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

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DOI: 10.1186/1471-2474-7-6 · Source: PubMed
Abstract
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.
BioMed Central
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BMC Musculoskeletal Disorders
Open Access
Research article
Comparison of AIMS2-SF, WOMAC, x-ray and a global physician
assessment in order to approach quality of life in patients suffering
from osteoarthritis
Thomas Rosemann*, Stefanie Joos, Thorsten Koerner, Joachim Szecsenyi and
Gunter Laux
Address: Department of General Practice and Health Services Research, University of Heidelberg, Voβstr. 2, 69115 Heidelberg, Germany
Email: Thomas Rosemann* - thomas_rosemann@med.uni-heidelberg.de; Stefanie Joos - stefanie_joos@med.uni-heidelberg.de;
Thorsten Koerner - thorsten_koerner@med.uni-heidelberg.de; Joachim Szecsenyi - joachim_szecsenyi@med.uni-heidelberg.de;
Gunter Laux - gunter_laux@med.uni-heidelberg.de
* Corresponding author
Abstract
Background: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Published: 26 January 2006
BMC Musculoskeletal Disorders 2006, 7:6 doi:10.1186/1471-2474-7-6
Received: 18 May 2005
Accepted: 26 January 2006
This article is available from: http://www.biomedcentral.com/1471-2474/7/6
© 2006 Rosemann et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
BMC Musculoskeletal Disorders 2006, 7:6 http://www.biomedcentral.com/1471-2474/7/6
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Background
About 10% of men and 18% of women 60 year and older
suffer from symptomatic osteoarthritis (OA) [1]. Among
people aged 75 or older it is the third most common rea-
son to visit a primary care physician [2]. Due to an increas-
ing life-expectancy as well as a constant increase in the
Body-Mass-Index (BMI), which constitutes a principal risk
factor for OA [3], the incidence of OA is expected to rise in
upcoming years [4].
Usually, the General Practitioner (GP) is not only the first
care provider but also sees the patient regularly during the
course of disease [5]. Moreover, the GP is the physician
who is most familiar with the social background of the
patients. These socio-economic and psychosocial factors
contribute substantially to the Quality of Life (QoL) of
patients [6-8]. It is known that the treatment plans of GPs
and specialists are quite similar, but also that there is a
broad range of possible approaches to the disease by GPs
[2,5,9]. However, previous findings indicate that GPs as
well as specialists seem to have a perspective that is dom-
inated by physical aspects of OA. Psychosocial aspects and
their influence on QoL seem to be underestimated [10].
Moreover, it is known that radiographic changes and sub-
jective complaints show very poor correlation, therefore it
could be assumed that their contribution to physicians
assessment of patients QoL may be limited. However, the
extent to which psychosocial and radiological findings
influence GPs assessment remains unclear. Interestingly,
QoL is coming more and more into the focus of health
care professionals and represents an increasingly impor-
tant outcome parameter in many clinical trials [11]. Dif-
ferent questionnaires have been developed and validated
to assess the impact of joint diseases on QoL. Assessing
QoL in patients suffering from OA the most frequently
used instruments are the McMaster Universities Osteoar-
thritis Index (WOMAC) [12,13], the Arthritis Impact
Measurement Scale (AIMS) [14,15] and the Lequesne-
Index [16].
WOMAC and Lequesne-Index both focus on physical
effects of arthritis on mobility and physical activity and
are limited to the lower limbs (hip and knee). The AIMS
questionnaire originally developed by Meenan et al. in
1980 for rheumatoid arthritis is a more comprehensive
tool, which includes in 78 items the five dimensions phys-
ical, affect, symptom, social interaction and role [14]. In
1997, Guillemin et al. developed a shorter version, the
AIMS2-SF, containing 26 items, to reduce time effort and
to increase acceptance among patients. In several valida-
tion studies, the AIMS2-SF, which is recently available in
a German version [20], has proven to be a reliable and
valid instrument to asses QoL of patients with rheumatoid
arthritis and OA [17-19] and. Due to its comprehensive-
ness the AIMS2-SF gives insight into different dimensions
of QoL in OA.
The aim of our study was to examine which dimensions of
QoL of osteoarthritis patients are considered by GPs. To
reveal factors influencing GPs' picture of patients QoL we
estimated relationship to different assessment tools,
AIMS2-SF, WOMAC, and x-ray.
Methods
Recruitment of patients
The study was approved by the ethical committee of the
University of Heidelberg. From April to July 2004, 222
patients were approached in 21 primary care practices.
