Comparison of AIMS2-SF, WOMAC, x-ray and a global physician assessment in order to approach quality of life in patients suffering from osteoarthritis

Department of General Practice and Health Services Research, University of Heidelberg, 69115 Heidelberg, Germany.
BMC Musculoskeletal Disorders (Impact Factor: 1.72). 02/2006; 7(1):6. DOI: 10.1186/1471-2474-7-6
Source: PubMed


Chronic diseases like osteoarthritis (OA) substantially affect different dimensions of quality of life (QoL). The aim of the study was to reveal possible factors which mainly influence general practitioners (GPs) assessment of patients' QoL.
220 primary care patients with OA of the knee or the hip treated by their general practitioner for at least one year were included. All GPs were asked to assess patients' QoL based on the patients' history, actual examination and existing x-rays by means of a visual analog scale (VAS scale), resulting in values ranging from 0 to 10. Patients were asked to complete the McMaster Universities Osteoarthritis Index (WOMAC) and the Arthritis Impact Measurement Scale2 Short Form (AIMS2-SF) questionnaire.
Significant correlations were revealed between "GP assessment" and the AIMS2-SF scales "physical" (rho = 0.495) and "symptom" (rho = 0.598) as well as to the "pain" scale of the WOMAC (rho = 0.557). A multivariate ordinal regression analysis revealed only the AIMS2-SF "symptom" scale (coefficient beta = 0.2588; p = 0.0267) and the x-ray grading according to Kellgren and Lawrence as significant influence variables (beta = 0.6395; p = 0.0004).
The results of the present study suggest that physicians' assessment of patients' QoL is mainly dominated by physical factors, namely pain and severity of x-ray findings. Our results suggest that socioeconomic and psychosocial factors, which are known to have substantial impact on QoL, are underestimated or missed. Moreover, the overestimation of x-ray findings, which are known to be less correlated to QoL, may cause over-treatment while important and promising targets to increase patients' QoL are missed.

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    • "Several composite questionnaires are used to analyze OA and its symptoms, including pain and associated disability. These questionnaires include, specifically, the Western Ontario and McMaster Universities Osteoarthritis Index [38], the Lequesne index [39] and the Arthritis Impact Measurement Scales [40]. "
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    ABSTRACT: Pain is the primary outcome measurement in osteoarthritis, and its assessment is mostly based on its intensity. The management of this difficult chronic condition could be improved by using pain descriptors to improve analyses of painful sensations. This should help to define subgroups of patients based on pain phenotype, for more adapted treatment. This study draws upon patients' descriptions of their pain, to identify and understand their perception of osteoarthritis pain and to categorize pain dimensions. This qualitative study was conducted with representative types of patients suffering from osteoarthritis. Two focus groups were conducted with a sample of 14 participants, with either recent or chronic OA, at one or multiple sites. Focus groups were semi-structured and used open-ended questions addressing personal experiences to explore the experiences of patients with OA pain and the meanings they attributed to these pains. TWO MAIN POINTS EMERGED FROM CONTENT ANALYSES: -A major difficulty in getting patients to describe their osteoarthritis pain: perception that nobody wants to hear about it; necessity to preserve one's self and social image; notion of self-imposed stoicism; and perception of osteoarthritis as a complex, changing, illogical disease associated with aging. -Osteoarthritis pains were numerous and differed in intensity, duration, depth, type of occurrence, impact and rhythm, but also in painful sensations and associated symptoms. Based on analyses of the verbatim interviews, seven dimensions of OA pain emerged: pain sensory description, OA-related symptoms, pain variability profile, pain-triggering factors, pain and physical activity, mood and image, general physical symptoms. In osteoarthritis, pain analysis should not be restricted to intensity. Our qualitative study identified pain descriptors and defined seven dimensions of osteoarthritis pain. Based on these dimensions, we aim to develop a specific questionnaire on osteoarthritis pain quality for osteoarthritis pain phenotyping: the OsteoArthritis Symptom Inventory Scale (OASIS).
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    • "X-rays sometimes show evidence of OA when there are no symptoms and, conversely, OA symptoms may occur when there is little radiographic evidence of OA (Felson et al. 2000a). OA is a complex disease and joint degeneration, as observed by X-ray, results in varying degrees of pain and immobility, with other factors such as quality of life and psychosocial issues having an impact on the people with this condition (Rosemann et al. 2006). Osteoarthritis management is conventionally concerned with controlling symptoms of pain and lack of mobility through the use of non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics (Hunt et al. 2009). "
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    • "While several outcome-based tools have been developed to evaluate OA, such as the WOMAC [11] and the Lequesne Index [12] they predominately measure pain and function, which has been the focus of the majority of OA research to date. However, increasing emphasis is being placed upon the socioeconomic and psychosocial issues associated with OA [13], attempting to measure the constructs patients consider to be important [14-16] and widen the understanding of the consequences of disease to the broader bio-psychosocial model [17]. "
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