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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 5  |  Page : 576-581

An investigation of the relationship between the functional status of the individuals with knee osteoarthritis and their quality of life


1 Department of Public Health Nursing, Karadeniz Technical University, Turkey
2 Department of Public Health Nursing, Atatürk University, Turkey

Date of Submission29-Mar-2021
Date of Acceptance03-Mar-2022
Date of Web Publication19-May-2022

Correspondence Address:
Mrs. L Adiguzel
Karadeniz Technical University, Faculty of Health Sciences, 61080, Trabzon
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_1370_21

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   Abstract 


Background: Knee osteoarthritis, a chronic and degenerative joint disease, is more common among the growing elderly population. With the increasing life expectancy and obesity, the significance of knee osteoarthritis for public health has become more evident. Aim: This study was carried out to investigate the relationship between the functional status of individuals with knee osteoarthritis and their quality of life. Patients and Methods: The population of the study consisted of individuals with 1-4 s level of knee osteoarthritis diagnosed over the age of 50 who attended the physical therapy and rehabilitation polyclinic at Atatürk University hospital. The study was carried out with 129 individuals with knee osteoarthritis without sample selection. The data were collected using a demographic questionnaire and The Knee Injury and Osteoarthritis Outcome Score (KOOS) and analyzed with SPSS 22.00 statistical package program using frequency, percentage, t-test, Mann–Whitney U test, Kruskal–Wallis H test, and Dunnett T3 post hoc test. Results: According to the results, the KOOS Function and Daily Life scores showing the functional status of the participants were 46.61 ± 16.17. The Function and Sports/Leisure Activities subscale scores were 29.49 ± 23.73, and the mean scores of the Quality of Life subscale were 34.15 ± 18.11. A positive significant relationship was determined between the functional status and the quality of life in the individuals. Conclusions: As the functional status of individuals improves, the quality of life increases too.

Keywords: Functional status, knee osteoarthritis, quality of life


How to cite this article:
Adiguzel L, Kilic D. An investigation of the relationship between the functional status of the individuals with knee osteoarthritis and their quality of life. Niger J Clin Pract 2022;25:576-81

How to cite this URL:
Adiguzel L, Kilic D. An investigation of the relationship between the functional status of the individuals with knee osteoarthritis and their quality of life. Niger J Clin Pract [serial online] 2022 [cited 2022 Jul 7];25:576-81. Available from: https://www.njcponline.com/text.asp?2022/25/5/576/345558




   Introduction Top


Osteoarthritis, a degenerative and chronic joint disease, has become more prevalent with a prolonged life expectancy.[1],[2] Knee osteoarthritis has been diagnosed in 52.4% of individuals aged 60 and older worldwide and 14.8% in those aged 40 and older in Turkey. It is reported to be more common in women than men, and the risk of developing osteoarthritis in overweight or obese individuals is three times higher than that in others.[3],[4]

With a multifactorial etiology, knee osteoarthritis is a disease that causes severe functional difficulties in movements that force the joints like walking, climbing up and downstairs, sitting and standing up, and reaching out something, which ultimately prevents individuals from performing their daily life activities. Individuals become dependent on others for their self-care needs.[5],[6],[7] As the level of dependence increases, the possibility of economic and psychological burnout in individuals increases.[8],[9]

The Osteoarthritis Subcommittee of the American College of Rheumatology (ACR) has recommended a set of clinical criteria for the classification of knee, hip, and hand osteoarthritis, which have been translated into algorithms by Altman to be benefitted in clinical trials and community-based studies. Diagnostic criteria developed for knee osteoarthritis are shown in [Table 1].[10]
Table 1: Diagnostic Criteria Developed for Knee Osteoarthritis

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Knee osteoarthritis, which develops frequently and has severe effects on the quality of life, can be prevented by positive health behaviors such as weight control, exercise, avoiding injuries, and balanced nutrition.[1],[2],[11],[12] Nurses should plan and implement interventions to protect and promote the health of the individual, follow up the treatment process, and manage the rehabilitation step.[5] Promoting the quality of life of individuals can be ensured with the provision of effective nursing service at all these stages.


   Subjects and Methods Top


Research design

This research was conducted in a descriptive and cross-sectional design.

Sample

Inclusion criteria for the study were as follows:

  • being diagnosed with knee osteoarthritis,
  • being 50 years of age or older,
  • being admitted to the relevant clinic,
  • living in Erzurum,
  • having no communication barrier, and
  • being a volunteer to participate in the study.