Inclusion criteria for patients were: age over 18 years,
meeting the criteria of OA according to the America Col-
lege of Rheumatology (ACR) [21,22] and sufficient Ger-
man language skills for understanding and answering the
questionnaire. All patients had to be treated by the physi-
cian for at least one year. Additionally, the availability of
a diagnose-specific radiograph, not older than six months
at the date of questionnaire completion, was required. In
all participating practices the patients were identified by
ICD-10 codes in patient files and put on a list in alphabet-
ical order. Patients from this list were contacted in consec-
utive order of appearance in the practice and informed
about the option to participate in the survey. After giving
their written informed consent they received the question-
naire and an envelope. The enveloped questionnaires
were returned in a sealed box at the practices. Neither the
GP nor the practice team had any possibility to see
patients' answers.
Table 1: Baseline-characteristics of patients separated by sex
Sex Mainly affected joint N Kellgren
(Mean)
S.D. Duration
Mean
S.D. Age S.D.
Hip Knee
w 3760972.85*0.9611.34** 6.29 43.76** 23.58
m 78 45 123 2.55* 0.74 8.78** 5.11 49.86** 13.30
Total 115 105 220 2.68 0.85 9.90 5.79 47.17 18.75
Level of significance (t-test for group comparison): *p < 0.05; **p < 0.01)
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Two of the addressed patients refused to complete the
questionnaires due to time effort, so that 220 patients
could finally be included. Enrolled patients received the
validated German version of the WOMAC and AIMS2-SF
questionnaire, each containing 5 point-Likert scales. In
addition, patients received short written information
about the aim of the study and were asked to personally
complete the questionnaire without any assistance. For
subgroup analysis data on school and professional educa-
tion and present occupation were retrieved.
The patient's GP was asked to evaluate the severity of
arthritis based on available radiographs, the patient's his-
tory and clinical examination based on classification crite-
ria of the American College of Rheumatology. The GP's
evaluation was scored on a visual analogue scale. The
scale was organized in that manner that the results
achieved ordinal values with 10 representing no limita-
tion of QoL by arthritis to 0 with massive limitation of
QoL. The x-rays were scored according to the criteria of
Kellgren and Lawrence [13], Grade 0 = normal and Grade
4=massive alterations with close to complete reduction of
the joint space. If only one joint was affected, the score for
this joint was used. If different joints were affected,
patients' highest radiological score was used.
Statistical analysis
Data were analysed with the SPSS statistical package (ver-
sion 12.0). In a standardisation process, the items of AIMS
and WOMAC were recoded and transformed, so that
results between 0 and 10 were yielded for all items with 10
representing the best health status and 0 representing the
worst. This standardisation process was performed
according to the recommendations of Guillemin (AIMS2-
SF) and Bellamy (WOMAC), respectively. The radiological
grading according to Kellgren and Lawrence was not
adjusted. Descriptive analysis included mean and stand-
ard deviation separated for the mainly affected joint (hip
or knee). In order to assess floor and ceiling effects the
percentages of participants achieving the lowest and high-
est possible score were calculated.
Group comparisons were adjusted for sex and age and, in
case of ANOVA, post hoc corrections according to Bon-
feroni were performed to avoid effects caused by multiple
testing.
As a first estimation of factors influencing GPs' assessment
of patients' QoL, we computed correlations of socio-
demographic variables, AIMS2-SF, WOMAC, and Kell-
gren-score with the GP score. The correlations of the indi-
vidual scales with the overall scores were computed via
Spearman rang correlation. P-values are provided in order
to show levels of statistical significance.
In order to identify factors independently associated with
GP ratings of patient quality of life, we additionally per-
formed a polytomous ordinal logistic regression analysis
[23]. The purpose of this procedure is to model the
dependence of an ordinal categorical response variable
(here: GP ratings of patient quality of life) on a set of dis-
crete and/or continuous variables (here: age, gender, edu-
cation, physical, affect, symptoms, social interaction,
function, stiffness, pain, Kellgren score).
Figure 1
Table 2: Kellgren Score distribution according to joint
Kellgren-Score Total
1234
Joint* Hip 8 31 56 20 115
Knee 11 38 39 17 105
Total 19699537220
*Adjusted ANOVAs (gender, age) revealed no significant differences
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Subgroup analysis
Finally, subgroup analyses were performed by age, gender
and level of education. A low level of education was
defined by secondary school. More advanced degrees were
considered high education. For the subgroup analysis the
Student-t-Test for independent samples was used.
