Quality of Life and its Associated Factors among Patients with Lower Limb Osteoarthritis

Anjana V S*, Preemy Mathew A, Remmya Raveendran

Department of Medical Surgical Nursing, Government College of Nursing Alappuzha,

Kerala University of Health Sciences, Thrissur, India.

*Corresponding Author E-mail: anjnasathian233@gmail.com, anjanasathian9061@gmail.com

ABSTRACT:

Osteoarthritis is a degenerative joint condition. Osteoarthritis is one of the significant contributors to years lived with disability among the musculoskeletal conditions. In 2019, about 528 million people worldwide were living with osteoarthritis; an increase of 113% since 1990. About 73% of people living with osteoarthritis are older than 55 years, and 60% were female.¹ Around 23.46 million individuals in India had osteoarthritis in 1990; this increased to 62.35 million in 2019. The age-standardized prevalence of osteoarthritis has increased from 4,895 in 2019, per 100,000 persons. Similarly, disability-adjusted life years due to osteoarthritis increased from 0.79 million to 2.12 million. While age-standardized disability-adjusted life years increased from 164 to 180 per 100,000 persons from 1990 to 2019. Osteoarthritis was the 20^th most common cause of years lived with disabilities in India in 2019, accounting for 1.48 % of all years lived with disability; increasing from 23^rd most common cause in 1990.²The present study was intended to find out the quality of life (QOL) and associated factors among patients with lower limb Osteoarthritis.The study was aimed to assess the QOL of patients with lower limb Osteoarthritis and to find the associated factors of QOL of patients with lower limb Osteoarthritis. A descriptive cross-sectional design was adopted for the study. Every consecutive case of lower limb Osteoarthritis, who meet inclusion criteria, attending Orthopaedics Out Patient Department, T.D Medical College Hospital, Alappuzha were selected as sample in this study. Data were collected by interview, biophysiological measurements and clinical record review. The study finding showed the mean age of patients with lower limb Osteoarthritis was 60.08 years and majority (83.5%) of patients were females. Majority (88.8 %) of patients with lower limb Osteoarthritis had primary Osteoarthritis and in 72.4 % patients knee joints were involved. More than three quarters (81.2 %) of patients with lower limb Osteoarthritis had moderate pain on lower limbs, and 18.8 % of patients had severe pain on lower limbs. Majority (87.64 %) of patients had poor QOL and 12.35 % of patients had good QOL. Most of (95.9 %) patients with lower limb Osteoarthritis had poor QOL in physical domain and in mental domain more than half (57.6 %) of patients with lower limb Osteoarthritis had good QOL. Linear logistic regression analysis revealed that, the QOL of patients with lower limb Osteoarthritis is 3.06 times poor among patients with severe pain on lower limb when compared to patients with moderate pain.

KEYWORDS: QOL, Associated factors, Patients with lower limb Osteoarthritis.

INTRODUCTION:

Arthritis is the term used to describe disorders that affect joints.³ Osteoarthritis is acquired from daily wear and tear of the joint. It affects mainly weight-bearing joints of the body, including the knee, feet, back, and hip. Osteoarthritis is the most common form of arthritis in the world.⁴ The prevalence of osteoarthritis increases with age. It is the most common rheumatic disease and 4^th most common cause of disability worldwide.⁴It affects about 4% of the total population. More than 30 percent of women have some degree of osteoarthritis by age 65.⁵Global Burden of Disease (GBD) analysis in 2019 shows that approximately 1.7 billion people globally live with musculoskeletal conditions including low back pain, neck pain, fracture, osteoarthritis, rheumatoid arthritis, amputation and other injuries.⁵Osteoarthritis contributes to the overall global burden of musculoskeletal conditions with 528 million people;19 million years lived with disability.⁵

In India nearly 45% of women over the age of 65 years have symptoms while radiological evidence is found in 70% of those over 65 years. In India, it is the second most common rheumatologic problem and is the most frequent joint disease with a prevalence of 22% to 39%.⁶Osteoarthritis of the knee is a major cause of mobility impairment, particularly among females.It was estimated to be the 10^th leading cause of nonfatal burden. Osteoarthritis is one among the disease that reduces the health-related QOL.⁶

WHO has designated 2021-2030, the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and QOL.⁷

A systematic review of 610 articles in 2017, revealed that the QOL of patients with osteoarthritis is influenced by specific individual factors like gender, body weight, physical activity, mental health and education. Compared with males, females had worse QOL. Obesity and lower physical activity were associated with poor QOL. Self-management programs delivered by health care professionals, higher educational levels and higher total mindfulness were reported to improve QOL. Poverty, psychological distress, depression and lack of familial relationships reduce the health-related QOL.⁸

Identification of factors associated with poor QOL may help to develop effective interventions needed to alleviate pain and improve adherence to the treatment regimen, which will help to prevent the progression of disease and improve QOL of patients with lower limb osteoarthritis.