Exclusion criteria for the study were as follows:

  • being younger than 50 years of age,
  • living in other cities,
  • being not definitively diagnosed, and
  • having communication barrier


All the patients were intended to be included in the study without the sample selection, but 18 patients refused to participate in the study; so the study was completed with 129 patients. The age of the patients was determined as 50 according to the classification criteria of ACR.

Study instruments

The Descriptive Information Form: Developed by the researcher in line with the literature,[5],[13],[14],[15] the form consists of 18 questions investigating the individual's sociodemographic characteristics like age, gender, marital status, and information about the disease like the presence of accompanying diseases, duration of the disease, and disease-related complaints.

The Knee Injury and Osteoarthritis Outcome Score (KOOS) Scale: The scale, created in 1995 to determine the symptoms of knee osteoarthritis and the functional status of an individual with the disease, is also used for knee injuries. The Turkish validity and reliability study of the scale was conducted by Paker et al. in 2007.[16] It consists of five subscales as follows: Pain, Symptoms, Activities of Daily Living (ADL) Function, Sport and Recreation Function, and Quality of Life.

Data collection

Necessary permission was obtained from the ethics committee and institution. A pilot study was carried out with 20 people, but no unclear or missing items were detected. The data were collected from those who agreed to participate in the study using the face-to-face interview method.

Data analysis

The data were analyzed with the SPSS 22.0 package program. All data were evaluated and summarized with descriptive statistics. In addition to descriptive statistics, t-test, Mann–Whitney U test, Kruskal–Wallis H test, and Dunnett T3 post hoc test were used to determine whether there was a difference between the data, and if so, from which group it originated. Correlation tests were performed to find out the relationship between the functional status and the quality of life.

Research hypotheses

H0: There is no relationship between the functional status and the quality of life of individuals with knee osteoarthritis.

H1: There is a relationship between the functional status and the quality of life of individuals with knee osteoarthritis.


   Results Top


The mean age of the participants was 62.42 ± 10.91. 68.2% were female, 58.9% were married, and 73.3% were overweight or obese [Table 2].
Table 2: Distribution of Individuals' Socio-Demographic Characteristics

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The results showed that 52.7% had an accompanying disease, and the most common complaint was pain. 43.7% took medication regularly, and 74.4% had knee osteoarthritis for more than 2 years. 47.3% suffered from seasonal complaints due to knee osteoarthritis, and 52.7% had no seasonal complaints due to knee osteoarthritis [Table 3].
Table 3: Distribution of Individuals' Disease Characteristics

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The mean scores participants obtained from each subscale were as follows: 40.60 ± 19.69 in Pain subscale, 44.82 ± 14.70 in Symptom subscale, 46.61 ± 16.17 in the ADL Function subscale, 29.49 ± 22.73 in Sport and Recreation Function subscale, and 34.15 ± 18.11 in the Quality of Life subscale [Table 4].
Table 4: KOOS Subscale Mean Scores of Participants

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According to their place of residence, the difference between the participants' scores in the ADL Function subscale was found to be significant at the KW value P > 0.05 significance level (KW = 6.188, P =0.045), suggesting that there is a difference between the place of residence and the score of “ADL Function” subscale of KOOS Scale. The Dunnett T3 post hoc test conducted to find out the origin of the difference revealed that those living in the city center and the district had higher scores in the ADL Function subscale.

The t value of the difference between the gender of the participants in the study and the KOOS “Quality of Life” subscale score was found to be insignificant (P > 0.05) (t =0.191, P =0.849), showing no difference in terms of the “Quality of Life” subscale of the KOOS scale by gender.

The t value, referring to the difference between the marital status of the individuals and the “Quality of Life” subscale, was found to be significant at P < 0.05 significance level (t = 2.062, P =0.041), which shows a difference between the “Quality of Life” subscale of the KOOS Scale according to the marital status. The difference stems from the fact that married participants had higher mean scores of the “Quality of Life” subscale.

According to the BMI values of the participants, the F value of the difference between them in terms of the “Quality of Life” subscale was found to be insignificant according to the P > 0.05 significance level (F =0.556, P =0.575), suggesting that there is no difference between the mean scores of the KOOS “Quality of Life” subscale according to BMI.

The correlation values of the relationship between the Pain subscale and the other subscales were positively significant according to the significance level of P <.005 with the following results: r =0.498 in the Symptoms subscale, r =0.405 in the Sport and Recreation Function subscale, r =.736 in the ADL Function subscale, and r =.665 in the Quality of Life subscale [Table 5].
Table 5: Relationship Between Mean Scores of KOOS Subscales

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The correlation value of the relationship between the Symptoms subscale and the Quality-of-life subscale was determined as r =0.367, which was significant at the significance level of P <.005, whereas the correlation value for the relationship between the Symptoms subscale and the Sport and Recreation Function subscale was found to be r =0.147, which was insignificant at P >.005 significance level [Table 5].