Results
Table 1 reflects the baseline characteristics of the study
sample, separated by gender. Main manifestation of OA in
women was knee (60), while only 37 suffered mainly
from OA of the hip. 78 men suffered mainly from OA of
the hip, while in 45 cases men were mainly affected at the
knee. This is in line with arthritis epidemiology showing
that women suffer more from gonarthritis and men more
from coxarthritis. Mean duration of disease among
women was 11.3 years and 8.8 years among men. This dif-
ference was significant as well as the difference in age:
men were older (49.8 vs. 43.7 years; p < 0.01).
Table 2 shows the distribution of the Kellgren and Law-
rence score according to the affected joint. ANOVA
adjusted for age and gender with post hoc Bonferoni cor-
rection revealed no significant differences in Kellgren
scores between patients suffering from osteoarthritis of
hip or knee. Figure 1 shows the distribution of the GP
scores in percentages.
In Table 3 the characteristics of the study sample are sep-
arated by the affected joint. Differences were assessed by
adjusted ANOVA: Patients suffering from OA to the knee
had a significantly higher BMI (27.9 vs. 26.3; p < 0.05;
adjusted for sex and age), and suffered longer from the
joint affection (11.2 vs. 9.3 years; p < 0.01; adjusted for sex
and age). Regarding age, the hip and the knee group did
not differ (ANOVA adjusted for sex).
Table 4 displays the descriptive statistics of the different
assessments separated by the affected joint. As can be
Table 4: Descriptive statistics and score distributions for the different assessments
Assessment range joint N Mean SD p
GP score 0–10 Hip 115 3.97 2.36 0.43
Knee 105 4.23 2.48
Kellgren-Score 1–4 Hip 115 2.77 0.82 0.13
Knee 105 2.59 0.89
AIMS2-SF 0–10 physical Hip 114 3.61 1.57 0.15
Knee 101 3.92 1.64
affect Hip 115 4.20 1.32 0.40
Knee 104 4.34 1.25
symptom Hip 115 3.05 2.70 0.03
Knee 105 3.88 2.95
social Hip 114 5.04 2.00 0.58
Knee 104 5.18 1.87
role Hip 63 8.33 2.69 0.12
Knee 46 7.41 3.41
WOMAC 0–10 Pain Hip 114 5.21 1.99 0.01
Knee 103 5.93 2.07
Stiffness Hip 115 4.96 1.97 0.08
Knee 105 5.48 2.43
Function Hip 115 5.59 2.30 0.23
Knee 105 5.98 2.50
Overall Hip 115 5.25 2.08 0.10
Knee 105 5.75 2.36
Table 3: Descriptive statistics and score distributions for the different assessments according to affected joint
Affected joint Range N Mean SD
Age Hip 38–89 115 56.53 12.39
Knee 25–83 105 58.54 12.02
BMI* Hip 20.3–39.7 115 26.35 3.49
Knee 19.6–41.1 105 27.95 4.82
Duration of OA** Hip 1–23 115 9.39 4.56
Knee 1–24 105 11.27 5.91
Level of significance: *p < 0.05; **p < 0.01
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seen, the GP score as well as the Kellgren score did not dif-
fer significantly from each other. Regarding the AIMS2-SF,
significant differences did occur in the scale "physical", in
which a mean of 3.95 for the knee group indicated more
limitation regarding physical aspects. The "symptom"
scale indicated more impact due to pain in the knee group
(p = 0.03). "Affect", "social" and "role" did not differ sig-
nificantly. In accordance to this finding the WOMAC
"pain" scale revealed significantly (p = 0.01) higher results
for the knee group (5.93 vs. 5.21).
"Stiffness" also differed significant between knee and hip
patients (5.48 vs. 4.96; p = 0.08).
Figure 2 displays the GP score distribution in relation to
the Kellgren score separated by hip and knee. As can be
seen, the median of GP scores increases with the Kellgren
score. Interestingly, in the hip and in the knee group the
GP score achieved the widest range when patients were
rated with a Kellgren score of two or four.
Table 5 displays statistically significant correlations for the
GP assessment and the scale "physical" (rho = 0.495) and
"symptom" (rho = 0.598) of the AIMS-questionnaire and
good correlations (rho = 0.557) with the "pain" dimen-
sion of the WOMAC. The radiological grading according
to Kellgren and Lawrence correlates quite well with the
"symptom" dimension of the AIMS. All other correlations
tended to be low, reaching the lowest values for the scales
social and role of the AIMS2-SF.
Table 6 displays score distributions in demographic sub-
groups. Age was positively correlated with the impact of
OA on QoL, reflected by higher scores in all instruments
in the group aged over 60, despite the "affect" and "social"
scale of the AIMS2-SF. Patients with lower education level
achieved higher values in most scores. Women obtained
higher values in most scores except for the "role" scale of
AIMS2-SF. 111 patients were already retired from work,
therefore numbers for the "role" scale were smaller.
