Factors associated with fatigue in hip and/or knee osteoarthritis: a systematic review and best evidence synthesis

Abstract

Objective To systematically identify and evaluate factors related to fatigue in individuals with hip and/or knee osteoarthritis (OA). Methods A systematic literature search was conducted using AMED, CINAHL, MEDLINE, ProQuest and Web of Science Core Collections databases. Inclusion criteria comprised cross-sectional, case-control or longitudinal studies on patients with a diagnosis of hip and/or knee OA that included self-reported fatigue measures. Study quality was assessed using the National Heart, Lung and Blood Institute quality appraisal tool and factors were synthesised with bio-behavioural framework. Study designs and quality were combined to determine current evidence levels using best-evidence synthesis grading. The full review protocol is available from PROSPERO (PROSPERO 2019: CRD42019138571). Results Twenty-four studies were included, of which 19 were high, 4 moderate and 1 low quality. There was strong evidence of association between poor self-reported physical function and high depressive symptoms with higher fatigue. Moderate evidence of association was found between severe pain, high numbers of comorbidities and low physical activity levels with higher fatigue. There was moderate or limited evidence of no association between most socio-demographic factors and radiographic OA severity with fatigue. Conclusion Targets for fatigue management may include improving physical function, reducing depressive symptoms, pain, comorbidities, and increasing physical activity levels. There is a need for more rigorous longitudinal studies to understand causal effect of fatigue determinants within the hip and knee OA populations.

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