The correlation value of the relationship between the ADL Function subscale and the Quality-of-Life subscale in the KOOS Scale was found to be r =0.592, which was positively significant at the P <.005 significance level [Table 5].


   Discussion Top


The functional status of the individuals in the study revealed that the mean score of the KOOS ADL Function subscale was 46.61 ± 16.17, and the mean score for the subscale of the Sport and Recreation Function was 29.49 ± 22.73, showing a significant deterioration in functional status. Başaran et al. noted that as the stage of the disease increases, the functional status gradually worsens according to the WOMAC scale.[17] Tosun et al. argued that individuals with osteoarthritis have disrupted functional status.[14] In a meta-analysis study by Van Dıjk et al. and some high-quality studies with a follow-up period of more than 3 years, functional status worsened in individuals with knee osteoarthritis.[18] In another study, a highly significant relationship was found between the patient's radiological stage and physical function according to the WOMAC scale.[19] The pain caused by knee osteoarthritis in the individual, the limitation of movement, the belief that the pain will increase with the movement, and the decrease in the physical functions of the individuals can help us to explain this result. The Quality of Life subscale score of the participants was found to be 34.15 ± 18.11. Relevant literature has citations that the quality of life of patients with advanced-stage radiologically decreased in those with knee osteoarthritis.[20] Afsar et al. found that SF-36 quality of life scores were lower in patients with knee osteoarthritis at high symptom levels.[21] In the study of Alkan et al., individuals with knee osteoarthritis had lower quality of life.[22] Impairment in functional status and chronic pain experience may explain the decline in the quality of life in individuals with knee osteoarthritis.

In this study, the relationship between the quality of life and gender was not statistically significant. Tel et al.'s study results are consistent with our study.[23] However, Kolukısa determined a significant difference between gender and SF-36 scale mean scores, and the average quality of life score was lower in female participants.[19]

In this study, the difference between the KOOS Quality of Life subscale of the individuals and their marital status was significant according to the t value P < 0.05 significance level. The difference was due to the higher average score of married individuals received from the Quality of Life subscale than the others. Similarly, in the study performed by Açıksöz, a significant difference was observed between marital status and the quality of life.[24] However, Tel et al. found no significant difference between marital status and the quality of life.[23] The spousal support of married individuals and the positive aspects of family life may help explain this finding.

A significant relationship was detected between the KOOS ADL Function subscale and the Pain subscale. The reason for this relationship is thought to be that the person experiencing pain has difficulty while performing daily life activities, and the pain may increase due to movement.

A positive and significant relationship was also found between the Pain subscale of the individuals' KOOS scale and the Quality of Life subscale. Various studies have highlighted that knee osteoarthritis negatively affects the quality of life of individuals.[23],[25] Our result is consistent with the literature. As a result of the deterioration of their functional status, individuals cannot meet their daily needs, become isolated from social relationships, and struggle with chronic pain.

Examination of the relationship between the functional status of individuals and their quality of life in the study showed a positive significant relationship between the ADL Function and the Quality of Life subscales. Tosun et al. explained that knee osteoarthritis deteriorates the functional status, and thus the quality of life decreases.[14] Jenkins and McCoy reveal the existence of a significant relationship between functional status and the quality of life in older adults with knee osteoarthritis.[26] Likewise, Yıldırım et al. stated that impairment in functional status in individuals with knee osteoarthritis with neuropathic pain causes deterioration in the quality of life.[27] Knee osteoarthritis impairs functional status by increasing pain, increases the level of dependence by changing the lifestyle of the individual, and significantly affects the quality of life. This result confirms the hypothesis of the study arguing a relationship between the functional status and the quality of life of individuals with knee osteoarthritis.


   Conclusion Top


There is a relationship between functional status and quality of life in individuals with knee osteoarthritis, and accordingly, raising functional status improves the quality of life. To promote the functional status and prevent the development of osteoarthritis, it is recommended to gain behaviors such as weight control, injury avoidance, healthy eating, and exercise. Nurses should plan the necessary interventions and manage the process to help the society and the patient group with knee osteoarthritis to achieve protective and improving behaviors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Yeşİl H, Hepgüler S, Öztürk C, Yeşİl M, Çapaci K. Risk factors of symptomatic knee, hand and hip osteoarthritis in a suburban area of İzmir city. Turk J Phys Med Rehabil 2014;60:126-33.  Back to cited text no. 11
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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