The association of comorbid conditions with patient-reported outcomes in Veterans with hip and knee osteoarthritis

Abstract

There is limited understanding of how comorbid health conditions affect osteoarthritis (OA)-related outcomes. This study examined associations of different comorbidity measures with baseline OA-related patient-reported outcomes (PROs) among patients with hip and knee OA. Data were from patients (N=300, 9 % female, mean age = 61.1; SD=9.2) enrolled in a randomized control trial at the Durham Veterans Affairs Medical Center. Separate multivariable regression models, adjusted for demographic and clinical characteristics, examined the association of each comorbidity measure with baseline PROs: pain, physical function, depressive symptoms, fatigue, and insomnia. Comorbidity measures included the Self-Administered Comorbidity Questionnaire (SACQ), conditions reported as activity-limiting (SACQ-AL), and indicators of depression, diabetes, hypertension, and back pain. Mean (SD) numbers of comorbid conditions and activity-limiting conditions were 3.4 (1.8) and 1.6 (1.4), respectively. Comorbidity scores (SACQ overall and SACQ-AL) and individual comorbidity conditions were each associated with worse OA-related PROs adjusting for demographic and clinical factors. Worse SACQ overall and SACQ-AL scores were associated with worse mean scores for pain, depressive symptoms, fatigue, and insomnia (p values <0.01). Additionally, increasing SACQ-AL scores were associated with worse mean scores for function (p<0.01). Depression was associated with worse pain (p=0.03), fatigue, and insomnia (p values <0.01). Diabetes was associated with worse fatigue (p=0.01), depressive symptoms (p=0.02), and insomnia (p=0.03). Back pain was associated with worse pain scores (p=0.02). Results provide evidence that comorbidity burden, particularly activity-limiting conditions, is associated with worse OA-related PROs. Interventions for patients with OA need to address comorbid conditions and their impact on key outcomes.

Anxiety and depression in patients with osteoarthritis: impact and management challenges

“…Of the original 866 English articles, 38 articles fulfilled our aforementioned criteria and thus were included for analysis in this review 18–55. These 38 articles outline the impact of anxiety and/or depression on patients living with OA and the challenges these comorbidities present in OA management, wherein some studies also examined approaches on how to address these challenges.…”

“…These comorbidities are frequently associated with higher pain and physical limitation,18,19,26,31,32,38,43,45,46,48,50,55 poor outcomes to both conservative and surgical interventions,20,30,31,34,35,37,44,47,56 and increased pharmacotherapy and health care utilization 23,48. Our results indicate that standardized interventions to manage these comorbidities are lacking as a number of different self-care management programs, telephone support programs, video information support programs, and new drug treatments were reported in the literature with varied success 21–23,28,33,36,39,40,42,47,49,51,54.…”

“…Four hundred and thirty-five records were excluded as 233 were review articles, 174 were published abstracts, seven were conference papers, seven were notes, six were editorials, three were short surveys, two were letters, two were meta-analysis, and one was a book series. After excluding further 356 records based on title and abstract information, 21 records with a sample size of <100, and 16 records based on year of publication, 38 records were included in the final review 18–55. No systematic search of article bibliographies or conference proceedings was performed in an attempt to identify any additional unpublished or otherwise unidentified data.…”

“…Of all the final studies included in this review, six were randomized controlled trials,18,33,39,40,52,54 14 were prospec tive cohort studies,20,21,30,31,34,37,41,44,46,48,49,51,55,56 14 were cross-sectional studies,19,25–29,32,36,38,43,45,47,53,57 one was a retro spective analysis,35 and three were surveys 23,42,50…”

“…Of the 38 studies included in our final analysis, 13 studies examined the impact of anxiety and depression on OA symptoms 18,19,26,31,32,38,43,45,46,48,50,55. There was a considerable overlap in reporting impact of these psychological conditions on patients with OA with pain being the key central element.…”