Course of functional status and pain in osteoarthritis of the hip or knee: A systematic review of the literature

Abstract

Objective. To systematically review studies describing the course of functioning in patients with osteoarthritis (OA) of the hip or knee and identifying potential prognostic factors. Methods. A systematic search was performed. Studies involving patients with hip or knee OA, >6 months of followup, and outcome measures on functional status or pain were included. Methodologic quality was assessed using a standardized set of 11 criteria; a qualitative data analysis was performed.Results. Approximately 6,500 titles and abstracts were screened and 48 publications were considered for inclusion. Eighteen studies, 4 of which met the high methodologic quality criteria, were included. For hip OA, there was limited evidence that functional status and pain do not change during the first 3 years of followup. After 3 years, however, a worsening of functional status and pain was seen. For knee OA, there was conflicting evidence for the first 3 years and limited evidence for worsening of pain and functional status after 3 years. Furthermore, limited evidence was established for negative associations between future functional status and laxity, proprioceptive inaccuracy, age, body mass index, and knee pain intensity. In contrast, greater muscle strength, better mental health, better self-efficacy, social support, and more aerobic exercise were protective factors in the first 3 years. Conclusion. Pain and functional status in hip or knee OA seem to deteriorate slowly, with limited evidence for worsening after 3 years of followup. In specific subgroups, prognosis in the first 3 years of followup was either worse or better, as both risk factors and protective factors were identified. Prognostic factors included biomechanical factors, psychological factors, clinical factors, and treatment modalities. To strengthen the evidence, further high-quality longitudinal research on hip or knee OA functioning is needed.

Patient characteristics that predict progression of knee osteoarthritis: A systematic review of prognostic studies

“…wiley.com/journal/10.1002/(ISSN)2151-4658); this was adapted for EMBase, CINAHL, AMED, and Web of Science. Reference lists of identified reviews were mined for further studies (5)(6)(7). Neither study type nor language was limited (10,13).…”

Functional Impairment Is a Risk Factor for Knee Replacement in the Multicenter Osteoarthritis Study

“…Katz et al reported significant differences by sex in functional status before TKA and noted that the differences were not the result of clinical characteristics of the patient, suggesting that patient preferences and access to surgery were possible reasons [7]. van Dijk et al reported no prognostic association between sex and future functional status over 3 years of followup in patients with knee OA [17]. It was reported that physical inactivity was associated with severe joint pain among men but not women [15], suggesting that there may be a complex relationship among activity levels, functional impairment, and pain, which may differ by sex.…”

Progression of functional limitations in relation to physical activity: a life course approach

“…The benefits of strength training on muscle strength and functional limitations among older people have been confirmed in randomized controlled trials [21,22]. Several well-conducted prospective studies have shown that physical activity protects against the development of chronic conditions such as cardiovascular diseases, arthritis, diabetes, and obesity [23,24], which, in turn, have been shown to be important risk factors for functional limitations [7,25,26].…”

“…By the year 2030, about a quarter of the US adult population is projected to suffer from arthritis [44]. With older age, the growing prevalence of chronic diseases such as arthritis accelerates the natural age-related decline in physical functioning [23]. A prospective study using data from the Health and Retirement Study showed that persons who had arthritis at the age of 50 to 62 had a higher risk of developing difficulties in mobility over a 10-year follow-up compared to those who did not suffer from arthritis [35].…”

“…For example, Sun et al [46] showed in their recent prospective study on a large group of middle-aged nurses that higher physical activity level in midlife predicted successful survival in old age, an outcome that also included physical functioning. Evidence from randomized controlled trials on the positive effect of physical activity in decreasing functional limitations, e.g., among persons diagnosed with arthritis is amounting [23,49]. However, intervention studies on promoting physical activity and testing the long-term benefits on functional limitations are rare.…”