RESUMEN
OBJECTIVE: To identify predictors of pain and disability in hip osteoarthritis. DESIGN: A prospective analysis of determinants of pain and functioning in hip osteoarthritis. STUDY SETTING: Rehabilitation clinic in a central hospital. PATIENTS: A total of 118 men and women aged 55-80 years who had radiologically diagnosed hip osteoarthritis and associated clinical symptoms and participated in a randomized controlled trial. MAIN MEASURES: The self-reported disease-specific pain and physical function were assessed using the pain and functioning subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index. The self-reported generic physical and mental functioning were assessed by using the Finnish-validated SF-36-item Health Survey RAND-36 subscales for function and physical and mental component summary scores. Outcome measures were recorded at 0, 3, 6, 12, 18 and 24 months. RESULTS: Multivariate linear mixed model analyses revealed that lower disease-specific pain score and better functioning (WOMAC) were predicted by higher educational level (9.61 (3.15 to 16.07); 9.07 (2.05 to 16.09)), supervised exercise training (-10.13 (-17.87 to -2.39); -11.58 (-19.40 to -3.77)), habitual conditioning physical activity (-0.48 (-0.96 to -0.01); -0.39 (-0.84 to 0.05)), absence of comorbidities (-6.30 (-12.35 to -0.24); -7.87 (-14.45 to -1.30)) and absence of additional knee osteoarthritis (-7.62 (-13.87 to -1.36); -8.02 (-14.81 to -1.23)), respectively. The same factors, except for the comorbidities, also predicted general physical functioning score (RAND-36). CONCLUSIONS: Higher education, absence of knee osteoarthritis and comorbidities, supervised exercise training and habitual conditioning physical activity predicted a lower presence of pain and better functional status in patients with hip osteoarthritis.
Asunto(s)
Terapia por Ejercicio , Osteoartritis de la Cadera/complicaciones , Dolor/etiología , Educación y Entrenamiento Físico , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Comorbilidad , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Osteoartritis de la Cadera/rehabilitación , Dimensión del Dolor , Pronóstico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de RiesgoRESUMEN
OBJECTIVE: To evaluate the short- and long-term effectiveness of exercise training in relation to pain, function and direct costs to health care systems attributable to hip osteoarthritis. DESIGN: Prospective, two-year randomized controlled trial. SETTING: An outpatient primary health care setting. SUBJECTS: One hundred and twenty men and women aged from 55 to 80, with radiologically diagnosed hip osteoarthritis with associated clinical symptoms. INTERVENTIONS: The combined exercise and general practitioner (GP) care group received 12 supervised (once per week) exercise sessions at the baseline and four additional booster sessions one year later. Both groups received standard GP care. MAIN MEASURES: The WOMAC Osteoarthritis Index, physical functioning score of RAND-36 (SF-36), the use and health care system costs of doctor visits and physiotherapy associated with hip osteoarthritis, number of total hip replacements, the use of analgesic and non-steroidal anti-inflammatory drugs (NSAIDs), performance-based outcome scores and body mass index (BMI). RESULTS: There were no differences between the groups with respect to WOMAC hip pain, physical functioning score of RAND-36, performance-based outcome scores or BMI. The effect of the exercise intervention on WOMAC function was statistically significant at 6 months (mean = -7.5; 95% confidence interval (CI) -13.9 to -1.0; P = 0.02) and 18 months (mean = -7.9; 95% CI -15.3 to -0.4; P = 0.04). There were no statistically significant differences in the total health care system costs between the groups. CONCLUSION: The mostly home-based exercise training programme provided in this study did not result in reduced hip pain over the two-year follow-up period.
Asunto(s)
Terapia por Ejercicio/métodos , Osteoartritis de la Cadera/rehabilitación , Dolor/rehabilitación , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Terapia por Ejercicio/economía , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/complicaciones , Osteoartritis de la Cadera/economía , Evaluación de Resultado en la Atención de Salud , Dolor/economía , Dolor/etiología , Estudios ProspectivosRESUMEN
OBJECTIVE: To determine the factors associated with self-reported pain and physical function in patients with hip osteoarthritis (OA). DESIGN: Cross-sectional study. SETTING: Rehabilitation clinic in a Finnish hospital. PARTICIPANTS: Participants with hip OA (N=118; 35 men, 83 women; age, 66.7+/-6.5y; range, 55-80y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported pain and self-reported disease-specific physical function were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index. Self-reported generic physical function was analyzed by using the Finnish version of the RAND 36-Item Short-Form Health Survey. As listed in the International Classification of Functioning, Disability and Health model, the effects of personal factors (age, sex, education, depression, life satisfaction, smoking, years of sporting activities), pathophysiologic factors (radiologic score of hip OA, body mass index [BMI], comorbidities, duration of knee pain) and body functions and structures (measurement of leg extensor power, passive internal rotation and flexion of the hip joint, the six-minute walk test [6MWT], Timed Up & Go [TUG] test, ten-meter walk test, sock test) were analyzed. RESULTS: The educational level (r=-.264, P<.001), comorbidities (r=.313, P<.001), and BMI (r=.252, P<.001) were identified as significant factors for self-reported disease-specific physical function as well as the educational level (r=.291, P<.001), life-satisfaction (r=-.319, P<.001), BMI (r=-.290, P<.001), and comorbidities (r=-.220, P<.005) for the self-reported generic physical function. No direct relationship with the pain and psychologic factors was detected. The number of comorbidities and duration of knee pain and life satisfaction explained 22% of self-reported pain. The number of comorbidities, passive hip flexion, and the TUG test explained 20% of self-reported disease-specific physical function whereas the passive hip flexion, 6MWT, and educational level explained 25% of self-reported generic physical function. CONCLUSIONS: Educational level, life satisfaction, and number of comorbidities were identified as significant factors for both self-reported pain and physical functioning in hip OA. Performance measures are better predictors of physical function than pain in hip OA. Factors explaining disability and pain in hip OA are multidimensional and no single predicting factor was found to be superior to any other.