Table 7 displays the results of the polytomous ordinal
regression analysis that mirrors the dependence of the GP
score on age, gender, education, on the AIMS2-SF scales
"physical", "affect", "symptoms", "social" and on the
WOMAC scales "function", "stiffness", "pain" as well as
on the radiological grading according to Kellgren and
Lawrence. Interestingly, in contrast to our bivariate com-
parisons, only "symptoms" and "Kellgren score" emerged
as significant influence variables:
= 0.2588, 95% CI [0.03, 0.49], p = 0.0267
= 0.6395, 95% CI [0.29, 0.99], p = 0.0004
whereby represent the regression coefficient estima-
tions according to the maximum likelihood method [24]
for the underlying regression model. Obviously, the
impact of "Kellgren score" appears to be stronger and is
more significant in comparison to "symptoms".
Conclusion
Physicians' assessment of patients' QoL is mainly influ-
enced by two factors, pain and radiological findings. The
results of the present study suggest that other factors,
which are known to have an important influence on QoL
of patients suffering from osteoarthritis such as socio-eco-
nomic and psychosocial factors, are not sufficiently con-
sidered by the GPs.
ˆ
β
SYMPTOMS
ˆ
β
KELLGREN
ˆ
β
j
Table 5: Correlations (Spearman rho) of GP score and x-ray findings with AIMS2-SF and WOMAC
AIMS2-SF WOMAC
Physical Affect Symptom Social Role (n = 109) Function Stiffness Pain
GP-Score 0.495** 0.370** 0.598** 0.161* -0.165 0.358** 0.373** 0.557**
Kellgren-Score 0.328** 0.320** 0.419** 0.107 -0.214 0.227 0.302 0.303
Level of significance: *p < 0.05; **p < 0.01
Figure 2
1234
Ke llgren-Score
2
4
6
8
10
G
P
-S
c
o
r
e
Hüfte Knie
1234
Ke llgren-Score
Hip Knee
4
3
2
1
4
3
2
1
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Strength and weaknesses of the study
To our knowledge, this is the first study exploring physi-
cians' assessment of patients' QoL by estimating factors
that may influence GPs. Some limitations have to be men-
tioned. In Germany more x-rays are taken in the care of
patients with OA in comparison to other countries [25].
Therefore influence of x-ray findings on GPs may be
higher than in other countries. Assessing the socio-eco-
nomic status of patients by asking for the annual income
is very uncommon in Germany, so that the educational
level was used.
Without a doubt OA has an important impact on patients'
QoL. This was revealed by multiple primary care based
studies [26,27]. There is also strong evidence that QoL of
patients suffering from chronic diseases is influenced by
multiple individual factors as for instance support from
family, the social situation, affect and mood [7,8,28-32].
Moreover, previous studies indicated that even physical
disability can not only be explained by structural changes
in the joint [6,29]. Neither the assessment of correlations
nor the logistic regression analysis could identify socioe-
conomic or psychosocial factors to have important influ-
ence on the GPs' assessment. This may indicate that these
factors are beyond the scope of physicians, even if the GP,
who is more familiar with the patient and his individual
situation than all other physicians, is estimating patients'
QoL. This is in accordance with findings of previous stud-
ies which, for instance, revealed that psychological factors
as well as concomitant depressions are often missed by
physicians treating OA [10]. In ignoring these factors, GPs
could also miss the possibility to involve additional
important caregivers or persons out of patients' social
context such as a spouse or other family members and
friends [33].