MATERIALS AND METHODS:

Quantitative approach and cross-sectional design were adopted for the study. The data were collected over 6 weeks. Every consecutive case of lower limb Osteoarthritis who meet the inclusion criteria was selected as sample in this study. Participants were seated comfortably in an area near the Orthopedics OPD. Participant information sheet provided and informed consent obtained from each participant. Socio-personal data were collected by interview. Clinical data were collected by using clinical record review and interview. Height and weight were measured by using calibrated stadiometer and weighing machine. Pain on the lower limb affected with Osteoarthritis was assessed by the Numeric Pain rating scale QOL of patients with lower limb osteoarthritis was assessed using the SF-36 Health Survey Questionnaire, by interview. Approximately 15-20 minutes were taken to complete the data collection from each patient.

The gathered data were organized, tabulated and subjected to descriptive and inferential statistical analysis with the help of Statistical Package for the Social science Software (SPSS). Socio-personal and clinical data were analysed by frequency and percentage, QOL of patients with lower limb osteoarthritis were described by frequency percentage and standard deviation. Factors associated with QOL were analysed by chi square test and logistic regression.

RESULT:

Socio-personal variables of patients with lower limb Osteoarthritis (Table 1):

Major findings in the present study are, among patients with lower limb Osteoarthritis,44.1 % of patients were in the age group 56-65 years, 83.5 % of patients were females and more than half of (58.8 %) patients were unemployed.

Table 1: Frequency distribution and percentage of patients with lower limb Osteoarthritis based on Socio-personal variables

Socio-personal variables and clinical variables	Frequency	Percentage
Age (in years)
36-45	13	7.6
46-55	33	19.4
56-65	75	44.1
Gender
Male	28	16.5
female	142	83.5
Occupation
Semi-professional	2	1.2
Clerk /shop/farm	6	3.5
Semi-skilled worker	4	2.4
Unskilled	58	34.1
Unemployed	100	58.8

Clinical variables of patients with lower limb Osteoarthritis (Table 2):

The study showed the majority (88.8 %) of patients had primary Osteoarthritis. The present study shows that, in the majority of (72.4 %) patients, knee joints were involved. Hip, knee, and ankle joints were involved in 4.1 % of patients with lower limb Osteoarthritis. Majority (81.2%) of patients with lower limb Osteoarthritis had moderate pain on lower limbs, and 18.8 % of patients had severe pain on lower limbs.

Table 2: Frequency distribution and percentage of patients with lower limb Osteoarthritis based on clinical variables

Clinical variables	Frequency	Percentage
Type of Osteoarthritis
Primary Osteoarthritis	151	88.8
Secondary Osteoarthritis	19	11.2
Joints involved in lower limb Osteoarthritis
Hip	1	0.6
Knee	123	72.4
Ankle	1	0.6
Hip+ Knee	16	9.4
Hip + ankle	7	4.1
Knee + ankle	15	8.8
Hip + knee +ankle	7	4.1
Intensity of pain on lower limbs
Moderate pain (4-6)	138	81.2
Severe pain (7-10)	32	18.8

QOL of patients with lower limb Osteoarthritis:

The present study revealed that, the majority (87.64 %) of patients had poor QOL and 12.35 % of patients had good QOL (Table 3). The study illustrated that most (95.9 %) of the patients with lower limb Osteoarthritis had poor QOL in the physical domain and the mean score of QOL in the physical domain was 22.53 with standard deviation of 12.56. The study showed that, in the physical domain, the QOL of patients with lower limb Osteoarthritis had the mean score of 48.88 with standard deviation of 20.38 in the dimension of general health.

Table 3: Frequency distribution and percentage of patients with lower limb Osteoarthritis based on QOL. (n=170)

QOL	f	%
Good QOL (>50)	21	12.35
Poor QOL (≤50)	149	87.65

Association of QOL of patients with lower limb Osteoarthritis with Socio personal variables and clinical variables (Table 4)

From the present study, it was found that there was a significant association between QOL of patients with lower limb osteoarthritis and pain and there was a significant association between QOL of patients with lower limb Osteoarthritis and occupation.

