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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    • "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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