluence of the increasing prevalence of risk factors such as obesity, aging, and joint injuries, the incidence and prevalence of osteoarthritis are also rising (Hunter and Bierma-Zeinstra, 2019). Symptoms may include severe pain, stiffness, and instability in the affected joint/s (Stark and Price, 2019;Törmälehto et al, 2019). Because there is no known cure and symptoms tend to worsen in severity over time, osteoarthritis can have a progressively debilitating impact on an individual's health and functioning (Hunter and Bierma-Zeinstra, 2019;Törmälehto et al, 2019), particularly when conservative management interventions are unsuccessful in restricting disease progression (Jones et al, 2007;O'Brien et al, 2019).…”

“…Because there is no known cure and symptoms tend to worsen in severity over time, osteoarthritis can have a progressively debilitating impact on an individual's health and functioning (Hunter and Bierma-Zeinstra, 2019;Törmälehto et al, 2019), particularly when conservative management interventions are unsuccessful in restricting disease progression (Jones et al, 2007;O'Brien et al, 2019). Patients with end-stage osteoarthritis experience considerable pain, as well as functional limitations in relation to mobility, activities of daily living, independence, and occupational and social participation (Neogi, 2013;O'Brien et al, 2019;Törmälehto et al, 2019). Symptoms can lead to disrupted sleep and fatigue (Sasaki et al, 2014a), and reliance on a caregiver (Hunter et al, 2014).…”

“…Symptoms can lead to disrupted sleep and fatigue (Sasaki et al, 2014a), and reliance on a caregiver (Hunter et al, 2014). These difficulties affect mood, psychological wellbeing and health-related quality of life (Jones et al, 2007;Sasaki et al, 2014a;Törmälehto et al, 2019).…”

“…Among high-income countries, the estimated proportion of gross domestic product associated with osteoarthritis-related medical costs ranges from 1 to 2.5% ( Hunter et al, 2014 ; Murphy et al, 2018 ). Personal costs include those incurred by loss of employment, premature retirement, and loss of income and personal savings ( Gupta et al, 2005 ; Schofield et al, 2013 , 2018 ; Woolf, 2015 ; Hunter and Bierma-Zeinstra, 2019 ), which increases the demand for sickness benefits and disability pensions ( Woolf, 2015 ; Törmälehto et al, 2019 ). Further indirect costs result from factors such as absenteeism, presenteeism, reduced productivity, caregiver time, and premature mortality ( Hunter et al, 2014 ; Xie et al, 2016 ).…”

Ethnic differences in the prevalence, socioeconomic and health related risk factors of knee pain and osteoarthritis symptoms in older Malaysians

“…In a recent, larger survey, data from 3053 individuals in the Osteoarthritis Initiative (OAI) study reported the presence of at least mild knee pain in 67.1%. [11] African Americans are most likely to report knee pain. Serial surveys data from the National Health and Nutrition Examination Survey and Framingham Osteoarthritis study suggest that the prevalence of knee pain in the US has increased by 65% between 1983 and 2005, with non-Hispanic Blacks more likely to report knee pain [12].…”