Table 7: Results of logistic regression analysis
Variable P 95% CI
Socio-demographic factors age 0.0555 0.6611 [-0.19, 0.30]
sex -0.0720 0.3530 [-0.22, 0.08]
education -0.0693 0.6552 [-0.37, 0.24]
AIMS2-SF physical -0.0272 0.8343 [-0.28, 0.23]
affect 0.0521 0.7276 [-0.24, 0.34]
symptoms 0.2588 0.0267 [0.03, 0.49]
social -0.0107 0.9060 [-0.19, 0.17]
WOMAC function 0.1235 0.2928 [-0.11, 0.35]
stiffness -0.0526 0.6726 [-0.30, 0.19]
pain 0.1389 0.3545 [-0.16, 0.43]
x-ray Kellgren-Score 0.6395 0.0004 [0.29, 0.99]
ˆ
β
Table 6: Mean scores for demographic subgroups
Sex Age Education
Male Female P < 60 >= 60 P High Low P
N 123 97 83 137 125 95
WOMAC Pain 4.92 6.41 ** 4.65 7.11 ** 4.62 6.31 **
Function 6.44 5.26 ** 5.13 6.84 ** 4.91 6.43 **
Stiffness 5.59 6.01 ** 4.65 6.12 ** 4.36 5.86 **
Global 4.90 6.23 ** 8.86 6.52 ** 4.65 6.12 **
GPs assessment 3.43 4.94 ** 3.36 5.30 ** 3.06 4.88 **
x-ray 2.55 2.85 2.58 2.84 ** 2.45 2.86 **
AIMS Physical 3.25 4.43 ** 3.20 4.74 ** 3.09 4.26 **
Affect 3.83 4.81 ** 3.95 4.79 ** 3.90 4.55 **
Symptom 2.32 4.57 ** 2.16 5.22 ** 1.83 4.44 **
Social 4.08 5.02 ** 4.05 5.23 ** 4.16 8.28 *
Role 1.74 (n = 74) 2.72 (n = 35) 2.06 (n = 97) 1.98 (n = 12) ** 5.25 (n = 63) 2.31 (n = 46)
Level of significance: *p < 0.05; **p < 0.01
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Our study suggests that instead of considering these
important factors, GPs assessment of QoL is more focused
on evident structural changes as documented in radio-
graphs. Though it has been known for a long time that
radiological findings show only poor correlation to pain
and patients QoL, physicians' estimations are still strongly
influenced by radiographs. Ignoring psychosocial influ-
ence factors may cause a lack of treatment and on the
other hand considering factors which are less related to
patients' QoL – as radiological findings – may lead to
inadequate treatment. The implications for practice are
obvious: our results suggest that physicians should con-
sider physiological and social factors more intensely when
treating patients suffering from OA. They should be aware
that these factors contribute substantially to patients' QoL
and may represent an important target for non-surgical
and non-pharmacological interventions. Moreover, GPs
should avoid overestimation of x-ray findings and treat
patients not pictures.
Competing interests
The author(s) declare that they have no competing inter-
ests.
Authors' contributions
TR conceived and performed the study and drafted the
manuscript. GL performed the statistical calculations. SJ
and TK contributed substantially to the manuscript. JS
participated in the study design. All authors read and
approved the final manuscript.
Acknowledgements
This study was part of the PRAXARTH project that aims to improve the
quality of life of patients suffering from OA. The project is financed by the
German Ministry of Education and Research (BMBF), grant-number
01GK0301. The authors wish to thank all the participating doctors, espe-
cially Katharina Joest for her support.
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    • "Knee osteoarthritis (OA) affects about 10 % of the population over the age of 60, with increased prevalence among women and elderly patients123. Reliable grading of the severity of knee OA is important for monitoring the patients during their follow-up period and evaluation of various treatment modalities . "
    [Show abstract] [Hide abstract] ABSTRACT: This study aims to evaluate the correlations between common clinical osteoarthritis (OA) diagnostic tools in order to determine the value of each. A secondary goal was to investigate the influence of gender differences on the findings. Five hundred and eighteen patients with knee OA were evaluated using the Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire, short form 36 (SF-36) Health Survey, and plain radiographs. Analysis of variance (ANOVA) was used to compare the different domains of the WOMAC and SF-36 questionnaires between genders and the radiographic scale. Higher knee OA x-ray grade were associated with worse clinical outcome: for women, higher scores for the WOMAC pain, function and final scores and lower scores in the SF-36 final score; in men, lower SF-36 overall and physical domains scores. Gender differences were found in all clinical scores that were tested, with women having worse clinical scores for similar radiographic grading (p values <0.001). Knee radiographs for OA have an important role in the clinical evaluation of the patient. Patients with higher levels of knee OA in x-ray have a higher probability of having a worse clinical score in the WOMAC and SF-36 scores. The gender differences suggest that for similar knee OA x-ray grade, women’s clinical scores are lower. Trial registration: NCT00767780
    Full-text · Article · Jan 2015
    • "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]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: 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. Methods: 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. Results: 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. Summary: 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).
    Full-text · Article · Nov 2013
    • "The present study focused on the experience of the GKC for people with OA specifically (Therkleson, 2010). OA is the most common form of arthritis and has complex multifaceted causes (Rosemann, Joos, Koerner, Szecsenyi, & Laux, 2006). It results in a variety of symptoms, primarily pain on mobilising, that are often unpredictable (Felson et al., 2000). "
    Dataset · May 2013 · PLoS ONE
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