Linear logistic regression analysis revealed that the QOL of patients with lower limb Osteoarthritis is 3.06 times poor among patients with severe pain on the lower limb when compared to patients with moderate pain.

DISCUSSION:

The research is undertaken to identify the QOL and associated factors among patients with lower limb osteoarthritis. The present study revealed that the majority (83.5%) of patients with lower limb osteoarthritis were females, the result was similar to the finding from a study done in the Korea National Health and Nutrition Examination Survey, regarding the association of health-related QOL and depression on activity restriction in Osteoarthritis, the results showed 80.3% of patients with Osteoarthritis were females.⁹

In the study the mean score in the physical domain was 22.53, indicating poor QOL of life in the physical domain. The result was supported by a study done in Bhubaneswar, India, regarding the effects of osteoarthritis on the elderly population, and a study done in Mumbai, India regarding pain, functional disability, and QOL in knee osteoarthritis, the mean score in the physical domain was 31.3 and 41.94 respectively.^10,11

The mean score in the mental domain was 55.84, indicating good QOL in the mental domain. The finding was consistent with a study done in Mumbai, India, the mean score in the mental domain was 52.42, which revealed good QOL.¹¹ A study done in Bhubaneswar, India, was inconsistent with the present study finding, the mean score in the mental domain (34.2) was less than 50 indicating poor QOL in the mental domain.¹⁰

From the present study, there was no significant association between QOL of patients with lower limb Osteoarthritis and education. A Contradictory finding was found in a study done in Palatine, on the impact of pain on QOL in patients with Osteoarthritis, there was a significant association between QOL and educational level among patients with Osteoarthritis.¹²

The present study showed there was significant association was found between QOL of patients with lower limb Osteoarthritis and pain. The QOL of patients with lower limb Osteoarthritis is 3.06 times poor among patients with severe intensity of pain on the lower limb when compared to patients with moderate intensity of pain. The finding were supported by study done in Palestine; higher severity of pain is significantly associated with lower health-related QOL.¹²

CONCLUSION:

The study was conducted among 170 patients to assess the QOL and associated factors among patient lower limb Osteoarthritis attending a tertiary care centre, Alappuzha.

The study revealed 13.5% of patients with lower limb Osteoarthritis had good QOL and 86.5% of patients had poor QOL. From the study it was found, significant association between QOL and occupation and QOL and pain and on lower limbs of patients with lower limb osteoarthritis.

The QOL of patients with lower limb Osteoarthritis is 3.06 times poor among patients with severe pain on lower limb when compared to patients with moderate pain.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

I would like to express sincere gratitude to Prof. Sulekha AT, Principal, Government College of Nursing, Alappuzha, for her scholastic suggestions and the needed administrative support during the research study. My heartfelt thanks to Mrs. Aswathy KL, Assistant Professor and former research guide for her tremendous support and timely help that serve as source of inspiration. I acknowledges the valuable suggestions of Mrs, Nisha Jacob, Associate Professor, Dr. Deepa P, Mrs. Jyothi K Divakaran, Mrs. Remya Raveendran, Mrs. Amina Beevi S, Assistant professors and all faculty members of Government College of Nursing Alappuzha.

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12. Shalhoub M, Anaya M, Deek S, Zaben H.A, Abdalla A Mazen, Jaber M Metal. The impact of pain on quality of life in patients with osteoarthritis: a cross-sectional study from Palestine. BMC Musculoskeletal Disorders. 2022; 23(1): 248

Received on 03.08.2024 Revised on 07.09.2024

Accepted on 04.10.2024 Published on 30.11.2024

Available online on December 31, 2024

A and V Pub Int. J. of Nursing and Med. Res. 2024; 3(4):161-164.

DOI: 10.52711/ijnmr.2024.37

Variables	B	SE	χ²	df	p value	OR	99% CI for OR
Variables	B	SE	χ²	df	p value	OR	Upper	Lower
Pain	1.11	0.49	5.11*	1	0.02	3.06	1.16	8.07
occupation	0.41	0.49	0.69	1	0.40	1.51	0.57	3.98
Age	0.51	0.55	0.84	1	0.35	1.66	0.56	4.92