Ouellet P.1,2, Lowry V.2, Vendittoli P.-A.2,3, Carlesso L.1,2, Desmeules F.1,2
1University of Montreal, School of Rehabilitation, Montreal, Canada, 2Maisonneuve-Rosemont Hospital Research Center, Orthopaedic Clinical Research Unit, Montreal, Canada, 3University of Montreal, Department of Surgery, Montreal, Canada
Background: Knee osteoarthritis (OA) is a common pathology and a great source of pain, disability and loss of Health-Related Quality of Life (HRQoL). Identification of determinants associated with worse pain, disability and poor HRQoL in patients with OA is important to better tailor therapeutic treatments for this population.
Purpose: To collect self-reported data regarding pain, disability and HRQoL and to measure the strength of the associations with preoperative determinants in patients suffering from knee OA and awaiting total knee arthroplasty (TKA).
Methods: Patients suffering from knee OA and awaiting TKA were recruited from the waiting list of the Maisonneuve-Rosemont Hospital in Montreal City, Canada. Participants self-reported pain and disability were assessed using the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and the the Lower Extremity Functional Scale (LEFS). HRQoL was assessd using the Short-Form 36 (SF-36). Independent variables including demographic, socioeconomic, psychosocial and clinical characteristics of the participants were collected. Psychological distress was evaluated using the 14 items Psychiatric Symptom Index (PSI) from the 1998 Quebec Health Survey (ESS) and fear-avoidance beliefs using the Fear-Avoidance Belief Questionnaire Physical Activity scale (FABQ-PA). Multivariate regression analyses were used to evaluate the strenght of the associations between the dependent and independent variables. Age and sexe were forced into all regression models.
Results: Sixty patients were recruited and participation proportion was 73%. The mean (SD) age of the participants was 66.5 (10.7) years with a majority of female (70%). The mean (95%CI) score for the WOMAC pain and physical function scales were respectively 49.4 (44.9 53.9) and 45.3 (40.8 49.8). The mean (95%CI) scores were 39.3 (35.9 42.7) for the LEFS and 28.1 (23.4 32.8) for the SF-36 physical function scale. PSI and FABQ-PA mean (SD) scores were respectively 25.0 (6.2) out of 56 and 16.6 (6.7) out of 24. Higher fear-avoidance beliefs, greater comorbidities and the use of a walking aid were significantly associated with worse pain (p 0.05) and contributed to 21% of the variance of the WOMAC pain score. Higher psychological distress was significantly associated with worse function (p 0.05) and contributed to 16% of the variance of the WOMAC function score. Higher fear-avoidance beliefs and psychological distress, as well as greater comorbidities were significantly associated with worse HRQoL and function (p 0.05), contributing to 35% of the variance of the SF-36 physical function scale and to 31% of the variance of the LEFS score respectively.
Conclusion(s): Participants reported important pain, disability and poor quality of life. High psychological distress and fear-avoidance beliefs were also present. Higher psychological distress and fear-avoidance beliefs, as well as greater comorbidities were significantly associated with higher self-reported pain and disability and poor HRQoL These associations may be considered clinically important.
Implications: Psychological distress, fear-avoidance beliefs and comorbidities should be evaluated more systematically and taken into account when designing and providing education and care to this population.
Funding acknowledgements: This project was supported by the Canadian Institutes of Health Research (CIHR).
Topic: Musculoskeletal: lower limb
Ethics approval: This project was approved by the Maisonneuve-Rosemont Hospital Research Ethic Committee, Montreal, Quebec, Canada.
All authors, affiliations and abstracts have been published as submitted.
